Cancer Res Treat.  2015 Oct;47(4):931-936. 10.4143/crt.2014.049.

Conventional Cisplatin-Based Combination Chemotherapy Is Effective in the Treatment of Metastatic Spermatocytic Seminoma with Extensive Rhabdomyosarcomatous Transformation

• Jeong Y
• Cheon J
• Kim TO
• Lim DH
• Lee S
• Cho YM
• Hong JH
• Lee JL

• KMID: 2403414
• DOI: http://doi.org/10.4143/crt.2014.049

Abstract

A 52-year-old man was presented with a huge left testicular mass and palpable cervical lymphadenopathy with retroperitoneal lymph node enlargement on an abdominal computed tomography. A left radical orchiectomy and an ultrasound-guided neck node biopsy were performed. A pathological examination revealed spermatocytic seminoma with extensive rhabdomyosarcomatous transformation, a condition known to be highly resistant to platinum-based chemotherapy. The patient received four cycles of etoposide, ifosfamide and cisplatin (VIP) chemotherapy. A repeat computed tomography revealed a substantial regression consistent with a partial response. Retroperitoneal lymph node dissection was attempted, which revealed rhabdomyosarcoma; however, complete microscopic resection was not achieved. After surgery, the residual abdominal lymph node progressed and salvage paclitaxel, ifosfamide and cisplatin (TIP) chemotherapy was employed, which again achieved a partial response. Here, we present a first case report of a spermatocytic seminoma with extensive rhabdomyosarcomatous transformation and multiple metastatic lymphadenopathies that showed a favorable response to platinum-based systemic chemotherapy.

Keyword

Seminoma; Drug therapy; Radiotherapy

MeSH Terms

Biopsy
Cisplatin
Drug Therapy
Drug Therapy, Combination*
Etoposide
Humans
Ifosfamide
Lymph Node Excision
Lymph Nodes
Lymphatic Diseases
Middle Aged
Neck
Orchiectomy
Paclitaxel
Radiotherapy
Rhabdomyosarcoma
Seminoma*
Cisplatin
Etoposide
Ifosfamide
Paclitaxel

Figure

• 

  Fig. 1. Testis in the study patient was replaced by a well-defined lobulated soft mass that extended to the tunica albicans and epididymis, with a yellowish-white color, smooth surface, focal hemorrhage, and necrosis.

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  Fig. 2. (A) Spermatocytic seminomatous component (H&E staining, ×400). (B) Undifferentiated spindle cell rhabdomyosarcomatous component exhibiting a marked pleomorphism and prominent nucleoli with abundant eosinophilic cytoplasm (H&E staining, ×400). (C) Seminomatous component, with tumor cells showing negativity for desmin (immunoperoxidase, ×400). (D) Sarcomatous component, with tumor cells showing strong positivity for desmin (immunoperoxidase, ×400).

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  Fig. 3. (A) The initial para-aortic lymph node size was about 11 cm (arrows). (B) After a first-line chemotherapy (VIP#4), the residual abdominal para-aortic lymph node size was about 3 cm (arrow). (C) Retroperitoneal lymph node involvement progressed. After a retroperitoneal lymphadenectomy (January 28, 2013), left para-aortic lymph node was about 4 cm in size (circle). (D) After the second-line chemotherapy (TIP#4), a deceased left para-aortic lymph node was seen (about 1.5 cm in size, circle) and the patient showed a near complete response. VIP, etoposide, ifosfamide and cisplatin; TIP, paclitaxel, ifosfamide and cisplatin.

Reference

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