Presentation Authors: Adam Calaway*, Isamu Tachibana, Richard Foster, Timothy Masterson, Clint Cary, Indianapolis, IN
Introduction: Sex cord stromal tumors (Sertoli or Leydig Cell Tumors) are rare and indolent testicular neoplasms of low malignant potential. Orchiectomy alone is curative in upwards of 90% of men. Little is known regarding the best treatment approach for the rare patient presenting with or developing metastatic disease during surveillance. We sought to investigate the clinical history of patients with clinical stage II sex-cord stromal tumors who underwent RPLND at our institution.
Methods: Our prospectively maintained testicular cancer database was queried to identify patients who presented with or developed Clinical Stage II sex cord stromal tumors who underwent RPLND at our institution between 1980 and 2018. Demographic, clinical and pathological characteristics were reviewed. Kaplan-Meier curves were graphed to assess recurrence-free and overall survival.
Results: Fourteen patients were included in the study. The median age at diagnosis was 44.2 (range: 16-67). Four patients presented with Clinical Stage II disease and 10 developed metastatic disease during follow-up with a median time to metastasis of 2.7 years (range: 0.4-19.5 years). Of the 10 patients with orchiectomy pathology data available, all patients had at least 1 risk factor on testis pathology (mean: 2.9 risk factors). Prior to RPLND, 13 of the 14 patients had received prior to referral to our institution: 4 had undergone a RPLND, 5 had been treated with chemotherapy and 4 received radiation therapy._x000D_
All patients recurred post-operatively with a median recurrence-free survival of 9.8 months. The sites of recurrence were usually multifocal with spread within the retroperitoneum, peritoneal viscera, distant lymph nodes and the lungs. 12 of 14 patients died of disease with a median overall survival of 14.4 months. The two surviving patients are living with disease and on investigational therapies 24 and 46 months since the time of RPLND.
Conclusions: Stage II sex cord stromal tumors are rare; yet, if metastatic disease occurs, these tumors are refractory to all treatment modalities. Patients presenting with sex cord stromal tumors should consider prophylactic primary RPLND especially in the setting of any pathological predictor of malignancy.