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ORIGINAL ARTICLE

Pattern of Germ Cell Testicular Carcinoma in Dharmais


Cancer Hospital Between January 2000 – December 2004
Yenny Dian Andayani*, Syafrizal Safei**

ABSTRACT INTRODUCTION
Aim: to nd out the distribution of germ cell tumor based Carcinoma of the testis is rarely found, only about 1%
on age, histopathology, stadium, chemotherapy regimen, of male cancers, mostly affecting people between 15-34
and number of cases per year in patients hospitalized in years of age. Around 95% of testicular carcinoma germ
Dharmais National Cancer Hospital during the period of cell are tumors.1,2,3 In the last 40 years the incidence of
January 2000 to December 2004.
germ cell tumor in the world has increased more than
Methods: the data were collected from medical record
of patients with testicular carcinoma that were treated on twofold..3 The incidence varies according to geography,
inpatient and outpatient basis in Dharmais National Cancer where the highest rate being in Scandinavia, Germany,
Hospital during the period of January 2000 to December New Zealand at 8-10 in 100 000 population; moderate
2004. The data were collected, recorded and analyzed in being in the US (4-6 in 100 000); and lowest incidence
descriptive manner and presented in tables of distribution rate being in the African region (2 in 100 000). In the US,
and frequency. 2003, 8980 new cases were reported and 360 among them
Results: there were 44 cases testicular carcinoma being had died. In Hongkong, incidence rate of germ cell tumor
analyzed; 40 cases (90.92%) were germ cell tumor, 42.50 % was 0.78 per 100 000 population.4 The ratio of incidence
aged 21-30 years old; and the most frequent histological rate among whites and colored population was 5:1.1,2
type was seminoma (47.50%). About 39.50% of the patients
Germ cell tumor is classified as seminoma and
were admitted in stage II of the disease, and 61.59% were
put on BEP regimen. Seminoma type was more frequent in > non-seminoma, according to the origin of germ cell and
30-year-old age group while on the other hand, non-seminoma its ability to differentiate in vivo. Seminoma type usually
was mostly found in <30-year-old patients. There was a occurs in the fourth decade and one-and-a-half more
relative increase of germ cell tumor cases from January 2000 to frequent than non-seminoma, which usually occur in
December 2004 in Dharmais National Cancer Hospital. the third decade.3,5 Patients in early stage have better
Conclusion: germ cell tumors were the most common prognosis. The management of testicular carcinoma is
testicular carcinoma in Dharmais National Cancer Hospital based on its histological type, clinical staging and tumor
from January 2000 to December 2004. Most of the marker. Radiation is given in stage I, while cisplatin-
patients were of 21-30-year-old age group. Seminoma based chemotherapy is given in more advanced stage.6
type, particularly germ cell tumor, was more frequent than
Due to its rare nature, it is very interesting to elucidate the
non-seminoma. Most of the patients were admitted to the
hospital in the stage II of the disease and the most common distribution of germ cell tumor type of testicular
chemotherapy used were BEP regiment. There was an carcinoma based on age, histological type, stage of
increased number of germ cell tumor cases from January disease and therapy, and the number of annual cases
2000 to December 2004 in Dharmais National Cancer of patients being treated in Dharmais National Cancer
hospital. Hospital during January 2000-December 2004. The aim
of this study is to elucidate the distribution of germ
Key words: germ cell tumor, seminoma, non-seminoma. cell tumor type of testicular carcinoma based on age,
histological type, stage of disease and type of
therapy given to patients being treated in Dharmais
National Cancer Hospital Jakarta during January 2000-
* Department of Internal Medicine, Faculty of Medicine, Sriwijaya
University-Dr. Mohammad Hoesin Hospital, Jl. Jend. Sudirman,
December 2004 and to elucidate whether there is an
Palembang. E-mail: phtdi_plg@yahoo.co.id, ** Department of increased number of annual cases of germ cell tumor
Internal Medicine, Faculty of Medicine University of Indonesia-Dr. Cipto type of testicular carcinoma during January 2000-
Mangunkusumo Hospital-Dharmais Cancer Hospital, Jakarta.
December 2004.
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Yenny Dian Andayani, et al Acta Med Indones-Indones J Intern Med

METHODS
The study was a retrospective descriptive, where the
data were collected from the patients’ medical records
with established diagnosis of germ cell tumor type of
testicular carcinoma being treated in ambulatory-based
or inpatients in Dharmais National Cancer Hospital for
5 years during January 2000-December 2004. The data
contain age, histopathology diagnosis, stage of disease
during rst admission, the type of therapy given, and
the number of annual case. After all data were gathered,
they were analyzed and displayed in the form of tables,
depicting distribution and frequency.

