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BMC Urology
Published in: BMC Urology 1/2013

Open Access 01-12-2013 | Case report

Retroperitoneal teratoma with somatic malignant transformation: A papillary renal cell carcinoma in a testicular germ cell tumour metastasis following platinum-based chemotherapy

Authors: Nina Zeh, Peter J Wild, Peter K Bode, Glen Kristiansen, Holger Moch, Tullio Sulser, Thomas Hermanns

Published in: BMC Urology | Issue 1/2013

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Abstract

Background

Malignant transformation describes the phenomenon in which a somatic component of a germ cell teratoma undergoes malignant differentiation. A variety of different types of sarcoma and carcinoma, all non-germ cell, have been described as a result of malignant transformation.

Case presentation

A 33-year-old man presented with a left testicular mass and elevated tumour markers. Staging investigations revealed retroperitoneal lymphadenopathy with obstruction of the left ureter and distant metastases. Histopathology from the left radical orchiectomy showed a mixed germ cell tumour (Stage III, poor prognosis). The ureter was stented and four cycles of cisplatin, etoposide and bleomycin chemotherapy administered. After initial remission, the patient recurred four years later with a large retroperitoneal mass involving the renal vessels and the left ureter. Left retroperitoneal lymph node dissection with en-bloc resection of the left kidney was performed.
Histopathology revealed a germ cell tumour metastasis consisting mainly of mature teratoma. Additionally, within the teratoma a papillary renal cell carcinoma was found. The diagnosis was supported by immunohistochemistry showing positivity for AMACR, CD10 and focal expression of RCC and CK7. There was no radiological or histo-pathological evidence of a primary renal cell cancer.

