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Tenuta M, Mazzotta P, Sesti F, Angelini F, Gelibter AJ, Speranza I, Paoli D, Lombardo F, Anzuini A, Magliocca FM, Franco G, Cortesi E, Santini D, Lenzi A, Gianfrilli D, Isidori AM, Pozza C. Testicular ultrasonographic features predict future risk for bilateral testicular germ cell tumour: A long-term single centre follow-up study. Andrology 2024. [PMID: 39078248 DOI: 10.1111/andr.13704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 07/01/2024] [Accepted: 07/05/2024] [Indexed: 07/31/2024]
Abstract
BACKGROUND Bilateral testicular germ cell tumours (B-GCT) are rare, with an incidence of 2-5%, and can be classified as synchronous (sB-GCT) or metachronous (mB-GCT). Our study aimed to identify clinical, biochemical, and radiological risk factors for mB-GCT in a cohort of patients with GCT at a single tertiary referral centre. METHODS This retrospective case-control study included patients with GCT referred to Policlinico Umberto I-Sapienza University of Rome, from 2005 to 2023. We evaluated clinical history, testicular ultrasound features, hormone levels, semen analysis, histological characteristics, staging, and treatments. mB-GCTs were compared with unilateral GCT patients with a follow-up longer than the median time-to-onset of the second tumour. RESULTS Of 319 patients, 52 experienced B-GCT, with a median time-to-onset of the second tumour of 62 months (range: 8-229). The mB-GCT group showed higher gonadotropin levels (FSH 13.6mUI/mL vs. 7.4mUI/mL, p < 0.001; LH 6.6mUI/mL vs. 3.9mUI/mL, p = 0.004), lower sperm concentration (27 × 106/ejaculate vs. 78 × 106/ejaculate, p = 0.009), smaller residual testis volume (10.4 mL vs. 16.3 mL, p < 0.001), more inhomogeneous echotexture [57.5% vs. 14%, p < 0.001], and presence of microlithiasis (75% vs. 19.5%, p < 0.001). Kaplan-Meier curves confirmed that ultrasound features of the residual testis increased the cumulative risk of developing a second tumour. Microlithiasis was a strong independent predictor (OR 30.712, 95% CI 3.357-280.942, p = 0.002). CONCLUSIONS Histological features of the first tumour or its treatment do not influence the onset of a second tumour. However, low residual testis volume, inhomogeneous echotexture, and microlithiasis significantly increase this risk. A comprehensive evaluation of the residual testis at baseline is essential for developing a personalised surveillance programme in GCT survivors, with regular ultrasound follow-up recommended beyond the conventional 5-year limit.
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Affiliation(s)
- Marta Tenuta
- Division of Endocrinology and Andrology, Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Paola Mazzotta
- Division of Endocrinology and Andrology, Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Franz Sesti
- Division of Endocrinology and Andrology, Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Francesco Angelini
- Division of Endocrinology and Andrology, Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Alain J Gelibter
- Division of Oncology B, Department of Radiological, Oncological and Anatomopathological Sciences, Sapienza University, Rome, Italy
| | - Iolanda Speranza
- Division of Oncology A, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
| | - Donatella Paoli
- Division of Endocrinology and Andrology, Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Francesco Lombardo
- Division of Endocrinology and Andrology, Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Antonella Anzuini
- Division of Endocrinology and Andrology, Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Fabio Massimo Magliocca
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University, Rome, Italy
| | - Giorgio Franco
- Department of Maternal and Child Health and Urological Sciences, Sapienza University, Rome, Italy
| | - Enrico Cortesi
- Division of Oncology B, Department of Radiological, Oncological and Anatomopathological Sciences, Sapienza University, Rome, Italy
| | - Daniele Santini
- Division of Oncology A, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
| | - Andrea Lenzi
- Division of Endocrinology and Andrology, Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Daniele Gianfrilli
- Division of Endocrinology and Andrology, Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Andrea M Isidori
- Division of Endocrinology and Andrology, Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Carlotta Pozza
- Division of Endocrinology and Andrology, Department of Experimental Medicine, Sapienza University, Rome, Italy
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Azik H, Omri N, Kamil M, Miki H, Shay G, Roy M, Yuval F, Barak R, Ben S, Yariv S, Reuven BD, Gilad AE. Analysis of clinical characteristics, treatment patterns, and outcome of patients with bilateral testicular germ cell tumors. Discov Oncol 2024; 15:30. [PMID: 38321336 PMCID: PMC10847073 DOI: 10.1007/s12672-024-00874-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 01/24/2024] [Indexed: 02/08/2024] Open
Abstract
INTRODUCTION Bilateral testicular germ cell tumor (BGCT) is a rare disease, occasionally considered to be more aggressive than unilateral germ cell tumors (GCT) in some reports. Among BGCT, a synchronous disease might be diagnosed at a higher stage than a metachronous disease, resulting in lower cancer-specific survival. Hence, our study aimed to perform a comparative analysis between unilateral testicular GCT, bilateral synchronous GCT, and bilateral metachronous GCT, aiming to verify the possibility that BGCT is diagnosed with a higher stage and may require more aggressive management. MATERIAL AND METHODS In our multicenter retrospective study we reviewed medical records of 40 patients with BGCT (24 metachronous and 16 synchronous). Clinical characteristics, pathological features of the primary and secondary tumors, adjuvant treatments (chemotherapy and radiotherapy)and sperm quality were evaluated as well as cancer-specific survival and overall survival. A cohort of one-to-one matched patients with unilateral GCT were used to determine risk factors for developing BGCT. RESULTS Patients with BGCT were slightly younger compared to those with unilateral GCT and had more advanced disease. Despite similar T-stage distribution between the two groups, nodal involvement was nearly twofold more frequent in patients with BGCT disease (42% vs 22%, p = 0.056). Additionally, although similar histological subtypes distribution at presentation among the two groups, the synchronous disease was diagnosed with a higher local T-stage (OR = 3.4), higher proportions of patients with elevated serum BHCG levels, and more frequent nodal involvement (OR = 2.2). This was later translated into an 18% higher disease-specific mortality rate. The median time to develop a contralateral tumor was 92 months. Pathological local T-stage (T2-T3) of the primary tumor predicted a shorter time interval to a diagnosis of a second contralateral tumor (HR 0.92, P < 0.05). CONCLUSION BGCT presents at a younger age and potentially with more advanced disease. Synchronous BGCT is diagnosed at a later stage compared to metachronous BGCT and has higher disease-specific mortality. Metachronous tumors might have a long time interval for the development of a contralateral neoplasm. The main predictor of developing an early metachronous disease is a high primary T stage.
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Affiliation(s)
- Hoffman Azik
- Urology Department, Rambam Health Care Campus, Haifa, Israel.
