• Atrium
• Heart
• Murmur
• Rare case
• Teratoma

• adverse (side) effects
• chemotherapy
• high dose chemotherapy with autologous stem cell transplantation
• refractory germ cell tumors
• relapsed germ cell tumor
• survival

• advanced
• chemotherapy
• clinical trials
• germ cell tumor
• testicular cancer

• Male
• Adolescent
• Young Adult
• Humans
• Testicular Neoplasms/drug therapy
• Testicular Neoplasms/pathology
• Neoplasms, Germ Cell and Embryonal/therapy
• Antineoplastic Combined Chemotherapy Protocols

• Chemotherapy-exposed
• Chemotherapy-naïve
• Late relapse
• Surveillance
• Testicular cancer

• Male
• Humans
• Testicular Neoplasms/drug therapy
• Testicular Neoplasms/surgery
• Testicular Neoplasms/diagnosis
• Neoplasm Recurrence, Local/pathology
• Neoplasms, Germ Cell and Embryonal/drug therapy
• Neoplasms, Germ Cell and Embryonal/surgery
• Seminoma/drug therapy
• Seminoma/surgery
• Chronic Disease
• Retrospective Studies

• laparoscopic retroperitoneal lymph node dissection
• late relapse
• teratoma with somatic‐type malignancy
• testicular cancer

• cancer
• case report
• cultural competency
• germ cell tumor
• testicular cancer
• transgender

• computed tomography (CT)
• germ cells tumors (GCT)
• oncologic diagnostic imaging
• retroperitoneal masses
• seminomatous and nonseminomatous GCT
• testicular cancer (TC)

• germ cell tumor
• late recurrence
• nonseminoma
• testicular cancer

• Biology of pure seminoma
• Case report
• Germ cell tumor relapse
• Late recurrence of pure seminoma
• Primary prostatic seminoma
• Pure seminoma
• Seminoma
• Seminoma tumor markers
• Treatment of relapsed seminoma

Late relapsing germ cell tumors (LR-GCT) are considered a rare distinct biologic entity as their clinical presentation and response to treatment is different to early recurrences. While serum tumor markers (AFP and ß-HCG) play an important role at the time of first diagnosis to correctly classify prognosis and treatment of germ cell tumors, they may not have the same significance in a late relapse situation.

Thirty-seven patients with LR-GCT with elevated serum tumor markers were identified in our database. Twenty-six patients underwent primary surgical resection of the late relapsing tumor. Eleven patients received salvage chemotherapy and a post-chemotherapy residual tumor resection. Serum tumor markers, histological findings and oncological outcome were analyzed.

In the histopathological specimen, viable cancer was found in 20 cases (54%) and teratoma was found in 16 cases (43%). In nine cases (24%), a somatic-type malignant transformation was present. In 19 of 37 patients (51.4%), the late relapse specimen presented a histological type of GCT, which was not present in the primary histology. Twenty-two patients (59.5%) were included in follow-up analysis. Mean and median follow-up time was 62.2 and 53 months, respectively. Seventeen patients (77.3%) suffered a relapse or had progressive disease after LR therapy. Five patients (22.7%) have been relapse-free after LR therapy (mean FU 61.6 months). Ten patients died of disease during follow-up (45.5%) and had a mean time from LR to death of 66.4 months. Eleven patients were alive at last follow-up (mean FU 62.2 months). Relapse and survival rate were similar between patients who received primary resection of LR tumor and patients who received salvage chemotherapy followed by surgery.

Patients with a late relapsing germ cell tumor and elevated markers have a poor prognosis and a high risk for another relapse independent on primary treatment. The histological type and aggressiveness of a late relapsing tumor cannot be predicted with serum tumor marker levels at the time of diagnosis of LR. In up to 54% of cases, primary histology did not coincide with LR histology. Therefore, we propose primary surgical resection of a late relapsing tumor if a complete resection is feasible in order to gain exact histology and tailor further treatment.

• Germ cell tumor
• Late relapse
• Surgery
• Tumor marker

• chemoresistance
• intratumoral heterogeneity
• nonseminomatous germ cell tumor
• prediction model
• pulmonary metastatic lesion

Although testicular cancer (TC) treatment has been associated with severe late morbidities, including second malignant neoplasms (SMNs) and ischemic heart disease (IHD), cause‐specific excess mortality has been rarely studied among patients treated in the platinum era.

