Clinical outcome after retroperitoneal lymphadenectomy of patients with pure testicular teratoma.

OBJECTIVES

To determine the pathologic findings and clinical outcome of patients with pure teratoma of the testis who underwent primary or postchemotherapy retroperitoneal lymphadenectomy (RPLND).

METHODS

From January 1989 to February 1998, 29 patients with pure testicular teratoma underwent primary (n = 11) or postchemotherapy (n = 18) RPLND.

RESULTS

Overall, 23 (79%) of 29 patients had retroperitoneal disease, with 18 (62%) initially presenting with advanced disease. The pathologic stage in the 11 patients undergoing primary RPLND was pN0 in 6 (55%), pN1 in 3 (27%), and pN2 in 2 (18%). Of the 7 patients with clinical Stage I undergoing primary RPLND, 1 had teratoma and 1 had seminoma in the retroperitoneum; of the 4 patients with clinical Stage IIA, 2 had teratoma and 1 had embryonal carcinoma. Four patients were lost to follow-up and the other seven had no evidence of disease (NED) at a median follow-up of 90.4 months, with no relapses. The pathologic findings in the 18 patients undergoing postchemotherapy RPLND revealed fibrosis in 8, teratoma in 9, and yolk sac tumor in 1. At last follow-up, 7 of the 9 patients with teratoma were NED, 1 was dead of disease, and 1 was dead of unknown causes. Of the 8 patients with fibrosis, 6 had NED and 2 were lost to follow-up. The patient with viable cancer had NED at last follow-up.

CONCLUSIONS

These data underscore the metastatic potential of pure testicular teratoma. A significant proportion (45%) of patients with low-stage pure testicular teratoma had retroperitoneal disease. Furthermore, a high proportion (62%) presented initially with advanced disease and demonstrated a considerable risk of relapse despite complete resection or favorable histologic features in the resected retroperitoneal specimen.