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  • My pathology report

    Hey all

    I got this electronically and don’t have an appointment for 10 days. From what I see, pure seminoma that was only on testes. I think this is great, no? Means no spread. Possibly adjuvant chemo because of rete testes?

    If you are familiar with these reports, pls let me know:
    ———-
    Tumor Size: Greatest dimension of main tumor mass in Centimeters (cm): 3.2

    Additional Dimension in Centimeters (cm): 2.5

    Additional Dimension in Centimeters (cm): 1.8

    Tumor Focality: Unifocal

    Tumor Extent

    Tumor Extension: Tumor limited to testis

    Accessory Findings

    Lymphovascular Invasion: Not identified

    MARGINS

    Spermatic Cord Margin: Uninvolved by tumor

    LYMPH NODES

    Regional Lymph Nodes: No lymph nodes submitted or found

    PATHOLOGIC STAGE CLASSIFICATION (PTNM, AJCC 8TTH EDITION)

    Primary Tumor (pT): pT1b: Tumor 3 cm or larger in size #

    Regional Lymph Nodes (pN): pNX: Regional lymph nodes cannot be assessed

    ADDITIONAL FINDINGS

    Additional Pathologic Findings: Germ cell neoplasia in situ (GCNIS)

    --------------------------------------------------------

    ELECTRONICALLY VERIFIED BY:Joan M. Sweet, MD

    jms/3/29/2019



    GROSS DESCRIPTION

    1. The specimen is labeled with the patient's name and as "right testicle and spermatic cord".



    Fixation: Received in 10% buffered formalin



    Resection specimen: Radical orchiectomy



    Overall measurements: 13.0 x 4.8 x 2.8 cm



    Tunica vaginalis: Intact and freely mobile



    Tunica albuginea: Intact with mild tan discoloration



    TESTIS:

    Measurements: 5.4 x 3.5 x 2.8 cm

    Parenchyma: The uninvolved parenchyma is unremarkable



    Epididymis:

    Measurement: 5.5 x 0.8 x 0.7 cm



    Spermatic cord:

    Length: 12.5 cm

    Diameter: Up to 2.8 cm

    Abnormalities: None



    TUMOUR:

    Number: 1

    Measurement(s): 3.2 x 2.5 x 1.8 cm

    Gross appearance: Well-demarcated, tan, firm and lobulated with focal stellate fibrosis

    Location: Testicular parenchyma

    Invasion of structures: Confined to the testicle with involvement of the rete testis



    Representative sections are submitted as follows:

    1A spermatic cord margin, en face

    1B mid spermatic cord

    1C-1G tumor (1C-1E includes involvement of rete testis)
    Last edited by BiotechieCanada; 03-30-19, 10:53 AM.

  • #2
    Hello- welcome to the club.

    I'll be happy to give you my "non-professional" opinion, but based on what I can see here is that with Pure-Seminoma, stage1B, no lymphovascular invasion, there's about an 80% chance that the surgery alone cured you. I would e-mail Dr. Einhorn if you want a professional opinion, which I always encourage, his e-mail is (leinhorn@iu.edu). My guess is that he will recommend surveilliance.

    My case was different to yours- I had a non-seminoma (more aggressive) and was stage 1, with no lymphovascular invasion. My tumor was about 2x the size of yours. I chose surveillance, and had 2 enlarged lymph nodes a year later. I did the RPLND, and then 2 rounds of chemo. I had a 5-year post-chemo CT earlier this week, and was given the 'all-clear'.

    If I could choose again? I would probably do the same thing. I feel there's a high chance you're already cured, and if you stick with your surveillance schedule, then anything that might still be lingering will be caught rather quickly, and eradicated with chemo. I think in your case, if you DO relapse, 3xBEP would be your go-to.