- Israeli Uro-Oncology Consortium, Tel Aviv, Israel.
| | - Nativ Omri
- Urology Department, Rambam Health Care Campus, Haifa, Israel
| | - Malshy Kamil
- Urology Department, Rambam Health Care Campus, Haifa, Israel
| | - Haifler Miki
- Israeli Uro-Oncology Consortium, Tel Aviv, Israel
- Urology Department, Sheba Medical Center, Ramat Gan, Israel
| | - Golan Shay
- Israeli Uro-Oncology Consortium, Tel Aviv, Israel
- Urology Department, Rabin Medical Center, Pethach Tikva, Israel
| | - Mano Roy
- Israeli Uro-Oncology Consortium, Tel Aviv, Israel
- Urology Department, Sourasky Medical Center, Tel Aviv, Israel
| | - Freifeld Yuval
- Israeli Uro-Oncology Consortium, Tel Aviv, Israel
- Urology Department, Carmel Medical Center, Haifa, Israel
| | - Rosenzweig Barak
- Israeli Uro-Oncology Consortium, Tel Aviv, Israel
- Urology Department, Sheba Medical Center, Ramat Gan, Israel
| | - Shalom Ben
- Urology Department, Sheba Medical Center, Ramat Gan, Israel
| | - Stabholz Yariv
- Urology Department, Sourasky Medical Center, Tel Aviv, Israel
| | | | - Amiel E Gilad
- Urology Department, Rambam Health Care Campus, Haifa, Israel
- Israeli Uro-Oncology Consortium, Tel Aviv, Israel
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3
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Hu Z, Yan X, Dai J, Li Y, Lu M. Contrast-enhanced ultrasound in the diagnosis of a solitary neck mass: a case report of metastatic seminoma. J Int Med Res 2022; 50:3000605221135482. [DOI: 10.1177/03000605221135482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Seminoma accounting for approximately 98% of malignant testicular tumours and it typically presents as a painless, palpable solid mass in the testis. Seminomas presenting only as a solitary neck mass are very rare. This case report describes a previously healthy 35-year-old male that presented with a 3-month history of the incidental discovery of a mass in his right neck. He had no testicular symptoms. He underwent neck ultrasound, contrast-enhanced ultrasound, computed tomography and positron emission tomography. Serum human chorionic gonadotropin (3.90 mIU/ml) was raised and alpha-fetoprotein (3.79 ng/ml) was within normal limits. Clinical examination and imaging examinations did not find any suspicious signs of testicular cancer. Biopsy from the neck mass confirmed the diagnosis of metastatic seminoma. The case report presents the ultrasound and contrast-enhanced ultrasound characteristics of seminoma and provides an update of the literature regarding this very rare metastatic site for seminomas.
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Affiliation(s)
- Ziyue Hu
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Centre, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Xiang Yan
- Department of Ultrasound, North Sichuan Medical College, Nanchong, Sichuan Province, China
| | - Jiulong Dai
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Centre, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Yanjie Li
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Centre, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Man Lu
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Centre, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
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4
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Symeonidis EN, Tsifountoudis I, Anastasiadis A, Mutomba WF, Kotakidou R, Hatzichristou D, Dimitriadis F. Synchronous bilateral testicular cancer with discordant histopathology occurring in a 20-year-old patient: A case report and review of the literature. Urologia 2021:3915603211028556. [PMID: 34219574 DOI: 10.1177/03915603211028556] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Bilateral testicular tumors are very rare, accounting for 1%-5% of all testicular germ-cell tumors (TGCTs). The vast majority of primary bilateral TGCTs are metachronous, with synchronous tumors comprising approximately 0.5%-1% of all cases. Those occurring synchronously share mostly the same histological pattern, predominantly seminoma, with synchronous bilateral TGCTs (SBTGCTs) with discordant subtypes being extremely rare. CASE PRESENTATION We present the case of a 20-year-old male complaining of a palpable painless right testicular mass incidentally noticed during sexual intercourse. Ultrasonography (US) and magnetic resonance imaging (MRI) of the scrotum demonstrated bilateral testicular lesions, while staging with contrast-enhanced computed tomography (CT) exhibited normal findings. Right radical orchiectomy and left testis-sparing surgery (TSS) with concomitant onco-testicular sperm extraction (onco-TESE) were initially performed. Histology of the right testis revealed a mixed germ-cell tumor, consisting of seminoma and embryonal carcinoma, while that from the left testis disclosed embryonal carcinoma and intratubular germ-cell neoplasia unclassified (IGCNU) infiltrating the surgical margins. Hence, left orchiectomy was subsequently scheduled with histology unveiling IGCNU in the greatest part of the remaining testicular parenchyma. Following adjuvant chemotherapy, with bleomycin, etoposide, and cisplatin (BEP), the patient received testosterone replacement therapy and remained free of recurrence at an 18-month follow-up. CONCLUSION This case highlights both the rarity of a bilateral testicular tumor's synchronous appearance and its extremely infrequent discordant histopathology. A comprehensive review of the major series of SBTGCTs with discordant histology cited in the literature is additionally presented.
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Affiliation(s)
- Evangelos N Symeonidis
- Department of Urology I, Aristotle University of Thessaloniki, "G. Gennimatas" General Hospital, Thessaloniki, Greece
| | - Ioannis Tsifountoudis
- Department of Radiology, 424 General Military Hospital of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Anastasiadis
- Department of Urology I, Aristotle University of Thessaloniki, "G. Gennimatas" General Hospital, Thessaloniki, Greece
| | - Wilbert F Mutomba
- Department of Urology I, Aristotle University of Thessaloniki, "G. Gennimatas" General Hospital, Thessaloniki, Greece
| | - Rodoula Kotakidou
- Department of Pathology, "G. Gennimatas" General Hospital, Thessaloniki, Greece
| | - Dimitrios Hatzichristou
- Department of Urology I, Aristotle University of Thessaloniki, "G. Gennimatas" General Hospital, Thessaloniki, Greece
| | - Fotios Dimitriadis
- Department of Urology I, Aristotle University of Thessaloniki, "G. Gennimatas" General Hospital, Thessaloniki, Greece
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5
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Blok JM, Groot HJ, Huele EH, de Wit R, Horenblas S, Nuver J, Groenewegen G, Bosch JR, Witjes JA, Tromp JM, de Brouwer PJ, van den Berg HA, Vanneste BG, Smilde TJ, Aarts MJ, Gietema JA, Meijer RP, Schaapveld M. Dose-Dependent Effect of Platinum-Based Chemotherapy on the Risk of Metachronous Contralateral Testicular Cancer. J Clin Oncol 2021; 39:319-327. [DOI: 10.1200/jco.20.02352] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patients with testicular germ cell tumor (TGCT) are at increased risk of developing a contralateral TGCT (CTGCT). Although some studies suggest that prior treatment with platinum-based chemotherapy affects CTGCT risk, a relationship between CTGCT risk and platinum dose has not previously been assessed. We analyzed the association between the number of platinum-based chemotherapy cycles and CTGCT risk. PATIENTS AND METHODS The risk of developing a metachronous CTGCT was evaluated in a nationwide cohort of 4,755 patients diagnosed with primary TGCT in the Netherlands between 1989 and 2007. Standardized incidence ratios were computed to compare CTGCT incidence with expected TGCT on the basis of TGCT incidence in the general population. The cumulative incidence of CTGCT was estimated in the presence of death as competing risk. The effect of treatment with platinum-based chemotherapy on CTGCT risk was assessed using multivariable Cox proportional hazards regression models. RESULTS CTGCT was diagnosed in 136 patients (standardized incidence ratio, 14.6; 95% CI, 12.2 to 17.2). The cumulative incidence increased up to 20 years after primary diagnosis, reaching 3.4% (95% CI, 2.8% to 4.0%) after 20 years of follow up. The risk of developing a CTGCT decreased with age (hazard ratio [HR], 0.93; 95% CI, 0.90 to 0.96), was lower after nonseminomatous germ cell tumor (HR, 0.58; 95% CI, 0.35 to 0.96) and decreased with every additional cycle of chemotherapy (HRper cycle, 0.74; 95% CI, 0.64 to 0.85). CONCLUSION Approximately one in every 30 survivors of TGCT will develop a CTGCT, with CTGCT incidence increasing up to 20 years after a primary TGCT. Treatment with platinum-based chemotherapy shows a dose-dependent inverse association with CTGCT risk.