Conclusions

To the best of our knowledge, malignant transformation into a papillary renal cell carcinoma has not been reported in a testicular germ cell tumour metastasis following platinum-based chemotherapy. This histological diagnosis might have implications for potential future therapies. In the case of disease recurrence, renal cell cancer as origin of the recurrent tumour has to be excluded because renal cell carcinoma metastases would not respond well to the classical germ cell tumour chemotherapy regimens.
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Literature
1.
Eble JN, Sauter G, Epstein JI, Sesterhenn IA: WHO histological classification of testis tumours, Pathology & Genetics, Tumours of the urinary system and male genital organs. 2004, Lyon: IARC Press
2.
Motzer RJ, Amsterdam A, Prieto V, Sheinfeld J, Murty VV, Mazumdar M, Bosl GJ, Chaganti RS, Reuter VE: Teratoma with malignant transformation: diverse malignant histologies arising in men with germ cell tumors. J Urol. 1998, 159: 133-138. 10.1016/S0022-5347(01)64035-7.CrossRefPubMed
3.
Jain D, Sharma MC, Sarkar C, Rishi A, Suri V, Garg A, Mahapatra AK: Spinal teratoma with renal differentiation–a rare phenomenon: report of two patients. Clin Neurol Neurosurg. 2008, 110: 265-269. 10.1016/j.clineuro.2007.09.016.CrossRefPubMed
4.
Comiter CV, Kibel AS, Richie JP, Nucci MR, Renshaw AA: Prognostic features of teratomas with malignant transformation: a clinicopathological study of 21 cases. J Urol. 1998, 159: 859-863. 10.1016/S0022-5347(01)63754-6.CrossRefPubMed
5.
Mohanty SK, Balani JP, Parwani AV: Primitive neuroectodermal tumor arising in a testicular teratoma with retroperitoneal metastasis: report of an interesting case with review of literature. Urology. 2007, 70 (812): e817-e810.
6.
Necchi A, Colecchia M, Nicolai N, Piva L, Catanzaro M, Biasoni D, Torelli T, Stagni S, Paolini B, Milani A, Salvioni R: Towards the definition of the best management and prognostic factors of teratoma with malignant transformation: a single-institution case series and new proposal. BJU Int. 2011, 107: 1088-1094. 10.1111/j.1464-410X.2010.09705.x.CrossRefPubMed
7.
International Union Against Cancer (UICC): TNM Classification of Malignant Tumours. Edited by: Sobin LH, Gospodarowicz M, Wittekind C. 2009, Wiley: New York, editionEdited by, 7
8.
International Germ Cell Cancer Collaborative Group: International germ cell consensus classification: a prognostic factor-based staging system for metastatic germ cell cancers. J Clin Oncol. 1997, 15: 594-603.
9.
Korfel A, Fischer L, Foss HD, Koch HC, Thiel E: Testicular germ cell tumor with rhabdomyosarcoma successfully treated by disease-adapted chemotherapy including high-dose chemotherapy: case report and review of the literature. Bone Marrow Transplant. 2001, 28: 787-789. 10.1038/sj.bmt.1703212.CrossRefPubMed
10.
Marusic Z, Zovak M, Hagenkord JM, Kash S, Koul MS, Sanger W, Gatalica Z, Kruslin B, Tomas D: Papillary renal cell-like carcinoma in a retroperitoneal teratoma. Pathol Int. 2010, 60: 581-585. 10.1111/j.1440-1827.2010.02559.x.CrossRefPubMed
11.
Kernek KM, Brunelli M, Ulbright TM, Eble JN, Martignoni G, Zhang S, Michael H, Cummings OW, Cheng L: Fluorescence in situ hybridization analysis of chromosome 12p in paraffin-embedded tissue is useful for establishing germ cell origin of metastatic tumors. Mod Pathol. 2004, 17: 1309-1313. 10.1038/modpathol.3800195.CrossRefPubMed
12.
Skinnider BF, Amin MB: An immunohistochemical approach to the differential diagnosis of renal tumors. Semin Diagn Pathol. 2005, 22: 51-68. 10.1053/j.semdp.2005.11.004.CrossRefPubMed
13.
Mertz KD, Demichelis F, Sboner A, Hirsch MS, Dal Cin P, Struckmann K, Storz M, Scherrer S, Schmid DM, Strebel RT, et al: Association of cytokeratin 7 and 19 expression with genomic stability and favorable prognosis in clear cell renal cell cancer. Int J Cancer. 2008, 123: 569-576. 10.1002/ijc.23565.CrossRefPubMed
14.
Ingold B, Wild PJ, Nocito A, Amin MB, Storz M, Heppner FL, Moch H: Renal cell carcinoma marker reliably discriminates central nervous system haemangioblastoma from brain metastases of renal cell carcinoma. Histopathology. 2008, 52: 674-681. 10.1111/j.1365-2559.2008.03003.x.CrossRefPubMed
