Diagnosis and treatment of testicular mixed germ cell tumors: A report of 27 cases
Chen, L-Bo.; Liu, Z-Hong.; Wang, H.; Liu, S-Min.
Zhonghua Nan Ke Xue 24(11): 987-991
2018
ISSN/ISBN: 1009-3591 PMID: 32212472 Document Number: 695184
To investigate the clinical features, diagnosis, treatment and prognosis of testicular mixed germ cell tumors (TMGCT). This retrospective study included 27 cases (2 children and 25 adults) of TMGCT confirmed surgically and pathologically in our hospital from December 2007 to December 2012. The patients' ranged in the age of onset from 7 months to 63 years, averaging at 29.5 years. We analyzed the clinical data and reviewed the related literature. At pathological examination, the TMGCTs displayed a variety of subtypes, including 13 cases of yolk sac tumor (48.1%), 13 cases of seminoma (48.1%), 18 cases of embryonal carcinoma (66.7%), 4 cases of choriocarcinoma (14.8%) and 17 cases of teratoma (63.0%). Of the total number of cases, 15 (55.6%) contained two different germ cell histological elements, 11 (40.7%) contained three, and 1 (3.7%) contained four; 18 cases (66.7%) were in stage Ⅰ, 6 (22.2%) in stage Ⅱ, and 3 (11.1%) in stage Ⅲ. All the patients underwent radical orchiectomy and, in addition, retroperitoneal lymph node dissection (RPLND) + BEP chemotherapy was administered for 3 cases of stage Ⅱ and 1 case of stage Ⅲ. Three cases of stage Ⅱ and 2 cases of stage Ⅲ refused RPLND and 1 case of stage Ⅲ refused chemotherapy. A 27－49-month (mean 30 months) follow-up was completed for 21 of the patients, during which retroperitoneal metastasis was found in 3 cases of stage Ⅰ and 2 cases of stage Ⅱ, who again received RPLND+BEP and experienced no more recurrence. One case of stage Ⅲ refused both RPLND and chemotherapy and died at 12 months. TMGCT is a rare carcinoma with atypical clinical features, mostly comprising two or three different germ cell histological elements. Comprehensive treatment of RPLND combined with BEP chemotherapy may achieve a high survival rate and reduce recurrence for most of the patients with TMGCT of stage Ⅱ or above.