The Effects of Chemotherapy on Spermatocytic Seminoma
Daniel M Berney, Wendy Ansell, Jonathan Shamash. St Bartholomew's Hospital, Queen Mary University of London, London, United Kingdom
Background: Spermatocytic seminoma is a rare testicular tumor, which ususally receives no treatment beyond excision. Rare cases of metastasis are reported in the literature, usually but not inevitably associated with sarcomatoid change. We present two cases of spermatocytic seminoma without sarcomatoid change which were treated with chemotherapy prior to excision and examine the possible effects of standard germ cell chemotherapy on these tumors.
Design: The files of Bartshealth hospitals were searched for cases of spermatocytic seminoma and reviewed for any which had received chemotherapy.
Results: 25 cases of spermatocytic seminoma were reviewed of which two had received chemotherapy after mutli-disciplinary discussion. A 30 year old male presented with a right testicular lump, which was initially diagnosed as a non-seminomatous germ cell tumor. He received 1 cycle of adjuvant BEP chemotherapy. On supra-regional review the diagnosis was changed to spermatocytic seminoma, and a second round of chemotherapy was not given. On histology, the tumour was over 6cm in size, and showed typical features for spermatocytic seminoma, though vascular invasion was seen. Immunochemistry for OCT3/4 was negative. On routine follow up he represented with haemoptysis and a single 4cm lung mass was seen on imaging. This was completely excised and showed features identical to the primary tumour. He remains well after 1 year of further follow up and recurrence free. A 47 year old man presented with a 5cm right and 1cm left testicular lump. Excision of the right testicle showed a spermatocytic seminoma. In order to preserve endocrine function, he underwent 2 cycles of BEP chemotherapy to shrink the second tumour and facilitate a partial orchidectomy. However no response was seen on imaging and he underwent a left orchidectomy. This showed a spermatocytic seminoma with anaplastic features, but no necrosis or other features of regression. He remains tumor free after 4 years.
Conclusions: These rare cases demonstrate that BEP chemotherapy appears to have little effect on the growth or prevention of recurrence of spermatocytic seminoma. Both tumors showed a high mitotic index with no necrosis and features completely different from those expected with typical post-chemotherapy germ cell tumors. The highly unusual metastatic case showed only a single metastasis and appears well after surgery. We suggest that this may represent an embolic phenomenon rather than true metastasis. The chemoresistance of these tumors suggests that other modalities should be preferred in the treatment of these exceptional cases.
Category: Genitourinary (including renal tumors)
Wednesday, March 6, 2013 1:00 PM
Poster Session VI # 172, Wednesday Afternoon