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Affiliation(s)
- Joost M. Blok
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Harmke J. Groot
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Eline H. Huele
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ronald de Wit
- Department of Medical Oncology, Erasmus University Hospital, Rotterdam, the Netherlands
| | - Simon Horenblas
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Janine Nuver
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Gerard Groenewegen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J.L.H. Ruud Bosch
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J. Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jacqueline M. Tromp
- Department of Medical Oncology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Peter J.M. de Brouwer
- Department of Radiation Oncology, Dr Bernard Verbeeten Institute, Tilburg, the Netherlands
| | | | - Ben G.L. Vanneste
- Department of Radiation Oncology, MAASTRO-clinic, Maastricht, the Netherlands
| | - Tineke J. Smilde
- Department of Medical Oncology, Jeroen Bosch Hospital, ’s-Hertogenbosch, the Netherlands
| | - Maureen J.B. Aarts
- Department of Medical Oncology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Jourik A. Gietema
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Richard P. Meijer
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Michael Schaapveld
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
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6
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Hellesnes R, Myklebust TÅ, Bremnes RM, Karlsdottir Á, Kvammen Ø, Negaard HFS, Tandstad T, Wilsgaard T, Fosså SD, Haugnes HS. Metachronous Contralateral Testicular Cancer in the Cisplatin Era: A Population-Based Cohort Study. J Clin Oncol 2020; 39:308-318. [PMID: 33356420 DOI: 10.1200/jco.20.02713] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE It is hypothesized that cisplatin-based chemotherapy (CBCT) reduces the occurrence of metachronous contralateral (second) germ cell testicular cancer (TC). However, studies including treatment details are lacking. The aim of this study was to assess the second TC risk, emphasizing the impact of previous TC treatment. PATIENTS AND METHODS Based on the Cancer Registry of Norway, 5,620 men were diagnosed with first TC between 1980 and 2009. Treatment data regarding TC were retrieved from medical records. Cumulative incidences of second TC were estimated, and standardized incidence ratios were calculated. The effect of treatment intensity was investigated using Cox proportional hazard regression. RESULTS Median follow-up was 18.0 years, during which 218 men were diagnosed with a second TC after median 6.2 years. Overall, the 20-year crude cumulative incidence was 4.0% (95% CI, 3.5 to 4.6), with lower incidence after chemotherapy (CT) (3.2%; 95% CI, 2.5 to 4.0) than after surgery only (5.4%; 95% CI, 4.2 to 6.8). The second TC incidence was also lower for those age ≥ 30 years (2.8%; 95% CI, 2.3 to 3.4) at first TC diagnosis than those age < 30 years (6.0%; 95% CI, 5.0 to 7.1). Overall, the second TC risk was 13-fold higher compared with the risk of developing TC in the general male population (standardized incidence ratio, 13.1; 95% CI, 11.5 to 15.0). With surgery only as reference, treatment with CT significantly reduced the second TC risk (hazard ratio [HR], 0.55). For each additional CBCT cycle administered, the second TC risk decreased significantly after three, four, and more than four cycles (HRs, 0.53, 0.41, and 0.21, respectively). CONCLUSION Age at first TC diagnosis and treatment intensity influenced the second TC risk, with significantly reduced risks after more than two CBCT cycles.
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Affiliation(s)
- Ragnhild Hellesnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Tor Åge Myklebust
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway.,Department of Registration, Cancer Registry of Norway, Oslo, Norway
| | - Roy M Bremnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Ása Karlsdottir
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - Øivind Kvammen
- Department of Oncology, Ålesund Hospital, Ålesund, Norway
| | | | - Torgrim Tandstad
- The Cancer Clinic, St. Olav's University Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, The Norwegian University of Science and Technology, Trondheim, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Sophie D Fosså
- Department of Registration, Cancer Registry of Norway, Oslo, Norway.,Department of Oncology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hege S Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
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7
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Abstract
Testicular cancer is responsible for approximately 0.1% of all cancer deaths in the USA, and seminoma is the most common type of testicular tumor. Ultrasonography is the primary imaging modality for accessing testicular and extratesticular lesions, while magnetic resonance imaging can be used for problem solving in lesion characterization in certain cases. CT imaging is usually performed for retroperitoneal staging of testicular cancer metastasis and follow-up after treatment. Extratesticular masses are common, yet rarely malignant. Imaging plays an important role in primary diagnosis of testicular cancer and differentiating it from common non-neoplastic findings. The purpose of this article is to review various imaging findings in testicular and extratesticular masses.
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8
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Sener TE, Ozveren B, Tinay I, Cam K, Turkeri L. Clinical Case Discussion: Bilateral Synchronous Testicular Cancer and Organ-sparing Surgery. Eur Urol Focus 2018; 4:737-739. [DOI: 10.1016/j.euf.2016.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 08/05/2016] [Indexed: 10/21/2022]
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9
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Marko J, Wolfman DJ, Aubin AL, Sesterhenn IA. Testicular Seminoma and Its Mimics: From the Radiologic Pathology Archives. Radiographics 2017; 37:1085-1098. [PMID: 28574809 DOI: 10.1148/rg.2017160164] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Testicular seminoma is the most common malignant tumor of the testis. It classically manifests as a painless mass. Radiologic evaluation with high-frequency ultrasonography (US) is critical for diagnosis. Seminomas are usually homogeneously hypoechoic masses at US. In challenging cases, magnetic resonance (MR) imaging may help confirm that a mass is intratesticular and provide data for local staging. Computed tomography (CT) provides valuable information for staging, including the presence and size of retroperitoneal lymph nodes. Testicular seminoma is treated with radical inguinal orchiectomy and is highly curable even at advanced stages of disease. Several neoplastic and nonneoplastic conditions may mimic testicular seminoma at imaging. Benign mimics include segmental infarction, hematoma, infection, epidermoid cyst, adrenal rests, sarcoidosis, splenogonadal fusion, and sex cord-stromal tumors. Malignant mimics include nonseminomatous germ cell tumors, lymphoma, and metastases. These conditions are individually reviewed with emphasis on features that allow differentiation from seminoma. Spermatocytic tumor, formerly known as spermatocytic seminoma, accounts for only 1% of testicular tumors. It is distinct from classic seminoma, with unique histologic, molecular, and genetic features. It affects an older patient population than classic seminoma and demonstrates indolent clinical behavior. Radiologists serve a key role in diagnosis, staging, and surveillance of patients with seminoma. A thorough knowledge of related clinical, radiologic, and pathologic findings will help the radiologist contribute to high-quality interdisciplinary care of affected patients.
