Bilateral testicular tumors. Combination of a testicular germ cell tumor with a contralateral benign non-germ cell tumor

Bilateral testicular tumors account for approximately 3.5% of all testicular malignancies and to our knowledge about 800 cases are reported in the literature. An even more seldom event is the appearance of a testicular germ cell tumor with a contralateral benign non-germ cell tumor. We report the 6th case of such a coincidence. The dignity of a contralateral tumor should be assured by frozen section and in case of benign histology organ preserving therapy is indicated. Even in cases of bilateral testis cancer tumor enucleation may be considered, if the strict conditions for resection and follow-up are respected.     

Management of the contralateral testis in patients with testicular germ cell cancer

Patients with testicular germ cell tumours (TGCT) are at increased risk of developing a tumour in the contralateral testis. Such a tumour may be preceded by carcinoma in situ (CIS), which is more common in patients with infertility, atrophic testis or a history of cryptorchism. Of 1219 patients with TGCT seen at the Royal Marsden Hospital between 1962 and 1984 in whom the contralateral testis was managed by surveillance, 38 (3.1%) developed a second tumour and 8 died of germ cell tumours. Seventeen of 26 assessable patients (65%) exhibited at least one of the known aetiological risk factors for carcinoma in situ. Diagnosis of carcinoma in situ may lead to more appropriate management of the contralateral testis.     

Effect of testicular torsion on the contralateral testis

It has been previously shown that unilateral testicular torsion can cause disruptive anatomic changes in the contralateral testis in rats [1]. In this experimental study plasma and urine prostaglandin E2 levels were studied correlatively with testicular histopathology in acute testicular torsion cases. As a result of this study, necrobiotic morphologic alterations causing testis necrosis and significant increase in plasma prostaglandin E2 levels were observed. Contralateral testicular histology was analyzed in all dogs. None of them showed abnormal tubular architecture.     

一侧睾丸扭转对对侧睾丸组织发育的影响

目的:研究一侧睾丸扭转以后对对侧睾丸组织的影响。方法:以大鼠为研究对象,按扭转时间及药物应用情况进行分组。在一侧睾丸扭转以后2个月,观察对侧睾丸曲细精管的变化。结果:一侧睾丸扭转2h以内,对侧睾丸曲细精管管腔和生精上皮增生;扭转6 h以后,曲细精管管腔和生精上皮萎缩;扭转6h以内应用别嘌呤醇能缓解对侧病变。结论:一侧睾丸扭转可以使对侧睾丸组织发育发生病理改变。     

睾丸混合性生殖细胞肿瘤临床病理分析

目的:探讨原发性睾丸混合性生殖细胞肿瘤(MGCT)的临床病理特征。方法:对我院13例原发性睾丸MGCT患者的临床病理资料进行回顾性分析,并结合相关文献进行讨论。结果:睾丸MGCT占我院同期睾丸生殖细胞肿瘤的24.1%(13/54),患者年龄2~53岁,平均28.3岁。全部病例均发生于单侧睾丸,左侧6例,右侧7例,左右侧比为0.86∶1。睾丸MGCT病理形态多样,肿瘤成分包括胚胎性癌(11例,84.6%)、精原细胞瘤(8例,61.5%)、畸胎瘤(6例,46.2%)、绒毛膜癌及卵黄囊瘤(均为4例,23.1%)。其中9例(69.2%)包含2种不同的生殖细胞肿瘤成分,3例(30.8%)包含3种不同的肿瘤成分,1例(7.7%)包含5种不同的肿瘤成分。结论:睾丸MGCT非常少见,好发于青壮年男性,不同的肿瘤成分其生物学行为、临床治疗和预后不同,因此准确的病理诊断非常必要,免疫组化标记对病理诊断与鉴别诊断具有重要作用。     

睾丸混合性生殖细胞瘤的诊治

目的 探讨睾丸混合性生殖细胞瘤的临床特征及治疗策略.方法 回顾性分析1例睾丸混合性生殖细胞瘤患者病史资料并结合相关文献讨论睾丸混合性生殖细胞瘤的生物学行为、治疗及随访策略.患者为22岁青年男性,发现左侧睾丸肿物2个月余,AFP 200.43ng/mL、β-HCG 554.17 mlU/mL,阴囊彩超及CT提示左侧睾丸实...     

