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35 year old, Seminoma with, I believe, LVI

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  • 35 year old, Seminoma with, I believe, LVI

    Hi All,

    I first want to thank you all for the community here. I've been reading a lot of posts here since I discovered i have TC.

    I thought i had felt something a few months prior, but what it would come and go, and i could never really be sure if i felt something. I was going to a urologist for an unrelated issue and asked him to check the testicle as i thought i had felt something a few days earlier. I had always expected to feel some extra marble or pea sized lump. all i felt was a slight rid and that the density changed a little.

    Here is my timeline and results to date:
    9/2016 - Vasectomy
    6/9/17 - Initial visit with a urologist for issue unrelated (it think) to TC
    6/13/17 - Ultrasound detected a mass on left testicle
    6/9/17 - AFP - 4.5, HCG- <2
    6/22/17 - Left testicle I/O
    6/30/17 - received Pathology report results
    7/3/17 - Chest Xray and Abdominal/Pelvic CT
    7/10/17 - Consult at Mass General Hospital

    I received the Pathology Report back on and it lists the following:
    • Diagnosis
    • Left, Testis, Orchiectomy
      • Malignant germ cell tumor/seminoma
      • Intratubular germ cell neoplasia
    • Tumor size: 2.0 x 1.6 x 1.5 cm
    • Lymphatic Vascular Invasion: Present, rare
    • Necrosis: absent
    • Tunical Albuginea: Negative for Tumor
    • Rete Testis: Negative for Tumor
    • Epidydmis : Negative for Tumor
    • Surgical resection margins: Negative for Tumor
      • Vascular
        • Artery: Negative for Tumor
        • Vein: Negative for Tumor
      • Vas Deferens: Negative for Tumor
      • Tunica Albuginea: Negative for Tumor
    • pT2 NX MX (Definitions based on AJCC, 7th Edition, 2010)
    • Primary Tumor (T):
    • pT2 Tumor limited to the testis and epididymis with vascular/lymphatic invasion, or tumor extending through the tunica albuginea with involvement of the tunica vaginalis
    • Regional lymph nodes (N):
    • NX Lymph nodes cannot be assessed
    • Distant Metastasis (M)
    • MX Distant Metastasis cannot be assessed
    • NOTE: on immunostains, the tumor cells are positive for OCT 3/4, C-Kit, D2-40 and essentially negative for CD30, supporting the diagnosis
    • case reviewed inter departmentally
    There is more on the report, but i think the above captures what most of you would be interested in. I've bolded a few sections above that kind of jump off the page for me.

    My urologist went over the results with myself and my wife and made it sound as if the removal of the testicle was sufficient. He did not mention anything about the LVI and kept saying the margins were clear. So i'm wondering if i'm misinterpreting the above results, or if I should be more concerned about LVI and the potential spread to the Lymph nodes.

    I went for a chest X-ray today and got an abdominal/pelvic CT done as well. I have a second opinion consult scheduled at Mass General on the 10th. The plan as of right now is to see what they determine (slides are on their way there so they can review them). If their recommendation is chemo/RT, i'm planning to get another opinion from Dana-Farber.

    Curious to hear all of your thoughts and if i'm on the right path. I'll admit it seems like i have an easy path ahead compared to other types of TC, but the potential LVI has me concerned.
    Last edited by Uberfly; 07-03-17, 05:06 PM.

  • #2
    Hi,

    I'm not as familiar with seminoma but LVI adds more risk for relapse. The risk may be low enough that active surveillance is suitable for your case. The CT will show if there are metastasis.

    I asked some folks if there is some special skills required for LVI detection in TC (since it's relatively infrequent) but I hear that this is done for many types tumors.
    Last edited by mcintoda; 07-03-17, 10:04 PM.
    Age 31 - Portland, OR
    01NOV16- Pain in right testicle, palpable mass
    13NOV16- R I/O. Markers normal
    27NOV16- Stage Ia non-seminoma, 1.3cm, 100% EC, no LVI
    06DEC16 - CT scan clear
    09DEC16 - Started 1xBEP. Neutropenic at day 15; Worst part for me was bleo (allergic).
    03JAN17- Ended 1xBEP; start surveillance
    18MAR17-2nd pathology report shows 90% EC , 10% seminoma

    Comment


    • #3
      Originally posted by mcintoda View Post
      Hi,

      I'm not as familiar with seminoma but LVI adds more risk for relapse. The risk may be low enough that active surveillance is suitable for your case. The CT will show if there are metastasis.

      I asked some folks if there is some special skills required for LVI detection in TC (since it's relatively infrequent) but I hear that this is done for many types tumors.

      Overa I think you have

      LVI is not so much a risk factor for relapse in seminomas. Only for non-seminomas.
      Diagnosed at age 31. Treated in NYC. Now living in Ottawa, ON, Canada.