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Affiliation(s)
- Jamie Marko
- From the Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (J.M.); American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1020, Silver Spring, MD 20910 (J.M., D.J.W.); Department of Radiology, Johns Hopkins School of Medicine, Washington, DC (D.J.W., A.L.A.); and Joint Pathology Center, Silver Spring, Md (I.A.S.)
| | - Darcy J Wolfman
- From the Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (J.M.); American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1020, Silver Spring, MD 20910 (J.M., D.J.W.); Department of Radiology, Johns Hopkins School of Medicine, Washington, DC (D.J.W., A.L.A.); and Joint Pathology Center, Silver Spring, Md (I.A.S.)
| | - Alex L Aubin
- From the Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (J.M.); American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1020, Silver Spring, MD 20910 (J.M., D.J.W.); Department of Radiology, Johns Hopkins School of Medicine, Washington, DC (D.J.W., A.L.A.); and Joint Pathology Center, Silver Spring, Md (I.A.S.)
| | - Isabell A Sesterhenn
- From the Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (J.M.); American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1020, Silver Spring, MD 20910 (J.M., D.J.W.); Department of Radiology, Johns Hopkins School of Medicine, Washington, DC (D.J.W., A.L.A.); and Joint Pathology Center, Silver Spring, Md (I.A.S.)
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10
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Synchronous bilateral testis cancer: clinical and oncological management. Contemp Oncol (Pozn) 2017; 21:70-76. [PMID: 28435402 PMCID: PMC5385482 DOI: 10.5114/wo.2017.66660] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 06/22/2016] [Indexed: 01/17/2023] Open
Abstract
Synchronous bilateral testis cancer (SBTC) is a rare event. It represents only 0.5–1% of all new cases of testicular cancer. Patients with this disease require careful management for psychological, oncological, and medical problems. We performed a PubMed search for all series that reported SBTC. We considered only articles in English, reporting on more than three cases. We also performed an analysis of the reported evidence regarding testosterone replacement and surgical treatment. We found 10 studies satisfying inclusion criteria for a total of 73 patients. The majority are bilateral seminoma, which present with a low stage at diagnosis, and mixed histology tumours, both with a good overall survival. On the other hand, cases with bilateral non-seminoma histology are associated with poor prognosis and high stage at presentation. Testis-sparing surgery should be an eligible choice in selected cases, to preserve fertility and avoid testosterone deficiency. Multiple biopsies are recommended in these patients, and in the case of intratubular germ cell neoplasia (ITGCN) presence, scrotal radiotherapy is mandatory. Subcutaneous testosterone pellets guarantee higher patient acceptance and physiological testosterone levels. Lifelong follow-up and psychological support, with special care for infertility and erectile dysfunction, must be considered in this cohort of patients.
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11
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Bertolotto M, Grenier N, Hamm B, Stocca T, Sarocchi F, Derchi LE. Imaging of Bilateral Synchronous Testicular Tumors of Different Histologic Types and Implications for Surgical Management. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:2511-2516. [PMID: 27698179 DOI: 10.7863/ultra.15.10048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 02/09/2016] [Indexed: 06/06/2023]
Abstract
The clinical history and imaging and pathologic findings in 4 patients with bilateral synchronous testicular tumors of dissimilar histologic types were reviewed. All patients had a large scrotal mass on one side and a smaller nodule on the other one. The appearances of each pair of lesions were different enough to suggest that they could possibly be of different histologic types. The most important role of imaging, however, was its capability to guide the surgical approach to these patients: in 1 case, the smallest lesion was recognized as an epidermoid cyst; in 2 others a conservative approach was deemed possible, given the lesions' small volumes and peripheral locations.
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Affiliation(s)
| | - Nicolas Grenier
- Department of Adult Diagnostic and Interventional Imaging, Hospital Group Pellegrin, University of Bordeaux, Bordeaux, France
| | - Bernd Hamm
- Department of Radiology, Charité Medical University, Berlin, Germany
| | - Tiziano Stocca
- Department of Radiology, San Giovanni di Dio Hospital, Gorizia, Italy
| | - Francesca Sarocchi
- Department of Surgical Sciences and Integrated Diagnostics, Pathology Section, University of Genoa, Genoa, Italy
| | - Lorenzo E Derchi
- Department of Health Sciences, Radiology Section, University of Genoa, Genoa, Italy
- Department of Emergency Radiology, Scientific Institute of Hospitalization and Treatment, Azienda University San Martino Hospital Scientific Tumor Institute, Genoa, Italy
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Di Gregorio M, Nollevaux MC, Lorge F, D'Hondt L. Metachronous testicular seminoma after radiotherapy and chemotherapy: a case report. World J Surg Oncol 2016; 14:147. [PMID: 27184033 PMCID: PMC4867539 DOI: 10.1186/s12957-016-0902-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 05/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bilateral testicular neoplasia is rare, with an incidence ranging from 1 to 5%. Long-term survival has improved in recent years due to advanced diagnostic approaches and new therapeutic methods that are highly effective against germ cell tumors. CASE PRESENTATION We present the case of a patient with a primary seminomatous testicular tumor, who developed a contralateral metastasis and a subsequent metachronous tumor following chemotherapy and consolidation radiotherapy treatment. CONCLUSIONS Strict follow-up, including physical examination and ultrasound examination of the contralateral testis, enabled early diagnosis of the second tumor, giving the patient a high likelihood of a definitive cure.
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Affiliation(s)
- Marcelo Di Gregorio
- Urology Department, CHU UCL Namur, 1 Av Gaston Thérasse, B-5530, Yvoir, Belgium.
| | | | - Francis Lorge
- Urology Department, CHU UCL Namur, 1 Av Gaston Thérasse, B-5530, Yvoir, Belgium
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Studniarek M, Skrobisz-Balandowska K, Modzelewska E. Scrotal imaging. J Ultrason 2015; 15:245-58. [PMID: 26674847 PMCID: PMC4657400 DOI: 10.15557/jou.2015.0021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 09/03/2015] [Accepted: 09/10/2015] [Indexed: 11/28/2022] Open
Abstract
Pathological lesions within the scrotum are relatively rare in imaging except for ultrasonography. The diseases presented in the paper are usually found in men at the age of 15-45, i.e. men of reproductive age, and therefore they are worth attention. Scrotal ultrasound in infertile individuals should be conducted on a routine basis owing to the fact that pathological scrotal lesions are frequently detected in this population. Malignant testicular cancers are the most common neoplasms in men at the age of 20-40. Ultrasound imaging is the method of choice characterized by the sensitivity of nearly 100% in the differentiation between intratesticular and extratesticular lesions. In the case of doubtful lesions that are not classified for intra-operative verification, nuclear magnetic resonance is applied. Computed tomography, however, is performed to monitor the progression of a neoplastic disease, in pelvic trauma with scrotal injury as well as in rare cases of scrotal hernias involving the ureters or a fragment of the urinary bladder.
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Affiliation(s)
- Michał Studniarek
- Department of Medical Imaging, Medical University of Warsaw, Warsaw, Poland
- Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
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Abstract
Testis cancer is the most commonly diagnosed cancer in young men. Most cases represent sporadic occurrences. Most commonly it presents at an early stage (clinical stage I) and is highly curable with radical orchiectomy. Even more advanced stages of testicular cancer are curable with a multimodality treatment approach. There are no widely accepted screening strategies for germ cell tumors. This article discusses the known risk factors and epidemiology of testis cancer, the presentation, and work up for new patients, and the prognosis and cure rates based on the staging and current treatment modalities for testis cancer patients.
