Lutke Holzik Martijn F, Hoekstra Harald J, Mulder Nanno H, Suurmeijer Albert J H, Sleijfer Dirk Th, Gietema Jourik A
Department of Surgical Oncology, University Medical Center Groningen, Groningen, The Netherlands.
Ann Surg Oncol. 2003 Mar;10(2):131-5. doi: 10.1245/aso.2003.05.024.
After chemotherapy for nonseminomatous testicular germ cell tumor (NSTGCT), residual masses or recurrent disease may contain a non-germ cell malignancy (NGCM).
Over 20 years, 369 patients with disseminated NSTGCT were treated with cisplatin-based polychemotherapy at the University Medical Center Groningen. Residual tumor masses were resected in 244 patients and recurrent tumor masses in 37 patients. Histology was reviewed, focusing on the presence of NGCM.
Nine patients developed an NGCM. Four patients had an NGCM in the resected residual tumor mass after chemotherapy: three patients had a sarcoma, and one patient had both a sarcoma and an adenocarcinoma. Five patients developed a late recurrence with an NGCM after 39, 40, 72, 72, and 84 months. One patient had a primitive neuroectodermal tumor, one had a sarcoma, and three had an adenocarcinoma in the resected recurrent tumor mass. A complete surgical resection was achieved in five (56%) of the nine patients. After a median follow-up of 48 months (range, 3-271 months), five patients had no evidence of disease (56%), three patients were dead of disease (33%), and one patient was alive with disease (11%).
Sarcoma, adenocarcinoma, or both in residual or recurrent tumor masses after combined-modality NSTGCT treatment are rare. Complete surgical resection of the tumor mass is the only curative treatment option.
非精原细胞瘤性睾丸生殖细胞肿瘤（NSTGCT）化疗后，残留肿块或复发性疾病可能包含非生殖细胞恶性肿瘤（NGCM）。
20多年来，格罗宁根大学医学中心对369例播散性NSTGCT患者采用了以顺铂为基础的多药化疗。244例患者切除了残留肿瘤肿块，37例患者切除了复发性肿瘤肿块。对组织学进行了复查，重点关注NGCM的存在情况。
9例患者发生了NGCM。4例患者在化疗后的切除残留肿瘤肿块中发现有NGCM：3例患者患有肉瘤，1例患者同时患有肉瘤和腺癌。5例患者在39、40、72、72和84个月后出现伴有NGCM的晚期复发。在切除的复发性肿瘤肿块中，1例患者患有原始神经外胚层肿瘤，1例患有肉瘤，3例患有腺癌。9例患者中有5例（56%）实现了完整的手术切除。中位随访48个月（范围3 - 271个月）后，5例患者无疾病证据（56%），3例患者死于疾病（33%），1例患者带瘤生存（11%）。
联合治疗NSTGCT后残留或复发性肿瘤肿块中出现肉瘤、腺癌或两者皆有较为罕见。肿瘤肿块的完整手术切除是唯一的治愈性治疗选择。
