Cytoreductive Surgery for Metastatic Testis Cancer: Tissue Analysis of Retroperitoneal Masses after Chemotherapy

No AccessJournal of Urology1 Jun 1982Cytoreductive Surgery for Metastatic Testis Cancer: Tissue Analysis of Retroperitoneal Masses after Chemotherapy J.P. Donohue, L.M. Roth, J.M. Zachary, R.G. Rowland, L.H. Einhorn, and S.G. Williams J.P. DonohueJ.P. Donohue , L.M. RothL.M. Roth , J.M. ZacharyJ.M. Zachary , R.G. RowlandR.G. Rowland , L.H. EinhornL.H. Einhorn , and S.G. WilliamsS.G. Williams View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)54256-1AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Survival of patients with massive retroperitoneal metastases from nonseminomatous germinal cell testis cancer has been enhanced dramatically by preoperative chemotherapy, consisting of platinum, vinblastine and bleomycin. Such chemical, systemic cytoreduction greatly reduces tumor bulk and facilitates retroperitoneal lymph node dissection. However, there are no reliable preoperative or intraoperative predictive criteria to indicate the precise nature of this residual tissue. Even gross morphologic examination is unreliable in ascertaining the presence or absence of persistent cancer in these tissues, which may assume a variety of gross appearances (cystic, solid, necrotic, fibrous and so forth). Retroperitoneal lymph node dissection was done in 51 patients with advanced retroperitoneal disease and/or pulmonary metastases for removal of persistent retroperitoneal mass lesions after 3 or 4 courses of platinum, vinblastine and bleomycin therapy. These specimens were analyzed for gross and microscopic features of hemorrhage, inflammation, calcification, fibrosis, necrosis, cystic changes, immature teratoma, mature teratoma and frank cancer (embryonal carcinoma, teratocarcinoma, choriocarcinoma and seminoma). All patients had a combination of several of these features in widely varying gross and regional distributions. Nineteen patients (37 per cent) had some focus of persistent malignancy, often small and seemingly distributed at random in a variety of gross presentations. Furthermore, the site of malignancy often was not in the central largest mass, which usually had necrotic or cystic features. We conclude that mere gross examination and biopsy or removal of the central portion of a residual tumor is inadequate if persistent cancer is to be ruled out. Rather, as complete a dissection as possible is recommended for this purpose. Detailed analysis of gross and microscopic findings will be presented and correlated with clinical management. © 1982 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byBeck S, Foster R, Bihrle R, Einhorn L and Donohue J (2009) Long-Term Outcome for Patients With High Volume Retroperitoneal Teratoma Undergoing Post-Chemotherapy SurgeryJournal of Urology, VOL. 181, NO. 6, (2526-2532), Online publication date: 1-Jun-2009.COMITER C, KIBEL A, RICHIE J, NUCCI M and RENSHAW A (2018) PROGNOSTIC FEATURES OF TERATOMAS WITH MALIGNANT TRANSFORMATION: A CLINICOPATHOLOGICAL STUDY OF 21 CASESJournal of Urology, VOL. 159, NO. 3, (859-863), Online publication date: 1-Mar-1998.Wood D, Herr H, Heller G, Vlamis V, Sogani P, Motzer R, Fair W and Bosl G (2018) Distribution of Retroperitoneal Metastases After Chemotherapy in Patients With Nonseminomatous Germ Cell TumorsJournal of Urology, VOL. 148, NO. 6, (1812-1815), Online publication date: 1-Dec-1992.Rasmussen O, Daugaard G, Christiansen S, Sørensen B and Rørth M (2018) Secondary Surgery in Patients with Malignant Germ Cell TumorsJournal of Urology, VOL. 147, NO. 2, (393-397), Online publication date: 1-Feb-1992.Fosså S, Ous S, Lien H and Stenwig A (2018) Post-Chemotherapy Lymph Node Histology in Radiologically Normal Patients with Metastatic Nonseminomatous Testicular CancerJournal of Urology, VOL. 141, NO. 3 Part 1, (557-559), Online publication date: 1-Mar-1989.Ellison M, Mostofi F and Flanigan R (2018) Treatment of the Residual Retroperitoneal Mass After Chemotherapy for Advanced SeminomaJournal of Urology, VOL. 140, NO. 3, (618-620), Online publication date: 1-Sep-1988.Ritchey M, Bagnall J, McDonald E and Sago A (2018) Development of Nongerm Cell Malignancies in Nonseminomatous Germ Cell TumorsJournal of Urology, VOL. 134, NO. 1, (146-149), Online publication date: 1-Jul-1985.Freiha F, Shortliffe L, Rouse R, Mark J, Hannigan J, Aston D, Spaulding J, Williams R and Torti F (2018) The Extent of Surgery after Chemotherapy for Advanced Germ Cell TumorsJournal of Urology, VOL. 132, NO. 5, (915-917), Online publication date: 1-Nov-1984.Skinner D (2018) Editorial CommentsJournal of Urology, VOL. 131, NO. 2, (343-345), Online publication date: 1-Feb-1984.David Crawford E, Mettler F and Duncan P (2018) Retrocrural Lymphadenopathy in Testicular CancerJournal of Urology, VOL. 131, NO. 2, (343-343), Online publication date: 1-Feb-1984.Donohue J, Zachary J and Maynard B (2018) Distribution of Nodal Metastases in Nonseminomatous Testis CancerJournal of Urology, VOL. 128, NO. 2, (315-320), Online publication date: 1-Aug-1982. Volume 127Issue 6June 1982Page: 1111-1114 Advertisement Copyright & Permissions© 1982 by The American Urological Association Education and Research, Inc.MetricsAuthor Information J.P. Donohue More articles by this author L.M. Roth More articles by this author J.M. Zachary More articles by this author R.G. Rowland More articles by this author L.H. Einhorn More articles by this author S.G. Williams More articles by this author Expand All Advertisement PDF downloadLoading ...