    Based on what I know from your story, and If I were in your shoes right now, I would choose surveillance. The reason is because you might already be cured, and if you were to discover sometime down the line that you aren't, first-line chemo should still give you a similar cure rate (well above 90%). Statistics aren't everything, but if you have the opportunity to avoid chemo, then why not?

    I would recommend doing adjuvant chemo if you're a worrier, and want the piece of mind that with would come with doing adjuvant chemo now, or if you feel you might not have access to routine check-ups for whatever reason later, and want to get whatever possible potential treatment out of the way. Either way, it looks like your prognosis is very good and the odds are that you are already cured.


    Originally posted by BiotechieCanada View Post
    Hey all

    I got this electronically and don’t have an appointment for 10 days. From what I see, pure seminoma that was only on testes. I think this is great, no? Means no spread. Possibly adjuvant chemo because of rete testes?

    If you are familiar with these reports, pls let me know:
    ———-

    Tumor Size: Greatest dimension of main tumor mass in Centimeters (cm): 3.2

    Tumor Extension: Tumor limited to testis


    Lymphovascular Invasion: Not identified

    --------------------------------------------------------

    TUMOUR:

    Number: 1

    Measurement(s): 3.2 x 2.5 x 1.8 cm

    Invasion of structures: Confined to the testicle with involvement of the rete testis
    6/28/13 - Diagnosed with TC
    7/02/13 - Left I/O
    Pre-I/O - AFP 232 | b-Hcg 276
    7/09/13 - CT scan CLEAN - negative for mets/lymph node enlargement
    7/28/13 - AFP 7 | b-Hcg <2
    7/30/13 - Pathology Result : pT1 NSGCT (15% EC , 10% Yolk Sac , 75% Immature Teratoma) no LVI/Epididymis/S.Cord involvement
    7/30/13 - Surveillance - Next CT + Blood in October 2013
    10/22/13 - AFP/HCG normal | CT Scan normal | 3-months all clear
    --Next Check-Up in February--

    Comment


    • #3
      Thanks for that! Exactly what I was thinking as well. I am a worrier, and need to know what the percentages of recurrence are if I choose adjuvant chemo vs just surveillance. I still need a CT which I’m getting in a week, but from the pathology report, I don’t see how it could have spread anywhere since it was limited to testes. Thanks again.

      Does Dr Einhorn reply to people? He must get so many inquiries!
      Last edited by BiotechieCanada; 03-30-19, 03:34 PM.

      Comment


      • #4
        Hello and sorry you have to join the club. I'm in similar situation, been reading a lot about statistics. Unfortunatelly, it is possible for TC to spread even it is just confined to testis. Actually, there is only small statistical difference between T1 and T4 regarding the possible spreading to lymph nodes, so your CT results will say as more. If CT will be ok, I'll say that you have ~10% chance of reccurence, give or take 2-3%. This is also important: "Additional Pathologic Findings: Germ cell neoplasia in situ (GCNIS)" - this is a cancer precursor that developed probably before you were born, and means that there is a slightly elevated chance of second primary on another testis sometime in the future. So, in my opinion, surveillance seems as a slightly better option in your case, no need to waste single dose of chemo now. But lets wait for CT.
        45yo, left I/O 07/30/2018, T1 pure seminoma, surveillance...
        Waiting...

        Comment


        • #5
          Well, just because pathology didn't find any evidence of spread, afraid you still need CT confirmation, because it does happen, even though it's kinda rare. I don't see anywhere in the report where it calls out the tumor type as seminoma? Did you leave that out somehow? If it is pure seminoma & if you get a clear CT, surveillance would be my first choice. If you are not comfortable with that, one dose of carboplatin is usually used for seminoma as adjuvant chemo.

          Dave
          Jan, 1975: Right I/O, followed by RPLND
          Dec, 2009: Left I/O, followed by 3xBEP

          Comment


          • #6
            Hi,

            Yes, I forgot the first line. Said histologic-Seminoma.

            Agreed, need the CT, but hopeful since margins in report looked good.

