TERATOMA WITH MALIGNANT TRANSFORMATION: DIVERSE MALIGNANT HISTOLOGIES ARISING IN MEN WITH GERM CELL TUMORS

No AccessJournal of UrologyClinical Urology: Original Articles1 Jan 1998TERATOMA WITH MALIGNANT TRANSFORMATION: DIVERSE MALIGNANT HISTOLOGIES ARISING IN MEN WITH GERM CELL TUMORS Robert J. Motzer, Alison Amsterdam, Victor Prieto, Joel Sheinfeld, V.V.V.S. Murty, Madhu Mazumdar, George J. Bosl, R.S.K. Chaganti, and Victor E. Reuter Robert J. MotzerRobert J. Motzer More articles by this author , Alison AmsterdamAlison Amsterdam More articles by this author , Victor PrietoVictor Prieto More articles by this author , Joel SheinfeldJoel Sheinfeld More articles by this author , V.V.V.S. MurtyV.V.V.S. Murty More articles by this author , Madhu MazumdarMadhu Mazumdar More articles by this author , George J. BoslGeorge J. Bosl More articles by this author , R.S.K. ChagantiR.S.K. Chaganti More articles by this author , and Victor E. ReuterVictor E. Reuter More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)64035-7AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Teratoma with malignant transformation refers to a form of germ cell tumor in which a somatic teratomatous component becomes morphologically malignant and develops aggressive growth. We evaluated the spectrum of histologies, chromosomal abnormalities and clinical outcome in patients with teratoma with malignant transformation. Materials and Methods: We identified 46 patients with germ cell tumor meeting morphologic criteria for malignant transformation. Histology, disease extent and treatment were correlated with survival. Tumors in 12 patients were studied by conventional cytogenetics or molecular genetic techniques for the isochromosome 12p [i(12p)], a marker for germ cell tumor, as well as other chromosomal abnormalities. Results: The site of first detection of malignant transformation occurred in the primary tumor of 21 cases (44%), at a metastatic site in 20 (43%) and in both sites in 5 (10%). Sarcoma was the most frequent histology, identified in 29 patients (63%) with rhabdomyosarcoma the most common subtype. Seventeen tumors (37%) contained a solid tumor histology other than sarcoma, with adenocarcinoma and primitive neuroectodermal tumor as the most common histologies. Four patients with mediastinal germ cell tumor containing sarcoma also had hematological malignancies, including a focus of nonHodgkin's lymphoma in the mediastinal primary tumor (1) and nonlymphocytic leukemia in spleen or bone marrow (3). Patients who had teratoma with malignant transformation components confined to the testis or retroperitoneum completely resected experienced a longer survival than those with distant metastases or incompletely resected tumors (p = 0.003). Chromosomal abnormalities associated with germ cell tumor (i [12p]) were identified in 11 of 12 tumors containing adenocarcinoma, primitive neuroectodermal tumor, sarcoma and leukemia. In addition to i (12p), chromosomal rearrangements characteristic of the transformed histology were detected in 4 tumors. Conclusions: A variety of nongerm cell histologies, including sarcoma, adenocarcinoma, primitive neuroectodermal tumor and leukemia, may occur in association with germ cell tumor. Chromosomal abnormalities in these tumors include i (12p), reflecting germ cell tumor clonality, as well as chromosomal abnormalities associated with the transformed histology. These tumors do not respond like germ cell tumor to cisplatin-containing chemotherapy regimens. Treatment should be tailored according to that used in standard management of the transformed histology, and surgical resection is the mainstay of therapy. References 1 : VAB-6: an effective chemotherapy regimen for patients with germ-cell tumors.. J. Clin. Oncol.1986; 4: 1493. Google Scholar 2 : Teratoma with malignant transformation in germ cell tumors in men.. Cancer1985; 56: 860. Google Scholar 3 : Evaluation of survival data and two new rank order statistics arising in its consideration.. Cancer Chem. Rep.1966; 50: 163. Google Scholar 4 : Molecular cytogenetic analysis of i (12p) negative human male germ cell tumors.. Genes, Chromosomes Cancer1993; 8: 230. Google Scholar 5 : Cytogenetic and molecular analysis of human male germ cell tumors: chromosome 12 abnormalities and gene amplification.. Genes, Chromosomes Cancer1990; 1: 289. Google Scholar 6 : Abnormalities of 2q: a common genetic link between rhabdomyosarcoma and hepatoblastoma.. Genes, Chromosomes Cancer1991; 3: 122. Google Scholar 7 : Catalog of Chromosome Aberrations in Cancer. New York: Wiley-Liss1994. Google Scholar 8 : Clinical and cytogenetic correlations in 