RESULTS
From the study, there were 44 cases of testicular
carcinoma, with the most frequent histopathological
type being testicular germ cell tumor (90.92%). Most of
the patients belonged to age group of 21-30 years old
(42.50%). The number of germ cell tumor seminoma type
was 47.50%, non seminoma 40% and mixed germ cell
was 12,50%. Clinical staging was able to be dened in
only 38 patients, while 2 patients did not have complete
data which made staging not feasible. Most patients were
admitted in stage II of the disease (39.47%). There were
only 26 subjects with complete data on therapy, while the
other fourteen did not have enough data. Nine patients
(34.61%) were irradiated, 88.88% of them were in stage I
of the disease. Sixteen patients were given BEP regimen
chemotherapy (61.59%); 56.25% were in stage II, while The table 2 showed that there were 7 cases (36.84%)
43.75% were in stage III of the disease. of seminoma in <30-year-old age group and 12 cases
(63.16%) in >30-year-old age group. For non-seminoma
type, nine cases (56.25%) were in <30-year-old age
group and seven cases (43.75%) in >30-year-old age
group. While the number of mixed germ cell in <30-year-
old age group were 4 cases (80%) and only 1 case (20%)
belonged to >30-year-old age group.

Figure 1. Distribution of germ cell tumor incidence during January 2000-December


2004
DISCUSSION
Of the 44 cases of testicular carcinoma, germ cell
tumor was the most frequent histopathological type
Figure 1 showed the increase of annual incidence of (90.92%), followed by rhabdomyosarcoma (6.81%)
germ cell tumor cases during January 2000-December and testicular lymphoma (2.27%). Javeed and Bosl GC
2004. reported that 95% of testicular carcinoma were germ

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Vol 40 • Number 1 • January 2008 Pattern of Germ Cell Testicular Carcinoma in Dharmais Cancer Hospital

cell tumor. 3,6 In this study, there were increasing found in 30-39 years old, while 51% of non-seminoma
incidences of annual germ cell tumor cases in Dhar- were also found in the same age group.8 From the litera-
mais National Cancer Hospital during January 2000- ture, it was mentioned that non-seminoma occur mostly
December 2004. In England, 1400 new cases were in the third decade, while seminoma in fourth decade. The
reported each year, while in the US, 8980 new cases ten-year difference may be caused by the ability of non-
were reported in 2003 alone.2,7 seminoma to grow and spread more rapidly.1,3 Thus,
Most of the patients belonged to age group of 21-30 the result of this study is also in accordance with the
years (42.5%). Similar data were reported by Javeed, result of the other studies, reconrming that seminoma
Gospodarowicz and IGCCG (International Germ Cell cases were mostly found in the fourth decade, while
Consensus Classication), stating that germ cell tumor seminoma in the third decade of life.
was mostly found in younger age, 20-35 years old.6,8,10
The study showed that the most frequent subtype CONCLUSION
of germ cell tumor was seminoma (47.50%), followed The distribution pattern of testicular carcinoma
by non-seminoma (40%) and mixed germ cell (12.5%). patients hospitalized in Dharmais Cancer Hospital
Similar data were found in the study performed by Chan Jakarta between January 2000-December 2004 showed
ATC and Gospodarowic,4,10 while IGCCG reported germ cell tumor as the most common type, mostly
differently where non-seminoma encompassed 80% of between 21-30 years of age. Non-seminoma tumors are
germ cell tumor, while seminoma was 3% and mixed mostly found below 30 years of age, while seminoma
germ cell was 18%.8 tumors are most commonly found above age 30 years.
Most patients involved in the study were admited in Most patients seek medical help at stage II, while BEP
the hospital in stage II and III of the disease (65.79%), regimen is the most common type of chemotherapy
while those admitted in stage I were only 34.21%. The given.
numbers showed that many of the patients were delayed The number of identied germ cell tumor cases
in seeking treatment ensuing increased mortality rate. has increased between January 2000 and December
Dearnaly and Chan in their reports stated that 75% 2004.
of seminoma patients were admitted in stage I, 4,7
which showed high awareness of the patients to seek
treatment. REFERENCES
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