Adult primary teratoma of the testis – report on 5 cases in clinical stage I disease

Abstract

Objectives:Testis pure teratoma accounts for 2.7% to 3% of all germcell tumors in adult where it behaves as a malignant neoplasm. Pureteratoma of the testis presents in clinicalstage I disease in 44% of thepatients whose risk of having pathologicalstage II disease is 16.7% to19.2%. Herein we report on 5 casesof adult pure teratoma of the testispresenting itself in clinical stage I disease.Materials and methods: From September 1976 to February 2000, 75patients underwent orchidectomy for clinical stage I nonseminomatous germcell cancer of the testis. Testis pure teratoma was detected in 5 patients(7%). Testis tumor markers wereevaluated in all cases. Patients underwentimaging examination to detect the clinical stage of the disease. Treatmentoptions after orchidectomy included retroperitoneal lymph node dissection(RPLND) in 4 patients and surveillance in 1.Results: The average age of the patients was 31 years (range 24–45).The tumor was on the left sided in 3 cases(60%) and right in 2 (40%).Tumor average size was 3.2 cm (rang 1–6).Histopathology detected thefollowing subtypes: mature teratoma in3 cases (60%), immature teratomain 1 (20%) and teratoma with malignanttransformation in (20%). Allpatients were at clinical stage I disease. Germ cell cancer microscopicmetastatic disease including embryonal carcinoma was detected in 1dissected lymph node of 1/4 patients (25%).Average follow up was 166months (range 93–249). All patients werealive and disease free and norelapses were detected during the follow up period.Conclusions: Primary pure teratoma of the testis does not respond tochemotherapy nor does it to radiation therapy. The disease treatmentoptions after orchidectomy for patients withclinical stage I disease includeRPLND or surveillance with their relativerisks and benefits. RPLND is thechosen treatment because it is both staging and treating. A close a longterm follow up is required since pure teratoma metastatic disease mayclinically develop after more than 10 years.