Acute experimental testicular torsion. No effect on the contralateral testis

Other investigators have shown that chronic unilateral testicular torsion produces negative effects on the contralateral testis in experimental animals. In the present study, bilateral testicular weight and histology, and concentrations and motility of spermatozoa from the cauda epididymidis were studied after 0 to 4 hours of acute unilateral testicular torsion in the rat. The obstruction of blood flow by torsion was documented, as well as the presence or absence of return blood flow after the relief of torsion. The above mentioned parameters of testicular function were studied at 7, 30, and 60 days after relief of torsion. Ipsilateral testis weights and epididymal sperm concentrations and motility were significantly reduced by 1, 2, and 4 hours of torsion. The histology of torsioned testes was also severely altered, and no seminiferous epithelial repair was evident 60 days after torsion. Contralateral testicles were not affected by ipsilateral torsion of 1, 2, or 4 hours duration, despite the fact that the ipsilateral testis function was completely compromised by 2 and 4 hours of torsion. These results indicate that there would be no clinical benefit in removing the acutely torsioned testis of Sprague-Dawley rats since it poses no threat to the contralateral testis.     

Spermatogenesis in the contralateral testis of patients with testicular germ cell cancer: histological evaluation of testicular biopsies and a comparison with healthy males

OBJECTIVE: To assess histologically signs of testicular dysgenesis (TD) in the contralateral testes of patients with testicular germ cell tumours (GCTs) and to compare these findings with the spermatogenetic quality in healthy men, as the contralateral testis is considered to be involved with dysgenetic features such as poor sperm production, and accordingly, GCTs are hypothesized to be part of the 'TD syndrome' (TDS). One testicular biopsy is thought to represent spermatogenesis in the entire testis. We evaluated this view by using testicular two-site biopsies. PATIENTS AND METHODS: 2318 patients with testicular GCT had a contralateral testicular two-site biopsy. Testicular biopsies taken on forensic autopsy from 1388 presumably healthy men served as controls. Spermatogenesis was rated histologically according to a modified Johnsen score. Clinical factors were recorded to explore associations with reduced spermatogenesis. Differences in spermatogenesis scoring results among two-site biopsies were noted. Statistical analysis involved Wilcoxon-Mann-Whitney and Jonckheere-Terpstra tests for comparing patients and controls, and for studying associations with clinical factors. Classification and regression-tree analysis was used to explore multivariate associations. RESULTS: Histologically, patients had significantly poorer spermatogenesis than healthy men. Clinically, hypospermatogenesis was significantly associated with testicular atrophy, undescended testes, male infertility, and advanced clinical stage; 5.4% of cases (95% confidence interval 4.43-6.27) had discordant findings of >2 points on double biopsy and 9.8% had differences of 1 point. Discordance was significantly associated with poor spermatogenesis and testicular atrophy. CONCLUSIONS: We confirmed histologically that there is markedly reduced spermatogenesis in the contralateral testes of patients with GCT. This result lends credence to the view that GCT is part of the so-called TDS. But as hypospermatogenesis is associated with advanced clinical stage, impairment of sperm production might at least partly be acquired secondary to the endocrine activity of GCT. There were clinically relevant discordant results on double biopsy in 5.4%, predominantly in infertile patients and in atrophic testes. Thus the histological evaluation of male infertility is best done by multiple biopsies.     

Effect of testicular torsion on contralateral testis and fertility in mature rats

The effect of unilateral testicular torsion on the contralateral testis and the fertility rate was studied in Charles River adult rats. Animals were divided into groups that underwent a sham operation or torsion and ligation of the left testicular vessels followed by orchiectomy after 24 h, orchiectomy after 48 h, release of the ligature after 24 h, release of the ligature after 48 h, and no further treatment following ligation. Another group of animals underwent unilateral orchiectomy. After 8 weeks animals were allowed to mate and were sacrificed 2 weeks later. The results did not point to either histological alterations in the contralateral testis or impairment of fertility in any group of treatment compared with the control.     

Morphological changes in the contralateral testis in patients with testicular tumor

Biopsy of contralateral testis of 20 patients with an unilateral testicular tumor was carried out to evaluate the morphological changes of the contralateral testis caused by the tumor. Serum beta-chorionic gonadotropin (beta-hCG), follicle-stimulating hormone (FSH), luteinizing hormone (LH) and alpha-fetoprotein (AFP) levels before orchiectomy were examined as a function influencing morphological changes of the contralateral testis. Typical carcinoma in situ was found in a case of ipsilateral testis. The presence of a few atypical germ cells, however, was the only finding of the contralateral testis of three patients. Five of 20 patients revealed hypospermatogenesis in the contralateral intact testis. Most of the other patients also showed sloughing of germinal epithelium suggesting disorder of spermatogenesis. Johnsen's mean score count and tubular wall thickening were related to neither clinical stages, ESR, serum beta-hCG, AFP, LH nor FSH levels. Tubular wall thickening was observed in 8 of 10 patients with a tumor weighting over 150 g, but was found in only 1 of 10 patients with a lighter tumor (p less than 0.01).     

Polyorchidism discovered as testicular torsion associated with an undescended atrophic contralateral testis: a surgical solution

We report a case of polyorchidism presenting as torsion of the supernumerary testis associated with an undescended atrophic contralateral testis. Biopsies of both descended testes revealed a normal histological pattern with active spermatogenesis. After the testicular torsion was corrected, one of the supernumerary testes was placed in the contralateral empty hemiscrotum and the undescended atrophic testis was removed. The aesthetic and functional results were excellent.     

