358 Article
358 Article
358 Article
Open Access
CLINICAL RESEARCH IN ONCOLOGY
ABSTRACT
Objectives: There are only sporadic reports on the clinical behavior and appropriate treatment of
anaplastic seminoma. This retrospective study summarizes our experience with the anaplastic variant of
classical (typical) seminoma.
Methods: Between 1986 and 2006, seven anaplastic seminoma patients were staged and treated at the
Northern Israel Oncology Center. Staging procedures included meticulous physical and neurological
examinations, complete blood count, full biochemistry profile, specific tumor markers, testicular
ultrasound, and other radiological measures. All patients underwent inguinal orchiectomy and were staged
properly. Six patients had stage I disease, and one patient had stage IIA disease. Patients were irradiated
with doses ranging from 2,500 to 3,000 cGy, and the stage IIA patient received an additional 1,000 cGy
boost to radiographically involved lymph nodes.
Abbreviations: AFP, alpha fetoprotein; AS, anaplastic seminoma; B-HCG, beta-subunit of human chorionic
gonadotropin; CS, classical (typical) seminoma; CT, whole-body computerized scan; HPF, high-powered field; LDH,
lactate dehydrogenase; MSKCC, Memorial SloanKettering Cancer Center; NIOC, Northern Israel Oncology Center.
Citation: Stein ME, Zidan J, Charas T, Drumea K, Ben-Yosef R. Anaplastic Variant of Classical Seminoma of the Testis:
Northern Israel Oncology Center Experience and Brief Review of Literature. Rambam Maimonides Med J 2014;5
(1):e0006. doi:10.5041/RMMJ.10140
Copyright: 2014 Stein ME, et al. This is an open-access article. All its content, except where otherwise noted, is
distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.
Conflict of interest: No potential conflict of interest relevant to this article was reported.
* To whom correspondence should be addressed. E-mail: [email protected]
Results: After a mean follow-up of 11 years, six patients are alive with no evidence of disease. One patient
died due to an unknown, non-oncological, cause, unrelated to his previous testicular tumor, while in
complete remission.
Conclusions: Despite the low patient numbers and the retrospective nature of our study, it can be
concluded that radiotherapy treatment for early-stage anaplastic seminoma patients might achieve the same
excellent survival as for classical seminoma. However, the general consensus achieved through large-scale
studies suggests that active surveillance should be offered to all stage I seminoma patients, regardless of the
pathologic variant.
KEY WORDS: Anaplastic seminoma, early stage, good prognosis, radiotherapy
INTRODUCTION
At the present time, testicular seminomas are
commonly categorized into classical seminoma (CS),
and into the spermatocytic and anaplastic variants
of CS. Mostofi1 established the diagnosis of
anaplastic seminoma (AS) in tumors with overall
morphologic features of seminoma but with more
than three mitotic figures per high-powered field
(HPF), cellular irregularity, no fibrovascular septae,
few lymphocytes, focal necrosis, and pleomorphic
cells with non-clear cytoplasm. On the other hand,
Von Hochstetter2 suggested that, if mitotic activity
continues to be used in separating AS from CS, the
critical threshold should be elevated to six mitoses
per HPF. According to these criteria, AS constitutes
5%15% of testicular seminomas.3
RESULTS
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