title: Clinico-pathological outcomes of post- primary and salvage chemotherapy retroperitoneal lymph node dissection for mixed germ cell tumors, King Hussein Cancer Center experience.
abstract: OBJECTIVE
  We sought to characterize clinical and pathologic outcomes of advanced mixed germ cell tumors after retroperitoneal lymph node dissection for post-chemotherapy residual masses.
  
  
  METHODS
  Between January 2006 and November 2015, 56 patients underwent retroperitoneal lymph node dissection (RPLND) for residual masses of greater than 1 cm after receiving either primary chemotherapy or salvage chemotherapy. Retrospective review of the patients' characteristics, clinical, pathological, and treatment outcomes were performed after institutional review board (IRB) and ethics committee approval.
  
  
  RESULTS
  The mean age at diagnosis was 30 years. Ninety percent of the patients received 3-4 cycles of BEP (bleomycin/etoposide/cisplatin) as primary chemotherapy, and 29% of them salvage chemotherapy prior to lymph node dissection. The mean size of the residual masses after chemotherapy was 6 cm. The histological findings were necrosis in 30%, viable tumor in 34% and teratoma in 36% of the retroperitoneal masses. The mean time to relapse after RPLND was 11 months, out of 9 relapses, 6 were in the retroperitoneum, 1 in the lung and 1 in the kidney and 1 in the contralateral testicle.
  
  
  CONCLUSIONS
  Our results indicated higher incidence of viable germ cell tumor in the retroperitoneal residual masses after primary and salvage chemotherapy when compared with previously reported global incidence rates.
authors.affiliation: Department of Surgery and Urology, King Hussein Cancer Center, Amman, Jordan.
authors.forename: Kholoud
authors.initials: K
authors.lastname: Alqasem
authors.affiliation: Department of Surgery and Urology, King Hussein Cancer Center, Amman, Jordan.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Abukhiran
authors.affiliation: Department of Surgery and Urology, King Hussein Cancer Center, Amman, Jordan.
authors.forename: Judy
authors.initials: J
authors.lastname: Jasser
authors.affiliation: Department of Surgery and Urology, King Hussein Cancer Center, Amman, Jordan.
authors.forename: Tamer
authors.initials: T
authors.lastname: Bisharat
authors.affiliation: Department of Surgery and Urology, King Hussein Cancer Center, Amman, Jordan.
authors.forename: Riyad T
authors.initials: RT
authors.lastname: Ellati
authors.affiliation: Department of Surgery and Urology, King Hussein Cancer Center, Amman, Jordan.
authors.forename: Jakub
authors.initials: J
authors.lastname: Khzouz
authors.affiliation: Department of Surgery and Urology, King Hussein Cancer Center, Amman, Jordan.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Al-Saidi
authors.affiliation: Department of Surgery and Urology, King Hussein Cancer Center, Amman, Jordan.
authors.forename: Ali
authors.initials: A
authors.lastname: Al-Daghamin
keywords: Chemotherapy; lymph node dissection; mixed germ cell tumors; retroperitoneal