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Affiliation(s)
- Scott M Stevenson
- Division of Urology, University of Utah School of Medicine, 30 North 1900 East, Salt Lake City, UT 84132, USA
| | - William T Lowrance
- Department of Surgery, Division of Urology, Huntsman Cancer Institute, University of Utah, 1950 Circle of Hope, #6405, Salt Lake City, UT 84112, USA.
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Anastasiou I, Deligiannis D, Katafigiotis I, Skarmoutsos I, Karaolanis G, Palla VV, Nonni A, Mitropoulos D, Constantinides CA. Synchronous Bilateral Testicular Tumors with Different Histopathology. Case Rep Urol 2015; 2015:492183. [PMID: 26060594 PMCID: PMC4427818 DOI: 10.1155/2015/492183] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 04/09/2015] [Accepted: 04/15/2015] [Indexed: 11/17/2022] Open
Abstract
A 40-year-old male presented to our outpatient department with the chief complaint of a painless mass on his right testis with gradual size increase over the past two months. Physical examination and ultrasound revealed a firm and nontender mass both on the right and on the left testis. The only elevated biomarker was b-hcG (24,7 mIU/mL) and computer tomography (CT) did not reveal any pathology. Bilateral high orchiectomies were performed, without previous frozen storage of the sperm. Histology proved typical seminoma of the left testis and embryonal carcinoma of the right testis. He received two cycles of adjuvant combination chemotherapy with bleomycin, etoposide, and cisplatin. Six months after the operation no residual tumor or recurrence was observed.
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Affiliation(s)
- Ioannis Anastasiou
- 1st University Urology Clinic, Laiko Hospital, University of Athens, 17 Agiou Thoma Street, Attiki, 11527 Athens, Greece
| | - Dimitrios Deligiannis
- 1st University Urology Clinic, Laiko Hospital, University of Athens, 17 Agiou Thoma Street, Attiki, 11527 Athens, Greece
| | - Ioannis Katafigiotis
- 1st University Urology Clinic, Laiko Hospital, University of Athens, 17 Agiou Thoma Street, Attiki, 11527 Athens, Greece
| | - Ioannis Skarmoutsos
- 1st University Urology Clinic, Laiko Hospital, University of Athens, 17 Agiou Thoma Street, Attiki, 11527 Athens, Greece
| | - Georgios Karaolanis
- 2nd Department of Surgery, Laiko General Hospital, Medical School of Athens, 17 Agiou Thoma Street, Attiki, 11527 Athens, Greece
| | - Viktoria-Varvara Palla
- Department of Obstetrics and Gynecology, G. Gennimatas General Hospital, Mesogeion Avenue 154, Attiki, 11527 Athens, Greece
| | - Afrodite Nonni
- Department of Pathology, National and Kapodistrian University of Athens, 17 Agiou Thoma Street, Attiki, 11527 Athens, Greece
| | - Dionysios Mitropoulos
- 1st University Urology Clinic, Laiko Hospital, University of Athens, 17 Agiou Thoma Street, Attiki, 11527 Athens, Greece
| | - Constantinos A. Constantinides
- 1st University Urology Clinic, Laiko Hospital, University of Athens, 17 Agiou Thoma Street, Attiki, 11527 Athens, Greece
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Yadav S, Gupta N. Bilateral synchronous spermatocytic seminoma: a rare case report. Pan Afr Med J 2014; 17:275. [PMID: 25309674 PMCID: PMC4191694 DOI: 10.11604/pamj.2014.17.275.4129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 04/06/2014] [Indexed: 01/22/2023] Open
Abstract
Testicular tumors are very common among man under the age of 45 years. The case of bilateral synchronous testicular seminoma is very rare. We present a case of bilateral synchronous testicular seminoma stage-I in a 42-year old Indian male who came to our hospital with chief complaints of dull ache in the abdomen and groin, bilateral scrotal swelling and heaviness, left-sided scrotal swelling since last four years, and right-sided since last two years. He underwent bilateral orchidectomy followed by radiotherapy. In this case we throw light on this rare condition and discuss the management.
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Affiliation(s)
- Sankalp Yadav
- Department of General Surgery, Dr N C Joshi Memorial Hospital, Karol Bagh, New Delhi, India
| | - Nishant Gupta
- Department of General Surgery, RML Hospital, President's Estate, New Delhi, India
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17
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Fizazi K, Gravis G, Flechon A, Geoffrois L, Chevreau C, Laguerre B, Delva R, Eymard J, Rolland F, Houede N, Laplanche A, Burcoveanu D, Culine S. Combining gemcitabine, cisplatin, and ifosfamide (GIP) is active in patients with relapsed metastatic germ-cell tumors (GCT): a prospective multicenter GETUG phase II trial. Ann Oncol 2014; 25:987-91. [DOI: 10.1093/annonc/mdu099] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Dieckmann KP, Anheuser P, Sattler F, Von Kügelgen T, Matthies C, Ruf C. Sequential bilateral testicular tumours presenting with intervals of 20 years and more. BMC Urol 2013; 13:71. [PMID: 24321309 PMCID: PMC4028980 DOI: 10.1186/1471-2490-13-71] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 12/04/2013] [Indexed: 12/27/2022] Open
Abstract
Background About 3 – 5% of all patients with testicular germ cell tumour (GCT) develop a contralateral cancer, the majority of which arise within 10–15 years. Little is known about the risk of second GCTs after more than two decades. Here we present 3 cases with very late presenting contralateral GCT and provide a summary of similar cases reported previously. Case presentations (1) This white Caucasian man underwent right-sided orchiectomy for a nonseminomatous GCT at the age of 22 years. Additional treatment consisted of retroperitoneal lymph node dissection (RPLND) and chemotherapy with 4 cycles of vinblastin / bleomycin. 36 years later, contralateral seminoma clinical stage 1 developed. Cure was achieved by orchiectomy. Histologically, testicular intraepithelial neoplasia (TIN; intratubular germ cell neoplasia) was detected in the tumour-surrounding tissue. (2) This white Caucasian male had right-sided orchiectomy for nonseminomatous GCT at the age of 29 years. Pathological stage 1 was confirmed by RPLND. 25 years later, he received left sided orchiectomy for seminoma stage 1. Histologically, TIN was found in the tissue adjacent to seminoma. Two brothers had testicular GCT, too, one with bilateral GCT. (3) This 21 year old white Caucasian man underwent left-sided orchiectomy for nonseminomatous GCT. Pathological stage 1 was confirmed by RPLND. 21 years later, he received organ-preserving excision of a right-sided seminoma, followed by BEP chemotherapy for stage 3 disease. Histologically, TIN was found in the surrounding testicular tissue. 22 cases of bilateral GCT with intervals of 20 or more years have previously been reported, thereof three with intervals of more than 30 years, the longest interval being 40 years. Conclusion Apart from increased risks of cardiovascular diseases and non-testicular malignancies, patients with GCT face the specific probability of a second GCT in the long run. This risk persists life-long and is not eliminated by chemotherapy. Contralateral testicular biopsy can identify patients at risk by revealing precursor cells of GCT though false-negative biopsies may occur sporadically. However, in view of the multi-facetted late hazards of GCT patients, this minor surgical procedure might somewhat simplify the long-time care of these patients.
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Affiliation(s)
- Klaus-Peter Dieckmann
- Klinik für Urologie, Albertinen-Krankenhaus Hamburg, Suentelstr, 11a, D-22457 Hamburg, Germany.
