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Prostatic relapse of an undifferentiated teratoma 24 years after orchidectomy.

Janowitz T, Welsh S, Warren AY, Robson J, Thomas B, Shaw A, Ainsworth NL, Neal DE, Mazhar D - BMC Res Notes (2015)

Bottom Line: A biopsy confirmed undifferentiated malignant tumour, shown immunohistochemically to be a yolk sac tumour.The patient was initially treated with bleomycin, etoposide and cisplatin chemotherapy, but developed bleomycin-related pulmonary side effects after two cycles.His Alpha feto-protein, beta human chorionic gonadotrophin and lactate dehydrogenase levels are normal.

View Article: PubMed Central - PubMed

Affiliation: Oncology Department, Addenbrookes Hospital, Hills Road, Box193, Cambridge, CB2 OQQ, UK. tj212@cam.ac.uk.

ABSTRACT

Background: Non-seminomatous germ cell tumours make up about 40 % of all germ cell tumours, which in turn are the most common tumours in men aged 15-44 years. Low risk stage I non-seminomatous germ cell tumours, which are confined to the testes, are commonly treated by orchiectomy and surveillance. Up to 20 % of patients with this diagnosis relapse, usually within 1-2 years of follow up, but very rarely after more than 5 years. The most common sites of relapse are the retroperitoneal lymph nodes, the mediastinum, and the lungs. We describe a case of relapse in the prostate over 20 years after initial diagnosis, which has not been described in the literature so far.

Case presentation: This report presents a 49-year-old white British man with relapsed testicular non-seminomatous germ cell tumour 22 years after initial treatment with orchidectomy only. He relapsed with a prostatic mass, haematospermia and back pain. His prostate specific antigen levels were within normal range. Alpha feto-protein and lactate dehydrogenase levels were elevated, and his human chorionic gonadotrophin levels were normal. A biopsy confirmed undifferentiated malignant tumour, shown immunohistochemically to be a yolk sac tumour. The patient was initially treated with bleomycin, etoposide and cisplatin chemotherapy, but developed bleomycin-related pulmonary side effects after two cycles. His treatment was changed and he completed four cycles of chemotherapy by receiving two cycles of etoposide, ifosfamide, and cisplatin. Post treatment blood tumour markers were normal, but a follow up computed tomography showed a mass in the base of the prostate, the trigone and the left distal ureter which was surgically resected. The histology from the surgical resection was of necrotic tissue. The patient is now in follow up at 3 years after treatment with no evidence of residual disease on computed tomography. His Alpha feto-protein, beta human chorionic gonadotrophin and lactate dehydrogenase levels are normal.

Conclusions: Very late relapse in stage I non-seminomatous germ cell tumours is extremely rare and the prostate is a highly unusual site of relapsed disease. For diagnosis of late relapse, this case confirms the value of serum biomarkers in germ cell tumours, in particular non-seminomatous germ cell tumours.

No MeSH data available.


Related in: MedlinePlus

T2-weighted magnetic resonance images. a, b Axial and coronal T2-weighted magnetic resonance images demonstrate a heterogeneous high signal lesion in the left seminal vesicle and prostate gland. There is a urinary catheter in situ. The lesion is markedly different to the low signal lesion typically found in primary prostatic carcinoma
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Fig1: T2-weighted magnetic resonance images. a, b Axial and coronal T2-weighted magnetic resonance images demonstrate a heterogeneous high signal lesion in the left seminal vesicle and prostate gland. There is a urinary catheter in situ. The lesion is markedly different to the low signal lesion typically found in primary prostatic carcinoma

Mentions: A 49-year-old white British man presented to his General Practitioner and afterwards a Urologist with spontaneously resolving haematospermia, normal prostate specific antigen (PSA) and normal magnetic resonance imaging (MRI) of the prostate. His past medical history was remarkable for stage I NSGCT which was treated with orchidectomy 21 years previously. He took no regular medication. A year after resolution of the haematospermia he developed nocturia, poor urinary flow, and a feeling of pressure on his rectum. This was associated with severe back pain, for which he had started simple analgesia. Examination and ultrasound investigation of the remaining testis was normal. His PSA level was in the normal range at 1.11 microg/L but his AFP level at that stage was grossly elevated at 7787 ng/mL (normal range <10 ng/mL) with an lactate dehydrogenase (LDH) level of 486 U/L (normal range 0–250 U/L). HCG and free beta HCG levels were normal at less than 2 and less than 0.2 U/L, respectively. CT at that point demonstrated a pelvic mass with associated enlarged pelvic lymph nodes, mild left hydronephrosis, and multiple pulmonary metastases up to a diameter of 1.7 cm. An MRI was subsequently performed to better define the local anatomy prior to surgery. MRI demonstrated an extensive prostatic tumour extending into bladder (Fig. 1a, b), seminal vesicles, rectum and left ureter causing hydronephrosis. The total volume of the prostate was elevated at 113 mL. Histopathology from bladder biopsy confirmed the diagnosis of an undifferentiated malignant tumour that from its immunoprofile (AFP, PLAP and CD117 positive, CD30 and OCT 3/4 negative), was diagnosed as metastatic yolk sac tumour (Fig. 2). Due to the non-pulmonary visceral metastases in the prostate his disease fell into the high risk category and treatment with four cycles of bleomycin, etoposide, cisplatin (BEP) chemotherapy was initiated. He received a nephrostomy for decompression of the hydronephrosis and completed the first two cycles of BEP chemotherapy, but then developed evidence of bleomycin-related lung changes on chest radiography and CT. His treatment was changed to etoposide, ifosfamide, and cisplatin (VIP) chemotherapy and he completed another two cycles for a total of four cycles of chemotherapy. He did not have any long term effects from the bleomycin.Fig. 1


Prostatic relapse of an undifferentiated teratoma 24 years after orchidectomy.