Capsaicin effectively prevents apoptosis in the contralateral testis after ipsilateral testicular torsion

OBJECTIVE: To evaluate the effect of afferent nerve blockage by administration of capsaicin on apoptotic changes in the contralateral testis in rats undergoing ipsilateral testicular torsion. MATERIALS AND METHODS: Twenty male albino rats were randomly divided into four groups. In groups 1 and 2, rats underwent a sham operation and testicular torsion, respectively, after the intraperitoneal administration of 0.9% NaCl. Similarly, in groups 3 and 4 the rats underwent a sham operation and testicular torsion, respectively, after an intraperitoneal capsaicin injection. The testes were untwisted 24 h later and the contralateral testes harvested. Apoptosis was assessed in paraffin-embedded sections stained for nuclear DNA fragmentation. Fifteen cells were counted in each seminiferous tubule and the apoptotic cells recorded. A score was calculated for each group and the results compared using the Kruskal-Wallis analysis of variance and Mann Whitney U-tests, with P<0.05 considered to be significant. RESULTS: The mean apoptotic score of group 2 was significantly higher than that of the other groups. There was no difference between the apoptotic scores of groups 1 and 3, 1 and 4, and 3 and 4. CONCLUSION: Capsaicin effectively prevented apoptosis in the contralateral testes of rats that had undergone testicular torsion.     

Diffuse embryoma of the testis. A distinctive form of mixed germ cell tumor

Two testicular tumors characterized by a diffuse, orderly arrangement of embryonal, yolk sac, and trophoblastic elements are described as examples of a newly recognized form of mixed germ cell neoplasia. In one case, ribbons of embryonal carcinoma and yolk sac tumor wound around one another to create a distinctive necklace pattern. In the second case, differentiation of the yolk sac component was more advanced with the formation of numerous clusters of cells resembling hepatocytes. Tumors with these patterns are appropriately designated diffuse embryomas to distinguish them from polyembryomas and other forms of malignant mixed germ cell tumor.     

Carcinoma in situ of the testis in the presence of contralateral germ cell tumor

Carcinoma in situ (CIS) of the testis is considered a precursor of germ cell tumor. Diagnosis is made by biopsy, a procedure which is justifiable for patients with increased tumor risk. This group includes patients with testicular tumors who may develop contralateral second malignancies. After obtaining contralateral biopsies from 21 such patients we found one CIS. Treatment consisted of local irradiation (20 Gy) of the remaining testis. No clinical side effects were observed. In a control biopsy 6 months later, no evidence of CIS was found. Leydig cells were morphologically normal. Nine months after therapy, plasma testosterone levels were still normal, LH and FSH levels were increased. Long-term observations are needed to assess the value of radiotherapy as compared to orchiectomy.     

Different transformation of mature teratoma in a patient with mixed germ cell tumor of the testis

A 44-year-old male was referred with a left supraclavicular lymphadenopathy. A biopsy of the lymph node showed metastatic embryonal carcinoma. Tumor markers were present at high levels: alpha-fetoprotein 253.9 ng/mL, beta-human chorionic gonadotrophin 62 ng/mL. Computed tomography (CT) showed retroperitoneal adenopathy. High orchiectomy was done. The patient was treated with three cycles of etoposide plus cisplatin, achieved normalization of the serum tumor markers and underwent retroperitoneal lymph node dissection. Pathological findings of multiple lymph nodes showed teratomatous glands without viable cells. At follow-ups performed every 3 months, tumor markers remained within normal limits and no evidence of recurrence was observed. Eight years after first admission a CT scan revealed a cystic tumor 1 cm in diameter in the para-aortic region. The cystic tumor continued to slowly grow, expanding by 1 cm in diameter per year without elevation of tumor markers. The para-aortic tumor had grown to 4 cm in diameter and a left supraclavicular lymphadennopathy recurred. A resection of the supraclavicular cystic tumor showed mucinous cystadenocarcinoma, but a cystic tumor in the para-aortic region revealed mature teratoma. Here we report a case of mature teratoma with metastases at supraclavicular and para-aortic lymph nodes which had different transformations in spite of both regions consisting of cystic tumors.     

A case of bilateral testicular germ cell tumor

A case of bilateral successive tumor of germ cell origin is reported. A 29-year-old man visited our clinic with a complaint of swelling of right scrotal contents 18 months after initial left orchiectomy for a seminoma. The right orchiectomy was performed and its histological finding was also seminoma. Between 1965-1987 we treated 55 patients with testicular germ cell tumors. Two of them suffered a second germ cell tumor. One of them who had different histology of teratocarcinoma on left side and seminoma on right side had been reported previously. Herein, we report the second case and review the literature.