Testicular metastasis from prostate carcinoma three years after subcapsular orchiectomy. A case-report

Metastatic cancer to the testis is a rare phenomenon of prostate carcinoma with only 80 cases reported in the literature. Most of these secondary testicular tumors were diagnosed on routine pathohistological examination of testicular tissue after plastic orchiectomy. In none of these cases metachronous development of these metastases has been described. For the first time we report on a 75-year old patient who developed a prostate carcinoma metastatis to the right testicle three years after undergoing subcapsular orchiectomy. This case shows that the urologist has to think about a metastatic cancer when he sees a testicular tumor also after plastic orchiectomy.     

Overview of Surgical Pathology of the Thyroid Gland

The purpose of this overview is to provide timely information on selected topics on the surgical pathology of the thyroid gland. Selected publications of the author and his colleagues at the University of Michigan and the Maine Medical Center form the basis of this review. Information provided in our reports is updated by perusal of recent, pertinent publications. The following questions summarize the contents of the overview. What is a "lateral aberrant thyroid"? Does it always represent metastatic carcinoma? What are dyshormogenetic goiters? Can "focal thyroiditis" in thyroid glands removed for the treatment of Graves' disease and toxic nodular goiters be predictive of the development of postoperative hypothyroidism? What is the pathology of autonomously functioning (hot) nodules? Do tall-cell, columnar-cell, and diffuse sclerosing types of papillary carcinomas forbode bad prognoses? What is the controversy over Hurthle cell tumors? Does the presence of a better differentiated component in an anaplastic thyroid carcinoma modify its biologic behavior? Are poorly differentiated carcinomas unique histologic variants? Does their histology affect prognosis? What is the most common small-cell tumor of the thyroid gland? Has the Chernobyl nuclear disaster affected the incidence of childhood thyroid carcinoma? Are these radiation-induced tumors more aggressive? The answers, some of which are controversial, are found in this overview. The aims here were to provide information to surgeons and pathologists and to improve the care of patients with thyroid disease.     

Testicular metastasis from prostate carcinoma three years after subcapsular orchiectomy. A case-report A case-report

Metastatic cancer to the testis is a rare phenomenon of prostate carcinoma with only 80 cases reported in the literature. Most of these secundary testicular tumors were diagnosed on routine pathohistological examination of testicular tissue after plastic orchiectomy. In none of these cases metachronous development of these metastases has been described. For the first time we report on a 75-year old patient who developed a prostate carcinoma metastatis to the right testicle three years after undergoing subcapsular orchiectomy. This case shows that the urologist has to think about a metastatic cancer when he sees a testicular tumor also after plastic orchiectomy.     

Management of the contralateral testicle in patients with unilateral testicular cancer

Patients with a prior history of a germ cell tumor of the testicle are known to have an increased risk of development of a second germ cell tumor in the contralateral testicle. It is believed that all patients who develop a germ cell tumor of the testicle have a precursor lesion know as carcinoma in situ (CIS) or intratubular germ cell neoplasia. Approximately 50% of these patients will subsequently go on to develop a germ cell tumor in the testicle. A biopsy of the contralateral testicle in a patient with a previous history of a germ cell tumor of the testicle has been advocated by some, while others recommend a biopsy only in patients with other risk factors as well. The arguments for biopsy are that intervention may be used to prevent the development of a second germ cell tumor when CIS is detected. In this review we present the arguments for and against a biopsy of the contralateral testicle, review the techniques of biopsy as well as its complications, and discuss the interventions employed to prevent CIS from progressing.     

Sekundärprävention nach urologischen Tumorerkrankungen

It is generally agreed upon that patients require a caring as well as careful medical follow-up after cancer treatment. The goal of secondary prevention is to recognize a recurrence at an early stage and to use the curative chance while the tumor mass is still small. There is evidence of a medically effective and successful follow-up for tumors of the testicle and the bladder. For quality reasons, these follow-up regimes should be adhered to for quality reasons. In other diseases, e.g., renal cell carcinoma, prospective randomized studies are missing which demonstrate the effectiveness of follow-ups. In these cases asymptomatic patients should be stratified to individualized follow-up care.     

The effect of abnormal position,scrotal repositioning,and human gonadotropic hormone on the developing puppy testis

There are at least three hypotheses as to the cause of the abnormal function resulting from cryptorchism and/or its treatment: (1) The undescended testis has an inherent biological abnormality which accounts for the poor functional results from surgery and the increased tendency to malignant change; (2) The early development in a cryptorchid testis is normal, and the germinal epithelium is then altered by the ectopic position and the stimulus of anterior pituitary hormones; (3) An undescended testicle goes through its full development and then regresses by not being in the scrotum and yet having gonadotropic stimulus applied to it. While the first is beyond the scope of this research, the intent of this experimental design was to look into the second and third in puppies and adult dogs by seeking to answer the following questions: (1) What effect does an inguinal or abdominal position have on the development of the testis? (2) Does repositioning of a cryptorchid testis in the scrotum permit it to recover architecture and function? (3) What is the effect of gonadotropic hormone (HCG) administration on the testis under normal, cryptorchid, and replaced conditions?     

