The pathology of late recurrence of testicular germ cell tumors
The pathology of late recurrence of testicular germ cell tumors
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DOI：
10.1097/00000478-200002000-00012
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发表时间：
2000-02-01
影响因子：
5.6
通讯作者：
Ulbright, TM
中科院分区：
文献类型：
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作者：
Michael, H;Lucia, J;Ulbright, TM
共有91名男性在组织学上记录了睾丸生殖细胞肿瘤的晚期复发，其特征是对治疗有完全反应，随后的无病间隔至少为2年，并且没有第二原发病变的证据。90%的患者在最初诊断为睾丸生殖细胞肿瘤后不久接受了化疗;大多数其他患者最初都患有I期疾病。总的来说，60%的患者在晚期复发时有畸胎瘤，其中20例（22%）畸胎瘤是唯一的因素。因此，畸胎瘤是最常见的肿瘤在晚期复发。排除畸胎瘤与其他类型的肿瘤共存，卵黄囊瘤是晚期复发患者中最常见的肿瘤类型。它发生在47%的患者中，无论是单独的还是与畸胎瘤、另一种非畸胎瘤性生殖细胞肿瘤类型或“非生殖细胞恶性肿瘤”一起发生。罕见类型的卵黄囊瘤，包括腺性、壁细胞性、透明细胞性和多形性，常见于晚期复发，并常引起与“非淋巴细胞性”癌的鉴别诊断问题。少数晚期复发由其他类型的肿瘤组成。20%的晚期复发患者有非畸胎瘤性生殖细胞肿瘤而不是卵黄囊肿瘤，或者是单独的，或者与卵黄囊肿瘤一起，或者与“非畸胎瘤细胞恶性肿瘤”一起。除卵黄囊瘤外，大多数非畸胎瘤性生殖细胞肿瘤为胚胎性癌，但很少发生卵巢癌和绒毛膜癌。“非畸胎瘤细胞恶性肿瘤”，包括肉瘤和各种类型的癌，发生在23%的晚期复发患者中，单独或与非畸胎瘤生殖细胞肿瘤。在这些患者的许多不同部位观察到晚期复发，包括腹膜后、腹部、骨盆、肝脏、纵隔、肺、骨（股骨、椎骨和肋骨）、腹膜后和纵隔外的淋巴结（锁骨上、颈部和腋窝区域）、阴囊和腹股沟区域、肾上腺、胸壁和臀部。91例患者中有79例获得了随访数据。随访时间范围为2个月至13年后，患者的第一次晚期复发，平均随访时间为4.8年。晚期复发仅由畸胎瘤组成的患者结局最好，79%的患者在末次随访时没有疾病证据。晚期复发的患者包括纯“非淋巴细胞恶性肿瘤”或纯生殖细胞肿瘤（卵黄囊瘤或其他类型），预后差得多：只有36%至37%的人活着，没有疾病的证据。两种不同类型的非畸胎瘤性恶性肿瘤患者在其晚期复发的临床过程令人沮丧：只有17%的卵黄囊肿瘤和其他非畸胎瘤性生殖细胞肿瘤没有疾病的证据，而非畸胎瘤性生殖细胞肿瘤和“非畸胎瘤细胞恶性肿瘤”的患者都没有疾病。仅由畸胎瘤组成的晚期复发通常会有良好的结果，但所有其他患者的预后都很差。此外，晚期复发不太可能对化疗有反应，最好在可能的情况下通过手术切除治疗。
A total of 91 men had histologically documented late recurrences of testicular germ cell tumors characterized by a complete response to treatment with a subsequent disease-free interval of at least 2 years and no evidence of a second primary lesion. Ninety percent of the patients for whom information was available received chemotherapy shortly after their initial diagnosis of testicular germ cell tumors; most of the other patients were known to have stage I disease initially. Overall, 60% of patients had teratoma in their late recurrences, including 20 patients (22%) in whom teratoma was the only element. Thus, teratoma was the most common type of neoplasm in late recurrences. Excluding teratoma coexisting with other types of neoplasms, yolk sac tumor was the most frequent type of tumor in patients with late recurrence. It occurred in 47% of patients, either alone or with teratoma, another nonteratomatous germ cell tumor type, or a "nongerm cell malignant tumor." Unusual types of yolk sac tumor, including glandular, parietal, clear cell, and pleomorphic patterns, were seen frequently in late recurrences and often raised differential diagnostic problems with "nongerm cell" carcinomas. A smaller number of late recurrences consisted of other types of neoplasms. Twenty percent of patients with late recurrence had a nonteratomatous germ cell tumor other than yolk sac tumor, either alone, with yolk sac tumor, or with a "nongerm cell malignant tumor." Most of these nonteraromatous germ cell tumors other than yolk sac tumor were embryonal carcinoma, although rarely seminoma and choriocarcinoma were encountered. "Nongerm cell malignant tumors," including both sarcomas and carcinomas of various types, occurred in 23% of late-recurrence patients, either alone or with a nonteratomatous germ cell tumor. Late recurrences were seen in many different sites in these patients, including the retroperitoneum, abdomen, pelvis, liver, mediastinum, lung, bone (femur, vertebra, and rib), lymph nodes outside the retroperitoneum and mediastinum (supraclavicular, neck, and axillary regions), scrotum and inguinal regions, adrenal gland, chest wall, and buttocks. Follow-up data were available for 79 of the 91 patients studied. Duration of follow-up ranged from 2 months to 13 years after the patient's first late recurrences; the mean length of follow-up was 4.8 years. Patients whose late recurrences consisted of teratoma only had the most favorable outcomes, with 79% having no evidence of disease at last follow-up. Patients whose late recurrences consisted of pure "nongerm cell malignant tumor" or pure germ cell tumor (yolk sac tumor or other types) had a much worse prognosis: Only 36% to 37% were alive with no evidence of disease. Patients with two different types of nonteratomatous malignancies in their late recurrences had a dismal clinical course: Only 17% with both yolk sac tumor and other nonteratomatous germ cell tumor had no evidence of disease, whereas no patient with both nonteratomatous germ cell tumor and "nongerm cell malignant tumor" was disease free. Late recurrences consisting of teratoma alone often have a favorable out come, but the prognosis in all other patients is poor. Furthermore, late recurrence is not likely to respond to chemotherapy and is best treated by surgical excision when possible.