Clinicopathological Analysis of Choriocarcinoma as Pure and Predominant Component of Testicular Germ Cell Tumor
Isabel Alvarado-Cabrero, Narciso Hernandez-Toriz, Gladell P Paner. Mexican Oncology Hospital, IMSS, Mexico City, Mexico; University of Chicago, Chicago, IL
Background: Although well recognized in textbooks including the 2004 WHO "blue book", there is still a limited body of clinicopathological information regarding pure choriocarcinoma (CC) of the testis due to its rarity, including when it occurs as the predominant component of a mixed germ cell tumor (GCT). Herein, we present, to our knowledge, the largest surgical pathology series of pure CC and mixed GCT with predominant CC component of the testis.
Design: A comprehensive review of histology slides from 1,010 tumoral orchiectomies from the surgical pathology files (1999-2011) of a national oncology institution was performed. Six (0.6%) pure CC and 9 (0.9%) mixed GCT with predominant CC component were identified, which formed the basis of this study.
Results: Patients' age ranged from 21 to 39 years old (mean 28 years). All tumors were unilateral and involved the right (9/15) and left (6/15) testis. Mean tumor size was 5.7 cm (range 1.5 to 8 cm). The 9 predominant CC comprised 50-95% (7 tumors with >80% CC) of mixed GCT, that included 7/9 combined with 1 and 2/9 combined with 2 other GCT components that included teratoma (5/9), seminoma (3/9), yolk sac tumor (YST) (2/9) and embryonal carcinoma (1/9). CCs were often hemorrhagic cystic tumor comprised of syncitio- and cyto- and variable intermediate trophoblastic cells. No case of monophasic CC was identified in our review. Lymphovascular invasion was identified in all 15 cases, that was often multifocal. Spermatic cord and tunica vaginalis were involved by tumor in 5/15 and 1/12 cases, respectively. Serum tumor markers for 15 patients were: S1 (1), S2 (1), S3 (13), marked by high serum βHCG elevation. Stage for 15 cases was: pT2 (10), pT3 (5); NX (1), N1 (4), N2 (5), N3 (5); and M1a (2) and M1b (13). Distant metastasis mostly involved the lung (11) and liver (10). Chemotherapy (mostly bleomycin, etoposide, platinum or BEP) was administered to 14 patients. On follow-up, all 6 pure CC patients were dead of disease (DOD) (6-14 months, median 9.5 months). Follow up of 8 mixed GCT with predominant CC patients (10-72 months, median 27 months) showed 5 DOD, 1 alive with disease and 2 alive with no disease; the later were the only 2 patients with M1a disease on presentation.
Conclusions: This series confirms the proclivity for high stage presentation including presence of distant metastasis, hematogenous spread, and poor outcome of testicular CC. Mixed GCT with predominant CC component has similar tendency for high stage presentation and aggressive behavior to pure CC.
Category: Genitourinary (including renal tumors)
Tuesday, March 5, 2013 1:00 PM
Poster Session IV # 208, Tuesday Afternoon