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Adjuvant radiotherapy for synchronous bilateral testicular seminoma: a case report and a review of the pertinent literature. Case Rep Urol 2013; 2013:241073. [PMID: 23781383 PMCID: PMC3678426 DOI: 10.1155/2013/241073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 04/23/2013] [Indexed: 11/18/2022] Open
Abstract
Few cases of synchronous bilateral stage I seminomas have been reported in the world literature. We present a case of bilateral synchronous testicular seminoma, the current literature on the management of stage I seminoma, and the implications for radiotherapy. A forty-year-old man presented with synchronous bilateral classical seminomas, both stage IA. After undergoing bilateral inguinal orchiectomy, he received adjuvant external beam radiotherapy, with a standard paraaortic field. After 18 months of followup, he remains well, without evidence of recurrence. Bilateral germ cell tumors (BGCTs) are reported consistently at a low rate. Bilateral radical inguinal orchiectomy is standard of care, yet some groups have proposed an organ preservation approach. Of the reported cases of bilateral stage I synchronous GCT, with concordant seminoma histology, most of them were treated with bilateral orchiectomy and adjuvant radiotherapy. Although morbidity associated with radiotherapy directed at the abdomen is not negligible, adjuvant paraaortic radiotherapy remains safe and well-tolerated treatment regime. Bilateral synchronous stage I seminoma of the testes is rare. Organ preservation remains investigational. Chemotherapy is probably a reasonable option. We propose that patients with bilateral stage I synchronous GCT, with concordant seminoma histology, should be managed with bilateral orchiectomy, followed by paraaortic radiotherapy.
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20
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Risk and prognostic significance of metachronous contralateral testicular germ cell tumours. Br J Cancer 2012; 107:1637-43. [PMID: 23059747 PMCID: PMC3493782 DOI: 10.1038/bjc.2012.448] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Testicular germ cell tumour (TGCT) patients are at increased risk of developing a contralateral testicular germ cell tumour (CTGCT). It is unclear whether TGCT treatment affects CTGCT risk. METHODS The risk of developing a metachronous CTGCT (a CTGCT diagnosed ≥6 months after a primary TGCT) and its impact on patient's prognosis was assessed in a nationwide cohort comprising 3749 TGCT patients treated in the Netherlands during 1965-1995. Standardised incidence ratios (SIRs), comparing CTGCT incidence with TGCT incidence in the general population, and cumulative CTGCT incidence were estimated and CTGCT risk factors assessed, accounting for competing risks. RESULTS Median follow-up was 18.5 years. Seventy-seven metachronous CTGCTs were diagnosed. The SIR for metachronous CTGCTs was 17.6 (95% confidence interval (95% CI) 13.9-22.0). Standardised incidence ratios remained elevated for up to 20 years, while the 20-year cumulative incidence was 2.2% (95% CI 1.8-2.8%). Platinum-based chemotherapy was associated with a lower CTGCT risk among non-seminoma patients (hazard ratio 0.37, 95% CI 0.18-0.72). The CTGCT patients had a 2.3-fold (95% CI 1.3-4.1) increased risk to develop a subsequent non-TGCT cancer and, consequently, a 1.8-fold (95% CI 1.1-2.9) higher risk of death than patients without a CTGCT. CONCLUSION The TGCT patients remain at increased risk of a CTGCT for up to 20 years. Treatment with platinum-based chemotherapy reduces this risk.
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21
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Zequi SDC, da Costa WH, Santana TB, Favaretto RL, Sacomani CA, Guimaraes GC. Bilateral testicular germ cell tumours: a systematic review. BJU Int 2012; 110:1102-9. [DOI: 10.1111/j.1464-410x.2012.11056.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Because of a rising incidence of, and declining mortality from, testicular cancer, there are an increasing number of survivors of testicular cancer. Given their young age at diagnosis, the survivors have many years of life ahead of them during which they may experience adverse consequences from cancer and its treatment. Over the past few decades and particularly in this century, research into the short- and long-term effects of treatments of testicular cancer has grown rapidly, and now there exist a much greater body of data to help us counsel patients about the risks and side effects of these treatments.
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Affiliation(s)
- Timothy Gilligan
- Late Effects Clinic, Taussig Cancer Institute, Cleveland Clinic, 9500 Euclid Avenue, R35, Cleveland, OH 44195, USA.
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23
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Agrawal S, Bajpai R, Agrawal RK, Gupta TC. Bilateral synchronous seminoma with bilateral cryptorchidism of the testis. Indian J Urol 2011; 26:587-9. [PMID: 21369398 PMCID: PMC3034074 DOI: 10.4103/0970-1591.74472] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Synchronous bilateral germ cell tumo (BGCT) of the testis is rare and its association with bilateral cryptorchidism is even rarer. We report one case of BGCT of testis with bilateral cryptorchidism who presented as blunt injury abdomen in emergencyand was not diagnosed preoperatively. Postoperatively after an appropriate diagnosis, he was managed with chemotherapy. In this report, we have reviewed the larger series of BGCT for the presentation and management of synchronous BGCT to derive some conclusions.
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Affiliation(s)
- Sushma Agrawal
- Department of Radiotherapy, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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24
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Mortensen MS, Gundgaard MG, Daugaard G. Treatment options for carcinoma in situ testis. ACTA ACUST UNITED AC 2011; 34:e32-6. [DOI: 10.1111/j.1365-2605.2011.01178.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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25
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Nery F, Valadares D, Marques F. Metachronous Testicular Germ-cell Tumors: The Importance of a Long-Term Follow-up. World J Oncol 2010; 1:145-147. [PMID: 29147196 PMCID: PMC5649940 DOI: 10.4021/wjon2010.06.211w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2010] [Indexed: 11/28/2022] Open
Abstract
Testicular germ cell tumors (TGCT) are the most common malignancy in young male adults. They can be bilateral, and occur as a synchronous or metachronous tumor. The authors intend to characterize the prevalence and outcome of metachronous TGCT in the last 12 years of experience at our center. Cancer data base of our center was reviewed in order to find the patients that had TGCT in the period between 1996 and 2008 and, among those, the patients that had a second malignancy in the contralateral testicle after at least 6 months apart. Risk factors, clinical presentation, histological characteristics, staging, therapy and outcome were considered. Two out of 79 patients had metachronous TGCT, representing 2.5% of the group. Both cases had a low stage malignancy at the time of the diagnosis of the first tumor, and the diagnosis of the second TGCT happened 7 and 12 years later. Both patients are still alive without evidence of residual disease, under androgen replacement therapy and with testicular bilateral prostheses. Sperm cryopreservation was done in one of the patients. Long-term surveillance for TGCT is needed due to the probability of a second malignancy after the first 5 years of normal follow up. Special consideration must be given to patients submitted to bilateral orchiectomy concerning sperm cryopreservation, androgen replacement therapy and testicular prostheses.