In a large, multicenter cohort including 6042 patients with TC treated between 1976 and 2006, cause‐specific mortality was compared with general population mortality rates. Associations with treatment were assessed with proportional hazards analysis.

With a median follow‐up of 17.6 years, 800 patients died; 40.3% of these patients died because of TC. The cumulative mortality was 9.6% (95% confidence interval [CI], 8.5%‐10.7%) 25 years after TC treatment. In comparison with general population mortality rates, patients with nonseminoma experienced 2.0 to 11.6 times elevated mortality from lung, stomach, pancreatic, rectal, and kidney cancers, soft‐tissue sarcomas, and leukemia; 1.9‐fold increased mortality (95% CI, 1.3‐2.8) from IHD; and 3.9‐fold increased mortality (95% CI, 1.5‐8.4) from pneumonia. Seminoma patients experienced 2.5 to 4.6 times increased mortality from stomach, pancreatic, bladder cancer and leukemia. Radiotherapy and chemotherapy were associated with 2.1 (95% CI, 1.8‐2.5) and 2.5 times higher SMN mortality (95% CI, 2.0‐3.1), respectively, in comparison with the general population. In a multivariable analysis, patients treated with platinum‐containing chemotherapy had a 2.5‐fold increased hazard ratio (HR; 95% CI, 1.8‐3.5) for SMN mortality in comparison with patients without platinum‐containing chemotherapy. The HR for SMN mortality increased 0.29 (95% CI, 0.19‐0.39) per 100 mg/m² platinum dose administered (P_trend < .001). IHD mortality was increased 2.1‐fold (95% CI, 1.5‐4.2) after platinum‐containing chemotherapy in comparison with patients without platinum exposure.

Platinum‐containing chemotherapy is associated with a dose‐dependent increase in the risk of SMN mortality.

Platinum‐containing chemotherapy is associated with a dose‐dependent increase in the risk of cancer mortality among patients with testicular cancer. Patients with testicular cancer experience increased mortality from second malignancies as well as causes other than cancer, particularly ischemic heart diseases.

• cause-specific mortality
• cisplatin
• epidemiology
• platinum
• survivorship
• testicular cancer

• Cancer du testicule
• Compliance
• E-health
• E-santé
• Follow-up
• Germ-cell tumor
• Surveillance
• Testicular cancer
• Toxicity
• Tumeurs germinales
• toxicité

• Germ cell tumor
• Late relapse
• Mediastinal lymph node metastasis
• Testicular seminoma

• Germ cell tumor
• Nonseminomatous
• Retroperitoneal lymph node dissection
• Testicular cancer

• Adult
• Aftercare
• Defibrillators, Implantable
• Diagnosis, Differential
• Edema/etiology
• Head and Neck Neoplasms/complications
• Head and Neck Neoplasms/diagnosis
• Head and Neck Neoplasms/pathology
• Head and Neck Neoplasms/secondary
• Humans
• Male
• Neck/diagnostic imaging
• Neck Pain/etiology
• Radiography, Thoracic
• Teratoma/complications
• Teratoma/diagnosis
• Teratoma/pathology
• Teratoma/secondary
• Testicular Neoplasms/therapy
• Tomography, X-Ray Computed
• Ultrasonography
• Watchful Waiting

• psychological concerns
• reentry
• sexual problems
• survivors
• testicular cancer

• Combined Modality Therapy/methods
• Disease Management
• Disease Progression
• Drug Resistance, Neoplasm
• Humans
• Neoplasm Staging
• Neoplasms, Germ Cell and Embryonal/diagnosis
• Neoplasms, Germ Cell and Embryonal/mortality
• Neoplasms, Germ Cell and Embryonal/therapy
• Prognosis
• Recurrence
• Retreatment
• Treatment Outcome

• Active surveillance
• Chemotherapy
• Germ cell tumor
• Non-seminoma
• Radiotherapy
• Relapse
• Retroperitoneal lymph node dissection
• Salvage treatment
• Seminoma

• Anterior mediastinum
• Children
• Histopathology
• Surgical treatment
• Teratoma

