Teratoma with somatictype malignancy

Teratoma with somatic-type malignancy (malignant transformation) is characterized by the presence of malignant tissues of the type encountered in other organs and tissues, such as sarcoma of various types, particularly rhabdomyosarcoma and chondrosarcoma, as well as squamous carcinoma, adenocarcinoma, neuroblastoma, and primitive neuroectodermal tumors. The incidence of malignant transformation is approximately 3% to 6% in men undergoing PC-RPLND following induction or salvage chemotherapy and increases to 12% to 18% in men undergoing reoperative PC-RPLND and in those suffering later relapse [32-34]. Whereas there appears to be no difference in clinical outcome for men with mature and immature teratoma, the histologic finding of tera-toma with somatic-type malignancy has been associated with a poor prognosis [32,35,36]. Com-iter and colleagues [35] reported on 21 patients undergoing therapy for teratoma with somatic-type malignancy, and with a median follow-up of 50 months 17 of patients relapsed. Motzer and colleagues [32] reported on 46 patients with somatic-type malignancy managed with chemotherapy and/or surgical resection. With a median follow-up of 34 months, 25 remained disease free. Because teratoma with malignant transformation is generally resistant to standard chemotherapy, complete surgical resection, particularly of a solitary site, remains the treatment of choice. Donadio and colleagues [36] reported on 10 patients with somatic-type malignancy who received chemotherapy tailored to the histology of the malignant cell type. In this series, seven patients achieved a partial response to chemotherapy and three achieved durable long-term survival. Therefore, chemotherapy regimens should be administered based on the histology of the somatic-type malignancy, although prognosis is still guarded, and complete surgical resection remains of paramount importance.

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