Janowitz T, Welsh S, Warren AY, Robson J, Thomas B, Shaw A, Ainsworth NL, Neal DE, Mazhar D - BMC Res Notes (2015)

T2-weighted magnetic resonance images. a, b Axial and coronal T2-weighted magnetic resonance images demonstrate a heterogeneous high signal lesion in the left seminal vesicle and prostate gland. There is a urinary catheter in situ. The lesion is markedly different to the low signal lesion typically found in primary prostatic carcinoma
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4591709&req=5

Fig1: T2-weighted magnetic resonance images. a, b Axial and coronal T2-weighted magnetic resonance images demonstrate a heterogeneous high signal lesion in the left seminal vesicle and prostate gland. There is a urinary catheter in situ. The lesion is markedly different to the low signal lesion typically found in primary prostatic carcinoma
Mentions: A 49-year-old white British man presented to his General Practitioner and afterwards a Urologist with spontaneously resolving haematospermia, normal prostate specific antigen (PSA) and normal magnetic resonance imaging (MRI) of the prostate. His past medical history was remarkable for stage I NSGCT which was treated with orchidectomy 21 years previously. He took no regular medication. A year after resolution of the haematospermia he developed nocturia, poor urinary flow, and a feeling of pressure on his rectum. This was associated with severe back pain, for which he had started simple analgesia. Examination and ultrasound investigation of the remaining testis was normal. His PSA level was in the normal range at 1.11 microg/L but his AFP level at that stage was grossly elevated at 7787 ng/mL (normal range <10 ng/mL) with an lactate dehydrogenase (LDH) level of 486 U/L (normal range 0–250 U/L). HCG and free beta HCG levels were normal at less than 2 and less than 0.2 U/L, respectively. CT at that point demonstrated a pelvic mass with associated enlarged pelvic lymph nodes, mild left hydronephrosis, and multiple pulmonary metastases up to a diameter of 1.7 cm. An MRI was subsequently performed to better define the local anatomy prior to surgery. MRI demonstrated an extensive prostatic tumour extending into bladder (Fig. 1a, b), seminal vesicles, rectum and left ureter causing hydronephrosis. The total volume of the prostate was elevated at 113 mL. Histopathology from bladder biopsy confirmed the diagnosis of an undifferentiated malignant tumour that from its immunoprofile (AFP, PLAP and CD117 positive, CD30 and OCT 3/4 negative), was diagnosed as metastatic yolk sac tumour (Fig. 2). Due to the non-pulmonary visceral metastases in the prostate his disease fell into the high risk category and treatment with four cycles of bleomycin, etoposide, cisplatin (BEP) chemotherapy was initiated. He received a nephrostomy for decompression of the hydronephrosis and completed the first two cycles of BEP chemotherapy, but then developed evidence of bleomycin-related lung changes on chest radiography and CT. His treatment was changed to etoposide, ifosfamide, and cisplatin (VIP) chemotherapy and he completed another two cycles for a total of four cycles of chemotherapy. He did not have any long term effects from the bleomycin.Fig. 1

Bottom Line: A biopsy confirmed undifferentiated malignant tumour, shown immunohistochemically to be a yolk sac tumour.The patient was initially treated with bleomycin, etoposide and cisplatin chemotherapy, but developed bleomycin-related pulmonary side effects after two cycles.His Alpha feto-protein, beta human chorionic gonadotrophin and lactate dehydrogenase levels are normal.

View Article: PubMed Central - PubMed

Affiliation: Oncology Department, Addenbrookes Hospital, Hills Road, Box193, Cambridge, CB2 OQQ, UK. tj212@cam.ac.uk.

ABSTRACT

Background: Non-seminomatous germ cell tumours make up about 40 % of all germ cell tumours, which in turn are the most common tumours in men aged 15-44 years. Low risk stage I non-seminomatous germ cell tumours, which are confined to the testes, are commonly treated by orchiectomy and surveillance. Up to 20 % of patients with this diagnosis relapse, usually within 1-2 years of follow up, but very rarely after more than 5 years. The most common sites of relapse are the retroperitoneal lymph nodes, the mediastinum, and the lungs. We describe a case of relapse in the prostate over 20 years after initial diagnosis, which has not been described in the literature so far.

Case presentation: This report presents a 49-year-old white British man with relapsed testicular non-seminomatous germ cell tumour 22 years after initial treatment with orchidectomy only. He relapsed with a prostatic mass, haematospermia and back pain. His prostate specific antigen levels were within normal range. Alpha feto-protein and lactate dehydrogenase levels were elevated, and his human chorionic gonadotrophin levels were normal. A biopsy confirmed undifferentiated malignant tumour, shown immunohistochemically to be a yolk sac tumour. The patient was initially treated with bleomycin, etoposide and cisplatin chemotherapy, but developed bleomycin-related pulmonary side effects after two cycles. His treatment was changed and he completed four cycles of chemotherapy by receiving two cycles of etoposide, ifosfamide, and cisplatin. Post treatment blood tumour markers were normal, but a follow up computed tomography showed a mass in the base of the prostate, the trigone and the left distal ureter which was surgically resected. The histology from the surgical resection was of necrotic tissue. The patient is now in follow up at 3 years after treatment with no evidence of residual disease on computed tomography. His Alpha feto-protein, beta human chorionic gonadotrophin and lactate dehydrogenase levels are normal.

Conclusions: Very late relapse in stage I non-seminomatous germ cell tumours is extremely rare and the prostate is a highly unusual site of relapsed disease. For diagnosis of late relapse, this case confirms the value of serum biomarkers in germ cell tumours, in particular non-seminomatous germ cell tumours.

No MeSH data available.


Related in: MedlinePlus