15.
Dal Cin P: Genetics in renal cell carcinoma. Curr Opin Urol. 2003, 13: 463-466. 10.1097/00042307-200311000-00007.CrossRefPubMed
16.
Rioja J, Rodriguez-Fraile M, Lima-Favaretto R, Rincon-Mayans A, Penuelas-Sanchez I, Zudaire-Bergera JJ, Parra RO: Role of positron emission tomography in urological oncology. BJU Int. 2010, 106: 1578-1593. 10.1111/j.1464-410X.2010.09510.x.CrossRefPubMed
17.
Becherer A, De Santis M, Karanikas G, Szabo M, Bokemeyer C, Dohmen BM, Pont J, Dudczak R, Dittrich C, Kletter K: FDG PET is superior to CT in the prediction of viable tumour in post-chemotherapy seminoma residuals. Eur J Radiol. 2005, 54: 284-288. 10.1016/j.ejrad.2004.07.012.CrossRefPubMed
18.
De Santis M, Becherer A, Bokemeyer C, Stoiber F, Oechsle K, Sellner F, Lang A, Kletter K, Dohmen BM, Dittrich C, Pont J: 2-18fluoro-deoxy-D-glucose positron emission tomography is a reliable predictor for viable tumor in postchemotherapy seminoma: an update of the prospective multicentric SEMPET trial. J Clin Oncol. 2004, 22: 1034-1039. 10.1200/JCO.2004.07.188.CrossRefPubMed
19.
Motzer RJ, Agarwal N, Beard C, Bolger GB, Boston B, Carducci MA, Choueiri TK, Figlin RA, Fishman M, Hancock SL, et al: NCCN clinical practice guidelines in oncology: testicular cancer. J Natl Compr Canc Netw. 2009, 7: 672-693.PubMed
20.
De Santis M, Pont J: The role of positron emission tomography in germ cell cancer. World J Urol. 2004, 22: 41-46. 10.1007/s00345-004-0403-2.CrossRefPubMed
21.
Sacco E, Pinto F, Totaro A, D'Addessi A, Racioppi M, Gulino G, Volpe A, Marangi F, D'Agostino D, Bassi P: Imaging of renal cell carcinoma: state of the art and recent advances. Urol Int. 2011, 86: 125-139. 10.1159/000322724.CrossRefPubMed
22.
Ahmed T, Bosl GJ, Hajdu SI: Teratoma with malignant transformation in germ cell tumors in men. Cancer. 1985, 56: 860-863. 10.1002/1097-0142(19850815)56:4<860::AID-CNCR2820560426>3.0.CO;2-3.CrossRefPubMed
23.
Rebischung C, Cottu PH, Daban A, Terrier-Lacombe MJ, Theodore C, Bonvalot S, Vallancien G, Culine S: Germ-cell tumours containing non germ-cell neoplasms: teratoma with malignant transformation. Urol Oncol. 2001, 6: 239-242. 10.1016/S1078-1439(01)00133-8. K FCrossRef
24.
Ulbright TM, Loehrer PJ, Roth LM, Einhorn LH, Williams SD, Clark SA: The development of non-germ cell malignancies within germ cell tumors. A clinicopathologic study of 11 cases. Cancer. 1984, 54: 1824-1833. 10.1002/1097-0142(19841101)54:9<1824::AID-CNCR2820540910>3.0.CO;2-J.CrossRefPubMed
25.
Ganjoo KN, Foster RS, Michael H, Donohue JP, Einhorn LH: Germ cell tumor associated primitive neuroectodermal tumors. J Urol. 2001, 165: 1514-1516. 10.1016/S0022-5347(05)66339-2.CrossRefPubMed
26.
Guo CC, Punar M, Contreras AL, Tu SM, Pisters L, Tamboli P, Czerniak B: Testicular germ cell tumors with sarcomatous components: an analysis of 33 cases. Am J Surg Pathol. 2009, 33: 1173-1178. 10.1097/PAS.0b013e3181adb9d7.CrossRefPubMed
27.
Donadio AC, Motzer RJ, Bajorin DF, Kantoff PW, Sheinfeld J, Houldsworth J, Chaganti RS, Bosl GJ: Chemotherapy for teratoma with malignant transformation. J Clin Oncol. 2003, 21: 4285-4291. 10.1200/JCO.2003.01.019.CrossRefPubMed
28.
Spiess PE, Pisters LL, Liu P, Pettaway CA, Kamat AM, Gomez JA, Tannir NM: Malignant transformation of testicular teratoma: a chemoresistant phenotype. Urol Oncol. 2008, 26: 595-599. 10.1016/j.urolonc.2007.07.013.CrossRefPubMedPubMedCentral
29.
El Mesbahi O, Terrier-Lacombe MJ, Rebischung C, Theodore C, Vanel D, Fizazi K: Chemotherapy in patients with teratoma with malignant transformation. Eur Urol. 2007, 51: 1306-1311. 10.1016/j.eururo.2006.10.021.CrossRefPubMed
Metadata
Title
Retroperitoneal teratoma with somatic malignant transformation: A papillary renal cell carcinoma in a testicular germ cell tumour metastasis following platinum-based chemotherapy
Authors
Nina Zeh
Peter J Wild
Peter K Bode
Glen Kristiansen
Holger Moch
Tullio Sulser
Thomas Hermanns
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Urology / Issue 1/2013
Electronic ISSN: 1471-2490
DOI
https://doi.org/10.1186/1471-2490-13-9

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