            What are negatives of doing 1 round of Carboplatin? I am a worrier by nature, and so if this dramatically reduces risk of recurrence, would be an attractive option for me.

            Comment


            • #7
              Any chemo has potential side effects, the biggest concern is an increase in odds of some other cancer down the road. That said most seem to get through it with relatively light problems & back to normal fairly quickly. Personally, I would avoid any chemo that wasn't needed to save my life, but that is me.

              Dave
              Jan, 1975: Right I/O, followed by RPLND
              Dec, 2009: Left I/O, followed by 3xBEP

              Comment


              • #8
                Was also curious about Phantom pain in the other testicle. Ultrasound 2 weeks ago showed normal. All good before surgery. Now after sugery, dull pain sometimes in remaining testicle. Phantom pain? Anxiety related? It was just checked 2 weeks ago so I know it cant be TC! Am 5 days post surgery.

                Comment


                • #9
                  My husband had stage 1 pure seminoma and chose surveillance, then a year later had a relapse on one lymph node. But it was caught early. The weird thing is that oncologist wants to do a biopsy first before chemo. Not sure if he’s having second thoughts about it being cancer. But we shall see. Surveillance avoids poisoning your body with unnecessary chemo. You might be cured with just the surgery, but if you want peace of mind then do the carboplatin or save the big guns for later.

                  Comment


                  • #10
                    Thanks Violet. I’m curious what the relapse % for pure Seminoma becomes if you take 1 round adjuvant carbo.

                    Comment


                    • #11
                      There are a ton of different studies out there on the effectiveness of adjuvant treatments. Here's the one my oncologist pointed me to: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3163197/

                      See table 3. There's newer studies for sure. This one doesn't address additional risk factors. There are some that do.
                      6/4/18 BHCG 452, AFP 1
                      6/13/18 CT Scan, no involvement beyond left testicle
                      6/18/18 Radical Left inguinal orchiectomy, Pathology pure seminoma, rete testis obliterated
                      6/29/18 BHCG 7, AFP 1.5 (calc 1.8 half-life)
                      7/12/18 BHCG<1, AFP 1.5, LDH 220, Diagnosed as Stage 1b, T3N0
                      7/25/18 Adjuvant Chemotherapy, 780mg Carboplatin
                      8/27/18 Chest CT Scan clear
                      9/7/18 BHCG<2, AFP 2.0, LDH 182 (Different lab w/diff ranges than initial tests)
                      9/26/18 MRI to review liver cysts for possible metastasis, all clear. No lymphadenopathy
                      11/23/18 CT Scan, "No evidence of residual or recurrent disease, no lymphadenopathy or evidence of metastasis"
                      11/27/18 BHCG<2, AFP 2.0, LDH 173

                      Comment


                      • #12
                        Originally posted by BiotechieCanada View Post
                        Hi,

                        Yes, I forgot the first line. Said histologic-Seminoma.

                        Agreed, need the CT, but hopeful since margins in report looked good.

                        What are negatives of doing 1 round of Carboplatin? I am a worrier by nature, and so if this dramatically reduces risk of recurrence, would be an attractive option for me.

                        Carboplatin I believe comes with much fewer side effects than BEP. With pure seminoma you also ha e radiation as an adjuvant option. I’m so envious of your choices as a mixed seminoma/EC guy myself!

                        Einhorn will respond. I’m sure he gets quite a few inquiries, but testicular cancer has so few cases each year nationwide in the US something like only 8,000. I imagine the vast majority of patients not on this forum or Reddit even know contacting him is possible. Most people just go with their doctor’s recommendation in all likelihood.

                        Comment


                        • #13
                          I contacted him and got a response. He said if my CT comes back clean he STRONGLY recommends surveillance. After I meet with my doc next week I will bring this up. I need to understand why adjuvant treatment now is not the best choice and then go from there.