Testicular cancer is the most common malignancy in men aged 15–40 years [Bols et al.: Philadelphia, Wolters Kluwer, Lippincott Williams & Wilkins, 2011]. Its incidence comprises 0.8% of all male cancers worldwide, with a mortality rate of 0.1%. The incidence has nearly doubled from 1975 to 2007 leading to the concern of environmental causes [Thomas: Am J Epidemiol 2013; 178: 1240–1245]. Testicular cancer presents as a painless testicular mass without transillumination. Testicular cancer is subcategorized under germ cell testicular cancer or sex cord-stromal tumors. Of the germ cell tumors, approximately 90% originate in the testis, with the other 10% being extragonadal [Bols et al.: Philadelphia, Wolters Kluwer, Lippincott Williams & Wilkins, 2011]. Typically, if a patient presents with a testicular mass and is 50 years old or older, the diagnosis of a primary lymphoma is considered until proven otherwise [Bols et al.: Philadelphia, Wolters Kluwer, Lippincott Williams & Wilkins, 2011]. Germ cell testicular cancer is further divided into the subtypes of seminomatous and nonseminomatous; each presents with a unique histology and differing treatment implications.

Given the uniqueness of our patient's metachronous second testicular primary, we sought to compare our case findings to available historic publications. We sought to address the issues of the incidence of a second primary testicular malignancy with regard to varying histology, age of incidence, and timing of a second primary testicular cancer, the presence of bowel involvement, and finally a brief discussion of testosterone replacement therapy.

A review of our case presents several unique factors. The above varying literature has shown our patient to have met the odds of a contralateral testicular primary development in that he had a nonseminomatous primary, followed by a second testicular primary seminoma. Our patient exceeded the 15-year cumulative risk of contralateral metachronous testicular cancer of 1.9% versus the seemingly contradictory 5.2% cumulative risk 25 years after the first testicular germ cell tumor. With his second primary (seminoma), he presented with the common retroperitoneal landing zone site, though with an uncommon involvement of the gastrointestinal tract (<1%) and rare incidence of involving the duodenum.

• Contralateral metachronous testicular cancer
• Second primary testicular cancer
• Seminoma

• Cisplatin-refractory
• Germ cell tumor
• Platinum resistant
• Refractory
• Testicular cancer

• Bleomycin
• Germ cell cancer
• Prognostic factors
• Survival
• and cisplatin (BEP)
• etoposide

• Late relapse
• outcome
• radiation
• seminoma
• surveillance
• testicular

• Embryonal cell tumor
• Stem cell transplant

• Chemotherapy
• EAU guidelines
• Follow-up
• Germ cell tumour
• Metastatic disease
• Relapse
• Retroperitoneal lymph node dissection
• Risk-adapted treatment
• Testis cancer

Up to 3.2% of patients with testicular germ cell tumours represent with late-relapsing disease. Aggressive surgical resection confers the greatest chance of cure in this patient group. We present the case of a late and extensively relapsed nonseminomatous germ cell tumour with thrombus present along the entire length of the inferior vena cava, as well as in the right hepatic vein. Techniques practised in liver transplantation were used to achieve complete resection of the tumour thrombus. This case illustrates the enhanced potential for tumour resection through a fusion of principles derived from surgical oncology and liver transplantation.

Germ cell tumors (GCTs) comprise 95% of malignant tumors arising in the testes. The present study reports a patient diagnosed with non-seminomatous testicular cancer, stage IB, with a good risk prediction according to the International Germ Cell Cancer Collaborative Group classification. The patient received chemotherapy with bleomycin, etoposide and cisplatin, and achieved complete remission. Eleven years later, while receiving treatment with interferon β-1a for multiple sclerosis, the patient developed a relapse of the original cancer in the lungs and lymph nodes. The majority of GCTs relapse within the first two years of treatment, while 2–4% of patients can present with late relapses. There is no clear established association between multiple sclerosis and testicular cancer; we present the hypothesis that the inmunosupressor treatment that was administered for the multiple sclerosis promoted the cancer relapse.

• inmunosupression
• late relapse
• multiple sclerosis
• non-seminomatous germ cell tumor
• β-interferon

• germ cell and embryonal
• lymph node excision
• neoplasm recurrence
• neoplasms
• reoperation
• testis