Pathologic Subtypes (partial list)
- Germ Cell Tumors
- Seminoma
- Embyronal Carcinoma
- Yolk Sac Tumor
- Choriocarcinoma
- Teratoma: dermoid cyst, epidermoid cyst, etc
- Sex Cord/Gonadal Stromal Tumors
- Leydig Cell Tumor
- Sertoli Cell Tumor
- Granulosa Cell Tumor
- Thecoma
- Fibroma
- Other
- Gonadoblastoma
- Carcinoid
- Serous Carcinoma
- Mucinous Cystadenoma
- Mucinous Cystadenocarcinoma
- Brenner Tumor
- Nephroblastoma
- Paraganglionoma
Clinical
- Metastases to Lungs: hematogenous
- Epidemiology
- Lungs can appear as a first site of metastasis
- Lung is the only site of metastasis in 27% of cases
- Diagnosis
- CXR/Chest CT: lung nodule
- Clinical
Treatment
- Chemotherapy
- Residual masses after treatment: occur in 40% of cases with advanced disease and negative tumor markers
- 50% are necrotic tissue
- 25% are residual cancer (up to 50% are then cured by surgery)
- 25% are mature teratomas, that may grow (90% are then cured by surgery)
- Pulmonary Metastasectomy: indicated for patients with control of primary disease and lack of other pulmonary or non-pulmonary mets (mortality <2%/ morbidity: 10%)
- Prognostic Factors for Metastasectomy
- Number of resected mets: no difference (but all mets must be resected/ >50 can be resected at a time)
- Tumor aggressiveness: no association between disease-free interval (between diagnosis and occurrence of pulmonary mets) and survival (except in breast cancer), although tumor-doubling time <20 days has poorer outcome
- Type of malignancy: better outcome with malignancies that metastasize almost solely to lungs (sarcoma)
- Tumor chemo-responsiveness: no prognostic advantage/disadvantage
- Five-Year Survival after Metastasectomy (uncontrolled trials)
- Testicular/germ cell cancer: 50%
- Breast cancer: 36-45%
- Osteosarcoma: 25-50% (with resection of all lung mets)
- Soft tissue sarcoma: 20-35%
- Melanoma: 25%
- Renal cell cancer: 60%
- Colon/Rectal cancer: 45%
- Complications
- Persistent Air-Leak
- Infection: increased incidence with recent chemo pre-op
- ARDS: increased incidence with extensive use of chemo, XRT pre-op and high FiO2 post-op
References