Reporting of nonseminomatous germ cell tumor of the testis ... Discussion_Adenoid...Clinical History...
Transcript of Reporting of nonseminomatous germ cell tumor of the testis ... Discussion_Adenoid...Clinical History...
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Case Discussion
Miao Zhang, MD, PhD
Assistant Professor, Department of Pathology,
The University of Texas MD Anderson Cancer Center
Houston, TX
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Clinical History
• 64 yo African American male presented at 2005 with perineal pain. Initial MRI of the pelvis was normal.
• 2011, patient started to experience firmness at the base of the penis.
• 2013, a 4.1 x 2.6 x 1.6 cm lesion was seen on MRI.
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MRI At MDACC
Axial T2 weighted Coronal T2 weighted Sagittal T2 weighted
Urethral Mass: thick short arrows Urethra: long thin arrowProstate Gland: asterisk Rectum: arrowhead
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Cytokeratin 7
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p63
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CD117
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Biopsy Diagnosis
Basaloid carcinoma with salivary gland-like features
in fibromuscular tissue
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Case# Carpenter et al., Small et al., Hisamatsu et al., Trnski et al., Myers et al.,
Age (yo) 57 66 52 60 N/A
Surgical
Procedure
Excision Pelvic
exenteration
N/A Excision Pelvic
exenteration
Size (cm) 6 cm 3cm N/A N/A N/A
LVI N/A N/A N/A N/A N/A
LN
Involvement
N/A N/A N/A N/A N/A
Other
Treatment
Radiation Radiation Chemotherapy None Radiation,
Chemotherapy
targeted
therapy
Follow up 5y N/A 5y 6 month 7y
Outcome NED N/A NED NED AWD
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Complex Surgical Resection
Urethrectomy
Resection of pubic symphysis
Prostatectomy
Total penectomy
Anus and Rectum resection
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PenileUrethra
GlansPenis
Anus
Tumor
Rectum
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Urethral lumen
Tumor under pubic arch
Pubic Bone
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UrethraProstate gland
Prostate gland
Tumor
Rectum
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PSA
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Final diagnosis• Adenoid cystic carcinoma (3.7 cm), involving:
– membranous urethra, prostatic urethra, penile urethra, prostate gland, penile shaft (corpus spongiosum and corpora cavernosa), urogenital diaphragm, perianal soft tissue and muscular propria of rectum.
• Adenocystic carcinoma abutting soft tissue margin and prostate base margin.
• Prostatic adenocarcinoma, Gleason 9 ( 4+5 ), with 1/15 lymph node metastasis.
• Post-op radiation to the resection bed.
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18 month later, enlarging lung nodule
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Follow up
• CMS 400
• Clinical trials
• Now on Nivolumab—Anti-PD-1.
• PSA stable
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Case# Current case Carpenter et al., Small et al., Hisamatsu et
al.,
Trnski et
al.,
Myers et al.,
Age 73 57 66 52 60 N/A
Surgical
Procedure
Total penectomy,
urethrectomy,
resection of pubic
symphysis,
prostate, anus and
rectum.
Excision Pelvic
exenteration
N/A Excision Pelvic
exenteration
Size (cm) 3.7cm 6 cm 3cm N/A N/A N/A
LVI Not identified N/A N/A N/A N/A N/A
LN
Involvement
No N/A N/A N/A N/A N/A
Other
Treatment
Radiation Radiation Radiation Chemotherapy None Radiation,
Chemotherapy
and targeted
therapy
Follow up 40 month 5y N/A 5y 6 month 7y
Outcome AWD NED N/A NED NED AWD
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Summary• ACCs of the urethra/Cowper’s gland are rare
• Little is known about their prognosis and natural history
• Published cases suggest a slow growing malignancy
• Potential for long term survival, if aggressive therapeutic options are utilized
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Thank You
Questions?
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Follow-Up (See Notes)• Lung nodule (?months after surgery; ?when biopsy done• CMS 400• Clinical trials• ?No on Nivolimab—Anti-PD-1. • PSA stable
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Follow up
• CMS 400
• Clinical trials
• No on Nivolimab—Anti-PD-1.
• PSA stable
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Case# Carpenter et al., Small et al., Hisamatsu et
al.,
Trnski et
al.,
Myers et al.,
Age (yo) 57 66 52 60 N/A
Surgical
Procedure
Excision Pelvic
exenteration
N/A Excision Pelvic
exenteration
Size (cm) 6 cm 3cm N/A N/A N/A
LVI N/A N/A N/A N/A N/A
LN
Involvement
N/A N/A N/A N/A N/A
Other
Treatment
Radiation Radiation Chemotherapy None Radiation,
Chemotherapy,
targeted therapy
Follow up 5y N/A 5y 6 month 7y
Outcome NED N/A NED NED AWD
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• A firm area of induration over the right side of the pelvic floor, distal to the prostate, but also indistinguishable from the right side of the apex of the prostate.
• Biopsy
Rectal exam
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