                          Comment


                          • #14
                            Originally posted by BiotechieCanada View Post
                            I contacted him and got a response. He said if my CT comes back clean he STRONGLY recommends surveillance. After I meet with my doc next week I will bring this up. I need to understand why adjuvant treatment now is not the best choice and then go from there.
                            There is no wrong choice. Dr. Einhorn, from what I've noticed, usually recommends surveillance to people like yourself, whose cancer is very HIGHLY likely to have been removed and cured from the I/O surgery alone. He recommended surveillance for me as well, when I was first diagnosed with non-seminoma, and markers normalized after I/O + CT showed no evidence of metastasis. I took his advice, and relapsed after a year. Knowing what I know now, I can't say for certain, but I think I would've made the same choice.

                            I think he only recommends chemo if he feels its absolutely necessary, and usually doesn't recommend it in a 'what if?' , or 'just in case' type scenario. In the end it comes down to not subjecting yourself to these chemicals, when you might not need to, and might just be over-treating. I don't want to speak for him, but from my observation, he only wants to bring out the big guns if it becomes necessary.

                            Regardless, in the end, the only thing that matters is how YOU feel about it, and its always your decision. It's not like Dr. E would be upset or wouldn't understand if you decided to do adjuvant chemo now. He forms his opinions based on statistics and prognostic factors, and he's although he's a brilliant man, and a blessing for us to have, in this case it is your body and not his.
                            6/28/13 - Diagnosed with TC
                            7/02/13 - Left I/O
                            Pre-I/O - AFP 232 | b-Hcg 276
                            7/09/13 - CT scan CLEAN - negative for mets/lymph node enlargement
                            7/28/13 - AFP 7 | b-Hcg <2
                            7/30/13 - Pathology Result : pT1 NSGCT (15% EC , 10% Yolk Sac , 75% Immature Teratoma) no LVI/Epididymis/S.Cord involvement
                            7/30/13 - Surveillance - Next CT + Blood in October 2013
                            10/22/13 - AFP/HCG normal | CT Scan normal | 3-months all clear
                            --Next Check-Up in February--

                            Comment


                            • #15
                              Originally posted by BenceCali View Post
                              I think he only recommends chemo if he feels its absolutely necessary, and usually doesn't recommend it in a 'what if?' , or 'just in case' type scenario. In the end it comes down to not subjecting yourself to these chemicals, when you might not need to, and might just be over-treating. I don't want to speak for him, but from my observation, he only wants to bring out the big guns if it becomes necessary.
                              In my opinion that is exactly it. Eventual cure rates for those initially diagnosed with stage 1 are very high these days. So now they have moved on from curing those folks, to tuning just exactly how much chemo is involved and how folks are monitored to limit the amount of scan radiation. If they know that statistically only X percent of folks on Stage 1a/1b surveillance will relapse, they want to make sure that only X percent of those folks ever receive chemo. If X+Y percent folks do adjuvient chemo, that means that Y percent of folks were clinically over-treated with unnecessary chemo (even if it was of their own preference). They experts are trying their best to avoid that, and they know full well that with the monitoring in place, a relapse from stage 1 will be caught early enough that full chemo is highly likely to be curative.
                              6/5/15: bHCG 27,AFP 8.66, LDH 361, 5.6cm lymph node - Stage IIC
                              6/16/15: Left I/O 85% EC, 10% chorio, 5% yolk sac opinion 2 (mayo) 90% EC, 10% yolk sac
                              7/7/15: bHCG 56, AFP 42, LDH 322
                              7/13/15: begin 4xEP, end 9/18/15
                              10/1/15: bloodwork normal, ct scan shows 2 lymph nodes 1.0cm
                              10/26/15: 2nd opinion on CT results - lymph nodes normal. Surveillance!
                              4/6/16: 1.7cm X 1.5cm lymph node found with markers normal.
                              4/20/16: RPLND @ IU - teratoma only!
                              4/15/19: all clears up to this date!

                              Comment

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