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Imaging to differentiate teratoma and necrosis

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  • Imaging to differentiate teratoma and necrosis

    I thought this was interesting, as it seems that SOME sort of imaging should be able to detect the difference between teratoma and necrosis, which would prevent a lot of unnecessary RPLNDs.

    Eur J Nucl Med Mol Imaging. 2011 Feb;38(2):323-33. Epub 2010 Sep 30.
    αvβ3 imaging can accurately distinguish between mature teratoma and necrosis in 18F-FDG-negative residual masses after treatment of non-seminomatous testicular cancer: a preclinical study.
    Aide N, Briand M, Bohn P, Dutoit S, Lasnon C, Chasle J, Rouvet J, Modzelewski R, Vela A, Deslandes E, Vera P, Poulain L, Carreiras F.

    EA1772, IFR 146 ICORE, GRECAN, François Baclesse Cancer Centre and Caen University, Caen, France.

    We assessed whether imaging α(v)β(3) integrin could distinguish mature teratoma from necrosis in human non-seminomatous germ cell tumour (NSGCT) post-chemotherapy residual masses.

    Human embryonal carcinoma xenografts (six/rat) were untreated (controls) or treated to form mature teratomas with low-dose cisplatin and all-trans retinoic acid (ATRA) over a period of 8 weeks. In another group, necrosis was induced in xenografts with high-dose cisplatin plus etoposide (two cycles). (18)F-Fluorodeoxyglucose ((18)F-FDG) small animal positron emission tomography (SA PET) imaging was performed in three rats (one control and two treated for 4 and 8 weeks with cisplatin+ATRA). Imaging of α(v)β(3) expression was performed in six rats bearing mature teratomas and two rats with necrotic lesions on a microSPECT/CT device after injection of the tracer [(99m)Tc]HYNIC-RGD [6-hydrazinonicotinic acid conjugated to cyclo(Arg-Gly-Asp-D-Phe-Lys)]. Correlative immunohistochemistry studies of human and mouse α(v)β(3) expression were performed.

    Cisplatin+ATRA induced differentiation of the xenografts. After 8 weeks, some glandular structures and mesenchymal cells were visible; in contrast, control tumours showed undifferentiated tissues. SA PET imaging showed that mature teratoma had very low avidity for (18)F-FDG [mean standardised uptake value (SUV(mean)) = 0.48 ± 0.05] compared to untreated embryonal carcinoma (SUV(mean) = 0.92 ± 0.13) (p = 0.005). α(v)β(3) imaging accurately distinguished mature teratoma (tumour to muscle ratio = 4.29 ± 1.57) from necrosis (tumour to muscle ratio = 1.3 ± 0.26) (p = 0.0002). Immunohistochemistry studies showed that α(v)β(3) integrin expression was strong in the glandular structures of mature teratoma lesions and negative in host stroma.

    Imaging α(v)β(3) integrin accurately distinguished mature teratoma from necrosis following cisplatin-based treatment in human NSGCT xenografts.
    Nephew Will (19 years old)

    2-14-11 Left I/O; 50% EC, 40% teratoma; 10% yolk sac
    3-14-11: BEPx3
    4-18-11: Markers normalize
    6-13-11: IU pathology: 60% teratoma, 35% EC, 5% yolk sac
    7-7-11: left modified template nerve sparing RPLND at IU; 2/19 nodes with teratoma (2%), rest necrotic
    10-01-11: 1st post-RPLND TM ALL CLEAR
    12-01-11: 1st post-RPLND CT ALL CLEAR