Germ-cell tumours containing non germ-cell neoplasms: teratoma with malignant transformation

Objective: To evaluate the outcome of patients with non germ-cell neoplasms arising in germ-cell tumours [also designated teratoma with malignant transformation (TMT)]. Methods: The records of patients with TMT from three institutions were reviewed retrospectively. Results: 12 males were diagnosed as having TMT. All but 2 patients had a teratoma component in the primary tumour. Sarcoma was the most frequent histologic type of TMT, identified in 9 patients, with rhabdomyosarcoma ranking first among the subtypes (3/9). Other histological types included nephroblastoma and ependymoblastoma (1), adenocarcinoma (1) and bronchoalveolar carcinoma (1). All patients with advanced disease were treated with cisplatin-containing chemotherapy, followed by resection of residual masses in 5. Eight of the 10 patients who attained a complete remission subsequently relapsed. Histologically-adapted chemotherapy was administered to 7, of whom 3 obtained a partial response and 3 disease stabilisation. With a median follow-up of 5 years, 3 of 12 patients (25%) are alive and free of disease. Conclusions: TMT is a rare phenomenon occurring in a wide spectrum of histologic subtypes, the most common being sarcoma. Its poor prognosis compared with germ-cell tumours may be improved by histologically-adapted chemotherapy combined with optimal surgery.