      7/1/2015: felt tiny lump on side of R testicle
      7/30/2015: Ultrasound shows 2 intra-testicular masses.
      7/31/2015: tumor markers normal, CXR clear
      8/5/2015: R orchiectomy
      8/11/2015: Pathology: 1.2 x 1.0 x 1.0 cm, embryonal 80%, seminoma 20%, with LVI and rete testis invasion
      8/14/2015: CT abdomen/pelvis clear, Stage 1b
      8/24/2015: started 1 x BEP

      Comment


      • #4
        Thank you both for the responses.

        RJKD, do you have any references for LVI not being as much of a risk in seminoma as opposed to non-seminoma?

        Comment


        • #5
          Sorry to wecome you here. Keep us updated.
          17 year old son Grant dx 12/21/16
          pre/o markers 12/21/16- HCG:1065.15,AFP:298.8,LDH:1119
          pre/o CT Scan 12/22/16 normal
          r/o 12/22/16
          Post r/o Elevated Markers with INCREASE 4 weeks post r/o;
          PATHLOGY: mixed maligent germ cell 8.6 x 6.2 x 5.9 cm

          -80% Embryonal, 10% Yolk Sac, 5% Teratoma, 5% Choriocarcinoma w/LVI within Spermatic Cord and invasion into Rete Testis
          2nd CT scan on 1/24/17 3 nodes 2 over 2.5, one over 3.5
          BEP x 3 1/27/17
          Post Chemo CT Scan on 3/28/17 still showed a few nodes over 2 cm
          2nd Post Chemo CT Scan on 4/27/17 showed all nodes still over 2cm
          Post Chemo RPLND 5/8/17: Periaortic Teratoma, Intraaorticaval Teratoma, and Paracaval Teratoma found.

          Comment


          • #6
            Originally posted by Uberfly View Post

            RJKD, do you have any references for LVI not being as much of a risk in seminoma as opposed to non-seminoma?
            Over the years many studies have been undertaken to look at prognostic risk factors for relapse with seminoma, such as: patient age, tumor size, rete testis invasion, vascular invasion, epididymis invasion, hCG level, tunica albuginea invasion

            To date, most experts would agree that no validated prognostic factors for recurrence of seminoma exist.

            For the longest time, rete testis invasion and tumor size > 4 cm were mostly used but as these factors were being validated really only size of the original tumor seems to significantly be associated with risk of relapse and even then the risk is only 25% at 8 cm.

            The way I would look at it is if my tumor was <4cm and the rete testis wasn't involved then I would be one at lowest risk of relapse for seminoma. If I had either of those factors then perhaps I would be at a higher risk of relapse but that data isn't perfect.

            There are a lot of publications out there but here is a fairly recent one from some top TC experts https://www.ncbi.nlm.nih.gov/pmc/art...40004-0155.pdf

            Mike
            Oct. 2005 felt lump but waited over 7 months.
            06.15.06 "You have Cancer"
            06.26.06 Left I/O
            06.29.06 Personal Cancer Diagnosis Date: Got my own pathology report from medical records.
            06.30.06 It's Official - Stage I Seminoma
            Surveillance...
            Founded the Testicular Cancer Society
            6.29.13 Summited Mt. Kilimanjaro for 7th Cancerversary

            Comment


            • #7
              Thank you Mike for the link.


              I heard back from the urologist that the pelvis/abdominal CT scan was good. there were a few mesentery nodes that they saw, but they didn't have concern over them.

              I plan to discuss this with the folks at MGH.

              Comment


              • #8
                let us know what they think
                17 year old son Grant dx 12/21/16
                pre/o markers 12/21/16- HCG:1065.15,AFP:298.8,LDH:1119
                pre/o CT Scan 12/22/16 normal
                r/o 12/22/16
                Post r/o Elevated Markers with INCREASE 4 weeks post r/o;
                PATHLOGY: mixed maligent germ cell 8.6 x 6.2 x 5.9 cm

                -80% Embryonal, 10% Yolk Sac, 5% Teratoma, 5% Choriocarcinoma w/LVI within Spermatic Cord and invasion into Rete Testis
                2nd CT scan on 1/24/17 3 nodes 2 over 2.5, one over 3.5
                BEP x 3 1/27/17
                Post Chemo CT Scan on 3/28/17 still showed a few nodes over 2 cm
                2nd Post Chemo CT Scan on 4/27/17 showed all nodes still over 2cm
                Post Chemo RPLND 5/8/17: Periaortic Teratoma, Intraaorticaval Teratoma, and Paracaval Teratoma found.

                Comment


                • #9
                  So everything at Mass General was great. Looks as thought their pathology department did not see any LVI, so they staged it at 1a.

                  They do not recommend radiation or chemo at this point, so it looks like active surveillance is the plan. I have a wife that will keep me honest with the required surveillance schedule. They also mentioned monitoring those mesentery nodes.

                  Thank you all again for the guidance that this site provides. the advice above for prognostic risk factors and recommended treatment guidelines was spot on.

                  Comment

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