63 patients with therapy-related myelodysplastic syndromes and acute nonlymphocytic leukemia: further evidence for characteristic abnormalities of chromosomes no.. 5 and 7. J. Clin. Oncol.1996; 4: 325. Google Scholar 9 : Treatment of disseminated germ-cell tumors with cisplatin, bleomycin, and either vinblastine or etoposide.. New Engl. J. Med.1987; 316: 1435. Google Scholar 10 : Ifosfamide-based chemotherapy for patients with resistant germ cell tumors: the Memorial Sloan-Kettering Cancer Center Experience.. Sem. Oncol.1992; 19: 8. Google Scholar 11 : High-dose carboplatin, etoposide, and cyclophosphamide for patients with refractory germ cell tumors: treatment results and prognostic factors for survival and toxicity.. J. Clin. Oncol.1996; 14: 1098. Google Scholar 12 : Unusual neoplasms detected in testis cancer patients undergoing post-chemotherapy retroperitoneal lymphadenectomy.. J. Urol.1994; 152: 1144. Abstract, Google Scholar 13 : Clinical relevance of the i (12p) marker chromosome in germ cell tumors.. J. Natl. Cancer Inst.1994; 86: 349. Google Scholar 14 : Cytogenetic and immunohistochemical evidence for the germ cell origin of a subset of acute leukemias associated with mediastinal germ cell tumors.. J. Natl. Cancer Inst.1990; 82: 221. Google Scholar 15 : Hematologic neoplasia associated with primary mediastinal germ-cell tumors.. New Engl. J. Med.1990; 322: 1425. Google Scholar 16 : Association between mediastinal germ cell tumors and hematologic malignancies: an update.. Hum. Path.1990; 21: 699. Google Scholar 17 : Acute lymphoblastic leukemia. Possible origin from a mediastinal germ cell tumor.. Cancer1984; 53: 441. Google Scholar 18 : Sarcoma arising in a residual testicular teratoma after cytoreductive chemotherapy.. Cancer1984; 54: 2015. Google Scholar 19 : The growing teratoma syndrome.. Cancer1982; 50: 1629. Google Scholar 20 : Etoposide and cisplatin adjuvant therapy for patients with pathologic stage II germ cell tumors.. J. Clin. Oncol.1995; 13: 2700. Google Scholar 21 : The effect of age at diagnosis on outcome in rhabdomyosarcoma.. Cancer1996; 73: 109. Google Scholar 22 : Very-high-dose short-term chemotherapy for poor-risk peripheral primitive neuroectodermal tumors, including Ewing's sarcoma, in children and young adults.. J. Clin. Oncol.1996; 13: 2796. Google Scholar 23 : Extracranial primitive neuroectodermal tumors: the Memorial Sloan-Kettering Cancer Center experience.. Cancer1996; 67: 1825. Google Scholar From the Genitourinary Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Department of Pathology (Surgical Pathology and Cytogenetic Services), Department of Biostatistics, and Division of Urology, Department of Surgery, Memorial Hospital, New York, and Cell Biology and Genetics Program, Sloan-Kettering Institute, New York, New YorkAccepted for publication June 20, 1997© 1998 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited bySheinfeld J, Becerra M and Feldman D (2016) Are Some Cases of Somatic Type Malignancy Potentially Avoidable?Journal of Urology, VOL. 196, NO. 1, (11-13), Online publication date: 1-Jul-2016.Giannatempo P, Pond G, Sonpavde G, Albany C, Loriot Y, Sweeney C, Salvioni R, Colecchia M, Nicolai N, Raggi D, Rice K, Flack C, El Mouallem N, Feldman H, Fizazi K, Einhorn L, Foster R, Necchi A and Cary C (2015) Treatment and Clinical Outcomes of Patients with Teratoma with Somatic-Type Malignant Transformation: An International CollaborationJournal of Urology, VOL. 196, NO. 1, (95-100), Online publication date: 1-Jul-2016.Silberstein J (2014) Outcomes of Retroperitoneal Lymph Node Dissection for the Most Challenging CasesJournal of Urology, VOL. 192, NO. 5, (1320-1321), Online publication date: 1-Nov-2014.Rice K, Magers M, Beck S, Cary K, Einhorn L, Ulbright T and Foster R (2014) Management of Germ Cell Tumors with Somatic Type Malignancy: Pathological Features, Prognostic Factors and Survival OutcomesJournal of Urology, VOL. 192, NO. 5, (1403-1409), Online publication date: 1-Nov-2014. 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Volume 159Issue 1January 1998Page: 133-138 Advertisement Copyright & Permissions© 1998 by American Urological Association, Inc.MetricsAuthor Information Robert J. Motzer More articles by this author Alison Amsterdam More articles by this author Victor Prieto More articles by this author Joel Sheinfeld More articles by this author V.V.V.S. Murty More articles by this author Madhu Mazumdar More articles by this author George J. Bosl More articles by this author R.S.K. Chaganti More articles by this author Victor E. Reuter More articles by this author Expand All Advertisement PDF downloadLoading ...