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Affiliation(s)
- Filipe Nery
- Department of Internal Medicine, Centro Hospitalar do Porto - Hospital Santo Antonio, Portugal
| | - Diana Valadares
- Department of Internal Medicine, Centro Hospitalar do Porto - Hospital Santo Antonio, Portugal
| | - Franklim Marques
- Department of Internal Medicine, Centro Hospitalar do Porto - Hospital Santo Antonio, Portugal.,Director of Oncology Service, Centro Hospitalar do Porto - Hospital Santo Antonio, Portugal
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García Morúa A, Gutiérrez García JD, Ortiz Lara Gerardo E, Martínez Montelongo R, Gómez Guerra Lauro S. [Synchronous bilateral testicular seminoma in an adult patient with bilateral cryptorchidism: a case report and literature review]. Actas Urol Esp 2010; 34:210-1. [PMID: 20403290 DOI: 10.1016/s2173-5786(10)70044-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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27
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García Morúa A, Gutiérrez García J, Ortiz Lara Gerardo E, Martínez Montelongo R, Gómez Guerra Lauro S. Seminoma testicular bilateral sincrónico en un paciente adulto con criptorquidia bilateral: reporte de un caso y revisión de la literatura. Actas Urol Esp 2010. [DOI: 10.1016/s0210-4806(10)70044-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
Testicular cancer is of interest and importance because its incidence has been increasing in most countries over the past four decades. Although it remains an uncommon malignancy overall accounting for 1-2% of all tumours in men, testicular cancer is the most common malignancy in young men. There is marked geographical variation in the incidence of testicular cancer, with the highest incidence among men in Nordic countries and lowest incidence among men in the Middle East and Asia. The association between some risk factors, including cryptorchidism, a previous history of testicular cancer and a family history of testicular cancer, and the incidence of testicular cancer has been widely reported. We reviewed published reports and present the evidence to support or refute the association between the well-established and the less well-established risk factors and the incidence of testicular cancer.
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Affiliation(s)
- Rustom P Manecksha
- Department of Urology & Surgical Professorial Unit, Mater Misericordiae University Hospital, Dublin, Ireland
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[Metachronous testicular seminoma with an interval of 14 years from the first nonseminomatous testicular tumor: a case report]. Nihon Hinyokika Gakkai Zasshi 2009; 100:16-21. [PMID: 19198225 DOI: 10.5980/jpnjurol.100.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A 32-year-old man was admitted to our hospital with a complaint of right scrotal swelling. He had a past history of left testicular nonseminomatous germ cell tumor (NSGCT), stage IIB 14 years ago. He had undergone chemotherapy with 3 courses of PEP and retroperitoneal lymphnode dissection revealing pathological CR. He was diagnosed as having right testicular tumor. He underwent right high orchiectomy. Imaging studies and pathological studies revealed pure seminoma with spermatic cord invasion, stage I, pT3N0M0. He underwent chemotherapy with 3 courses of VIP. Herein we present a case of metachronous bilateral testicular germ cell tumor with a review of literatures.
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30
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Mai PL, Friedlander M, Tucker K, Phillips KA, Hogg D, Jewett MAS, Lohynska R, Daugaard G, Richard S, Bonaïti-Pellié C, Heidenreich A, Albers P, Bodrogi I, Geczi L, Olah E, Daly PA, Guilford P, Fosså SD, Heimdal K, Liubchenko L, Tjulandin SA, Stoll H, Weber W, Easton DF, Dudakia D, Huddart R, Stratton MR, Einhorn L, Korde L, Nathanson KL, Bishop DT, Rapley EA, Greene MH. The International Testicular Cancer Linkage Consortium: a clinicopathologic descriptive analysis of 461 familial malignant testicular germ cell tumor kindred. Urol Oncol 2009; 28:492-9. [PMID: 19162511 DOI: 10.1016/j.urolonc.2008.10.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Accepted: 10/01/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Familial aggregation of testicular germ cell tumor (TGCT) has been reported, but it is unclear if familial TGCT represents a unique entity with distinct clinicopathologic characteristics. Here we describe a collection of familial TGCT cases from an international consortium, in an effort to elucidate any clinical characteristics that are specific to this population. MATERIALS AND METHODS Families with >or=2 cases of TGCT enrolled at 18 of the sites participating in the International Testicular Cancer Linkage Consortium were included. We analyzed clinicopathologic characteristics of 985 cases from 461 families. RESULTS A majority (88.5%) of families had only 2 cases of TGCT. Men with seminoma (50% of cases) had an older mean age at diagnosis than nonseminoma cases (P = 0.001). Among individuals with a history of cryptorchidism, TGCT was more likely to occur in the ipsilateral testis (kappa = 0.65). Cousin pairs appeared to represent a unique group, with younger age at diagnosis and a higher prevalence of cryptorchidism than other families. CONCLUSIONS Clinicopathologic characteristics in these familial TGCT cases were similar to those generally described for nonfamilial cases. However, we observed a unique presentation of familial TGCT among cousin pairs. Additional studies are needed to further explore this observation.
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Affiliation(s)
- Phuong L Mai
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20852, USA.
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Sakuma Y, Matsukuma S, Yoshihara M, Sakurai S, Nishii M, Kishida T, Kubota Y, Nagashima Y, Inayama Y, Sasaki T, Nakamura Y, Miura T, Kameda Y, Tsuchiya E, Miyagi Y. Mutations of c-kit gene in bilateral testicular germ cell tumours in Japan. Cancer Lett 2008; 259:119-26. [DOI: 10.1016/j.canlet.2007.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2007] [Revised: 09/29/2007] [Accepted: 10/03/2007] [Indexed: 11/24/2022]
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Abstract
PURPOSE To report on long-term outcomes among patients with stage I seminoma treated by orchiectomy with or without adjuvant radiation. MATERIALS AND METHODS A retrospective review of medical records of patients treated between 1974 and 2002 was undertaken to identify factors associated with patient outcomes. RESULTS With a median follow-up of 7.7 years, 80% (4 of 5) of the surveillance group experienced a disease relapse, while only 3% (2 of 70) in the radiation therapy group had disease relapse. This difference in relapse rates was statistically significant, but there was no significant difference in overall survival between the 2 groups. There was a significant relationship between patient age and disease relapse, whereby all of the relapses were seen in patients younger than 36 years at diagnosis (P = 0.03). Of the total 75 patients, 7 (9%) developed second primary tumors. Six of them (6 of 7) were treated with adjuvant radiation, and 1 patient (1 of 7) was on surveillance. CONCLUSION In this study, risk of relapse was significantly associated with surveillance and in patients younger than 36 years at diagnosis. These results suggest that surveillance can only be safely adopted for patients who can be followed up closely. We consider adjuvant radiation a very effective choice despite the low risk of associated secondary malignancies.
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Affiliation(s)
- Gary Y Yang
- Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
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Pedrero Márquez G, Soto Delgado M, Ramírez Chamorro F, Rodríguez-Rubio Cortadellas F, Sánchez Bernal C, González Moreno D. Neoplasia testicular bilateral sincrónica. Presentación de un nuevo caso. Actas Urol Esp 2007. [DOI: 10.1016/s0210-4806(07)73596-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Fujimura T, Minowada S, Kishi H, Hamasaki K, Saito K, Kitamura T. Acute pericarditis as a result of unusual metastasis of the visceral pleura in a patient with testicular seminoma. Int J Urol 2006; 13:653-4. [PMID: 16771750 DOI: 10.1111/j.1442-2042.2006.01370.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 30-year-old man with a left testicular swelling was referred to our hospital. We performed a left high orchiectomy based on a diagnosis of clinical stage II testicular cancer. Pathological specimens of the left testis showed seminoma. The patient underwent three courses of combined chemotherapy. The retroperitoneal lymph nodes were dissected and there were no viable cancer cells. Twelve years later a right testicular tumor was discovered. The patient underwent a right high orchiectomy. Pathological specimens of the testis showed seminoma, and the patient was treated with prophylactic irradiation. One year after discharge a metastasis was found at a left supraclavicular fossa. The patient was treated with combined chemotherapy and irradiation. Six months after the treatment he complained of dyspnea. We diagnosed the condition as pleuritis carcimatosa. Two days after irradiation to the left thorax the patient suffered a sudden and fatal cardiac arrest. Autopsy survey revealed pericarditis as a result of a direct invasion of visceral pleural metastasis.
