Matthias Seehafer

[Solitary renal cell carcinoma metastasis to the thyroid gland--a paradigm of metastasectomy?].

Zusammenfassung Die Untersuchung dokumentiert den Stellenwert der Thyreoidektomie bei 10 Patienten mit solitärer Metastasierung eines Nierenzellkarzinoms. Bei fehlender postoperativer Morbidität und Mortalität konnte eine mittlere Überlebenszeit von 3,4 Jahren ermittelt werden.Vier Patienten entwickelten im weiteren Verlauf intrazerebrale Metastasen. Halsschwellung und der Befund eines intrathyreoidalen Knotens im Zustand nach Tumornephrektomie aufgrund eines Nierenzellkarzinoms muss an eine Metastase denken lassen, auch wenn eine lange Latenzzeit besteht. Mit immunhistochemischen Methoden kann stets eindeutig der Nachweis der Nierenzellkarzinommetastase geführt werden, wobei sich zur Abgrenzung vom primären follikulären Schilddrüsenkarzinom ein Panel aus TTF-1, Thyreoglobulin und CD 10 anbietet. Bei Solitärbefund ohne extrathyreoidale Tumormanifestation sollte immer eine R0-Resektion der Metastase angestrebt werden. Zur Verbesserung der Lebensqualität durch Verhinderung von Atemwegsobstruktionen sind bei Tumordissemination Palliativeingriffe und auch endoskopisch-interventionelle Verfahren (z.B. Trachealstent) gerechtfertigt.Abstract We investigated the usefulness of thyroidectomy for solitary metastases from renal cell carcinomas in ten patients. In the absence of postoperative morbidity and mortality, a mean survival time of 3.4 years was observed. Subsequently, four patients developed intracerebral metastases. Swelling of the neck and the discovery of a nodule in the thyroid of patients who have undergone nephrectomy for renal cell carcinoma should raise suspicion of a metastasis, possibly after a long latency period. With the aid of modern immunohistochemical methods, renal cell carcinoma metastasis can now be identified unequivocally, with differentiation from a primary follicular carcinoma of the thyroid rendered possible by a combination of TTF-1, thyroglobulin, and CD 10. In the event of a solitary lesion with no extrathyroidal tumour manifestation, an R0 resection of the metastasis should always be attempted. If tumour dissemination has occurred, palliative measures and endoscopic intervention (e.g. placement of an endotracheal stent) with the aim of improving quality of life by preventing obstruction of the airways are justified.

Metastasizing testicular germ-cell tumor with infiltration of the right heart: indication for primary metastasectomy

Cardiac intracavitary metastases are very uncommon. The case of a 42-year-old male patient with a testicular germ cell tumor extending into the superior caval vein, the left brachiocephalic vein, and the right heart, which manifested as a mild form of pulmonary embolization, is presented. Due to the perceived high risk of continuous embolization and the urgent need to begin systemic chemotherapy, a complete cardiac tumor resection was performed, utilizing a cardiopulmonary bypass, followed by a simultaneous orchiectomy. Histology revealed a 61-cm long vascular tumor as a metastasis of a yolk sac tumor originating from the left testis. There were no postoperative complications, and the patient is alive and without tumor recurrence 12 months after four cycles of systemic chemotherapy according to the PEB (cisplatin, etoposide, bleomycin) scheme. We conclude that in this special case aggressive surgical management following chemotherapy was very effective in controlling the disseminated testicular tumor.

Our experience with 23 consecutive patients on gemcitabine/carboplatin chemotherapy for treatment of metastasized transitional cell carcinoma of the urothelium.

Abstract  Aim:  To evaluate the activity and toxicity of gemcitabine plus carboplatin in patients with metastatic transitional cell carcinoma (TCC) of the urothelium.

Beidseitige testikuläre Raumforderungen im Rahmen des adrenogenitalen Syndroms

ZusammenfassungTestikuläre Raumforderungen in Verbindung mit dem adrenogenitalen Syndrom (AGS) stellen sowohl klinisch als auch pathologisch ein diagnostisches Problem dar. Die wichtigsten Differentialdiagnosen bilden hierbei der Leydig-Zelltumor und der benigne Tumor aufgrund der Ektopie adrenaler Zellen.Wir berichten von einem 14-jährigen Jungen mit AGS. Im Rahmen der Abklärung seiner Kleinwüchsigkeit und beidseitiger Raumforderungen der Hoden wurde ein 21-Hydroxylasemangel festgestellt. Palpatorisch waren die Hoden unempfindlich, fest und von knotiger Struktur. Die Serumspiegel des adrenokortikotropen Hormons (ACTH), des 17α-Hydroxyprogesterons (17α-OHP), des Testosterons und des Aldosterons waren erhöht. Unter Kortikosteroidtherapie kam es zu einer Normalisierung der Serummarker und zu einer Regression der testikulären Raumforderungen.Testikuläre Tumoren vergesellschaftet mit einem AGS treten typischerweise beidseitig auf und entwickeln sich durch fehlende oder inadäquate medikamentöse Therapie des AGS.AbstractTesticular masses in male individuals with the adrenogenital syndrome (AGS) are a clinical and pathological diagnostic dilemma. The major differential diagnosis of gonadal nodules in this setting includes interstitial Leydig cell tumors and secondary benign tumors possibly of adrenal origin.We report a case of adrenogenital syndrome occurring in a 14-year-old boy. Examinations to clarify the cause of his dwarfism and bilateral testicular masses revealed 21-hydroxylase deficiency. The testes were not tender and were firm and nodular on palpation. The serum levels of adrenocorticotrophic hormone (ACTH), 17 alpha-hydroxyprogesterone (17-alpha-OHP), testosterone, and aldosterone were found to be elevated. Under corticosteroid therapy the serum marker abnormalities were corrected and there was gradual regression of the tumor lesions in both testes.Testicular tumors with adrenogenital syndrome are typically bilateral and develop in untreated or inadequately treated males with AGS.

Diagnostic value of tumour marker regression models in stage 1 marker-positive testicular cancer.

The decay pattern and half-life period evaluation of serum tumour markers are useful parameters in the management of testicular cancer in clinic stage 1. α-Fetoprotein and human chorionic gonadotropin serum levels measured after orchiectomy can be used to predict the tumour stage. However, the optimal strategy for marker analysis after orchiectomy has not yet been defined. In this article we describe a graphic interactive method which uses tumour marker clearance to help identify patients with occult metastases after orchiectomy.