Recurrent seminomas: Clinical features and biologic implications

Som, Avik; Zhu, Rui; Guo, Charles C.; Efstathiou, Eleni; Xiao, Li; Pisters, Louis L.; Matin, Angabin; Tu, Shi-Ming

doi:10.1016/j.urolonc.2010.05.011

« BackUrologic Oncology: Seminars and Original Investigations

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Recurrent seminomas: Clinical features and biologic implications

Avik Som
- Department of Genitourinary Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
- Current affiliation: The Johns Hopkins University, Baltimore, MD.
- King Foundation Summer Scholar, The University of Texas M. D. Anderson Cancer Center, Houston, TX.
Rui Zhu, Ph.D.
- Department of Genetics, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
Charles C. Guo, M.D.
- Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
Eleni Efstathiou, M.D., Ph.D.
- Department of Genitourinary Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
Li Xiao, M.D.
- Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
Louis L. Pisters, M.D.
- Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
Angabin Matin, Ph.D.
- Department of Genetics, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
Shi-Ming Tu, M.D.
- Department of Genitourinary Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
- Corresponding author. Tel.: +1-713-563-7268; fax: ++1-713-745-1625

Received 10 March 2010; received in revised form 19 May 2010; accepted 21 May 2010. published online 07 September 2010.
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Abstract

Objectives

Certain patients with seminoma and clinically atypical phenotypes—visceral metastases, elevated levels of β human chorionic gonadotropin (βHCG), and/or recurrent disease—have a poor prognosis. The primary goal of this pilot study was to characterize the clinical characteristics and treatment profile of these rare patients. We also wished to test whether these tumors expressed any specific biomarkers that might distinguish them as a unique subtype of seminoma.

Materials and methods

We retrospectively identified 25 patients with a history of seminoma plus visceral metastases, βHCG levels >200 mU/ml, and/or recurrent disease. We reviewed these patients' histories for treatment efficacy and clinical outcome. Tissue samples were available from 6 of those patients, and we studied them for expression of the markers OCT 3/4, PLAP, CD30, TRA-1-60, c-kit, and gp200. We compared our results with the expression of those markers in tissue samples from mixed seminoma/embryonal carcinomas and classic seminomas.

Results

Our analysis suggested that certain chemotherapeutic regimens (such as ifosfamide, paclitaxel, and cisplatin) are efficacious for the treatment of patients with these atypical seminomas. Further, specimens from the atypical seminomas generally had staining profiles that resembled those of classic seminomas and the seminoma components in mixed germ-cell tumors, but the profiles differed from those of the embryonal carcinoma components in the same mixed germ-cell tumors.

Conclusions

Although these atypical seminomas tend to be resistant to chemotherapy, they may still respond to certain chemotherapeutic regimens. Our pilot immunohistochemical study also suggested that the unique phenotypes associated with these atypical seminomas do not result from any relationship with embryonal carcinomas. More study is needed to confirm these initial findings.

Keywords: Seminoma, Testicular neoplasms, Embryonal carcinoma, TRA-1-60, gp200