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Affiliation(s)
- Tetsuya Fujimura
- Department of Urology, International Medical Center of Japan, and Department of Urology, Faculty of Medicine, Tokyo University, Japan.
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Fosså SD, Chen J, Schonfeld SJ, McGlynn KA, McMaster ML, Gail MH, Travis LB. Risk of Contralateral Testicular Cancer: A Population-based Study of 29 515 U.S. Men. ACTA ACUST UNITED AC 2005; 97:1056-66. [PMID: 16030303 DOI: 10.1093/jnci/dji185] [Citation(s) in RCA: 143] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although risk estimates for synchronous and metachronous contralateral testicular cancers vary widely, many clinicians recommend routine biopsy of the contralateral testis for patients diagnosed with unilateral testicular cancer. We evaluated the risk of contralateral testicular cancer and survival in a large population-based cohort of men diagnosed with testicular cancer before age 55 years. METHODS For 29 515 testicular cancer cases reported to the National Cancer Institute's Surveillance, Epidemiology and End Results Program from 1973 through 2001, we estimated the prevalence of synchronous contralateral testicular cancer, the observed-to-expected ratio (O/E) and 15-year cumulative risk of metachronous contralateral testicular cancer, and the 10-year overall survival rate of both synchronous and metachronous contralateral testicular cancer, using the Kaplan-Meier method for the two latter assessments. Age-adjusted multivariable analyses were used to examine risk according to histologic type of the original cancer. RESULTS A total of 175 men presented with synchronous contralateral testicular cancer; 287 men developed metachronous contralateral testicular cancer (O/E = 12.4 [95% confidence interval {CI} = 11.0 to 13.9]; 15-year cumulative risk = 1.9% [95% CI = 1.7% to 2.1%]). In the multivariable analysis, only nonseminomatous histology of the first testicular cancer was associated with a statistically significantly decreased risk of metachronous contralateral testicular cancer (hazard ratio [HR] = 0.60, 95% confidence interval [CI] = 0.46 to 0.79; P<.001). Increasing age at first testicular cancer diagnosis was associated with decreasing risk of nonseminomatous metachronous contralateral testicular cancer (odds ratio = 0.90, 95% CI = 0.86 to 0.94). The 10-year overall survival rate after metachronous contralateral testicular cancer diagnosis was 93% (95% CI = 88% to 96%), and that after synchronous contralateral testicular cancer was 85% (95% CI = 78% to 90%). CONCLUSIONS The low cumulative risk of metachronous contralateral testicular cancer and favorable overall survival of patients diagnosed with metachronous contralateral testicular cancer is in accordance with the current U.S. approach of not performing a biopsy on the contralateral testis.
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Affiliation(s)
- Sophie D Fosså
- Department of Clinical Cancer Research, The Norwegian Radium Hospital, University of Oslo, Norway.
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Huyghe E, Soulie M, Escourrou G, Mieusset R, Plante P, Thonneau P. CONSERVATIVE MANAGEMENT OF SMALL TESTICULAR TUMORS RELATIVE TO CARCINOMA IN SITU PREVALENCE. J Urol 2005; 173:820-3. [PMID: 15711277 DOI: 10.1097/01.ju.0000152532.34475.4e] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We evaluated the prevalence of carcinoma in situ (CIS) in orchiectomy specimens performed for germ cell tumors smaller than 40 mm in diameter to propose an appropriate conservative approach to bilateral tumors or tumor of a solitary testis. MATERIALS AND METHODS Of 127 patients treated with orchiectomy between 1990 and 2002, 41 who presented with a tumor of less than 40 mm in diameter were selected for histological analysis of testicular parenchyma. The morphological items assessed were CIS, spermatogenesis and Leydig cell hyperplasia. RESULTS CIS was observed in 39 of the 41 patients (95%). CIS was evenly distributed throughout the testicular parenchyma (ie around and beyond the tumor) in all 39 cases. Spermatogenesis was observed in 12 of 41 specimens (29%), spermatogenesis without spermatozoa was noted in 14 (34%) and absent germ cells were found in 15 (37%). Leydig cell hyperplasia was observed in 24 cases (58%). CONCLUSIONS Histological analysis of whole orchiectomy specimens showed that CIS is almost always present in testicular parenchyma adjacent to germ cell tumor. In bilateral testis cancer or cancer occurring in a solitary testis tumorectomy plus radiotherapy appears to be the appropriate treatment in patients with a small tumor and no other risk factors. In patients who wish to father a child and have preserved spermatogenesis the natural history of CIS allows the postponement of testicular radiotherapy after orchiectomy, giving the double advantage of preserving testicular endocrine function and maintaining the possibility of natural fatherhood.
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Affiliation(s)
- Eric Huyghe
- Human Fertility Research Group, Paule de Viguier Hospital, Urological Surgery and Andrology Department, Rangueil Hospital, Toulouse, France
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Sakuma Y, Sakurai S, Oguni S, Satoh M, Hironaka M, Saito K. c-kit gene mutations in intracranial germinomas. Cancer Sci 2004; 95:716-20. [PMID: 15471556 PMCID: PMC11160023 DOI: 10.1111/j.1349-7006.2004.tb03251.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2004] [Revised: 07/20/2004] [Accepted: 07/26/2004] [Indexed: 02/01/2023] Open
Abstract
Gain-of-function mutations of the c-kit gene and the expression of phosphorylated KIT are found in most gastrointestinal stromal tumors and mastocytosis. Further, almost all gonadal seminomas/dysgerminomas exhibit KIT membranous staining, and several reports have clarified that some (10-25%) have a c-kit gene mutation. But, whether intracranial germinomas also have a c-kit gene mutation remains unsolved. To elucidate the presence, frequency, and location of c-kit gene mutations in intracranial germinomas, we analyzed five mutational hot spots (exons 9, 10, 11, 13, and 17) in the c-kit genomic DNA of 16 germinomas using polymerase chain reaction and direct sequencing. We found c-kit gene mutations at exon 11 (W557C) or 17 (D816V, D820V, and N822Y) in four germinomas (25.0%), although no statistically significant difference in any clinicopathological factor was found between patients with or without mutations. These results are similar to those seen in gonadal seminoma/dysgerminoma patients, and confirm that intracranial germinomas are exact counterparts of gonadal seminomas/dysgerminomas, as would be expected on histological and immunohistochemical grounds. Moreover, molecular targeting drugs such as imatinib mesylate (STI571), which is a selective inhibitor of KIT, might be promising agents for the treatment of intracranial germinomas with c-kit gene mutations.
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Affiliation(s)
- Yuji Sakuma
- Department of Pathology, Jichi Medical School, Minamikawachi-machi, Kawachi-gun, Tochigi 329-0498, Japan
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