ORGAN SPARING SURGERY FOR MALIGNANT GERM CELL TUMOR OF THE TESTIS

PURPOSE: We evaluate the indication, technique and long-term outcome of organ preserving tumor resection rather than standard orchiectomy in 73 patients with bilateral testicular germ cell tumors or tumors of a solitary testicle. MATERIALS AND METHODS: Tumor resection was performed in 73 patients with 52 and 17 metachronous and synchronous bilateral testicular germ cell tumors, respectively, and 4 testicular germ cell tumors of a solitary testicle. Histology of the enucleated germ cell tumor revealed seminoma in 42 (57.5%) patients, embryonal carcinoma in 14 (19.2%), mature teratoma in 11 (15.1%), and mixed and combined germ cell tumors in 6 (8.2%). Mean tumor diameter was 15 mm. (range 5 to 30). Associated testicular intraepithelial neoplasia was diagnosed in 82% of patients who underwent local radiation with 18 Gy. RESULTS: After a median followup of 91 months (range 3 to 191) 72 (98.6%) patients had no evidence of disease and 1 died of systemic tumor progression. No local relapse occurred in 46 patients with associated testicular intraepithelial neoplasia treated with local radiation. However, local recurrence did develop in 4 patients after 3, 6, 12 and 165 months without radiation but all survived after undergoing inguinal orchiectomy. Testosterone levels were normal in 62 (84.9%) patients, hypogonadism developed in 7 (9.6%) and preoperative levels remained low in 4 (5.5%). Of the 10 patients who postponed local radiation for paternity reasons 5 had successfully fathered a child after organ sparing surgery. CONCLUSIONS: After a long-term followup of greater than 7 years organ sparing surgery represents a viable therapeutic approach to bilateral testicular germ cell tumor with an excellent postoperative outcome. Tumor enucleation might be considered a standard approach if the guidelines are respected, including cold ischemia, organ confined tumor less than 20 mm., multiple biopsies of the tumor bed, adjuvant local irradiation postoperatively to avoid local recurrence, close followup and high compliance.     

Diagnostic and therapeutic approach to bilateral germinal tumor. Presentation of a case and review of the literature

The germinal bilateral tumor represents from 1 to 4% of the testicle tumors, and it usually turns to be one of the most difficult ones when talking about diagnosis and treatment. We are attaching a 30 years old patient case, with a diagnosis consisting in a seminoma with yolk sac tumor area from the left testicle, that was treated with orquiectomy. Eleven months later, the patient presented a second neoplasm in the contralateral testicle, whose histology was a classical seminoma with carcinoma "in situ" peritumoral, being also treated with orquiectomy. Medical literature is revised with emphasis in the involved risk factors and the techniques used to treat these testis tumor groups: carcinoma "in situ" detection appears to be the strongest predicting factor. Testicular contralateral biopsy is proposed in some select cases. Even though radical orquiectomy is still the treatment to choose, local radiotherapy and conservative surgery are also an option in patients with bilateral tumor.     

Germ cell tumors of the testicle or 'orchidomata'

An unusual case of a double testicular tumor, with different histology and the same marker chromosome, led to a search of the literature for cases of testicular tumors that were double, bilateral, or familial. The literature on abnormal chromosomes in tumors of the testis is also reviewed. After a discussion of the facts, it is suggested that most of the histological variants of germ cell tumors of the testicle are so closely related that they could be grouped together under the title of 'orchidomata'.     

Embryonal carcinoma of abdominal testis

Two cases are reported of embryonal carcinoma of an abdominal testis, one a large tumor with a massive retroperitoneal metastasis. Several months after removal of the testicle and roentgen-ray therapy both patients are in good health and present no evidences of metastasis or recurrence.Roentgen therapy is of proved value in embryonal testicular tumors.Local operation plus radiation is contrasted with the radical operation.     

Spontaneous orchi-epididymitis due to necrosis of ischemic vascular origin

The author reports the case of a patient presenting with a recurrent right hydrocele after tapping, associated with an infectious syndrome resulting in a swollen and painful right compartment of the scrotum, which failed to respond to antibiotic treatment. A right scrotal incision revealed a vaginal empyema and a swollen and enflamed testicle and epididymis. After a right ochiectomy, an anatomopathological examination showed a severe ischemia of the testicle and epididymis associated with arteriosclerotic stenosis of the testicular artery.     

Fertilitätsuntersuchungen maligner Tumoren (Hodentumoren, maligne Melanome, Schilddrüsenkarzinom)

The examination of 83 patients suffering from tumours (78 tumours of the testicle, 4 melanoblastomas, 1 carcinoma of the thyroid gland) led to conclusions on the effect of complex therapy on spermiogenesis. By means of spermiograms carried out in the course of the illness we found out restrictions of fertility which were more distinctly marked with patients suffering from gonadal tumours than with patients suffering from extragonadal tumours. The loss in ejaculation after RLN with existing tumours of the testes has to be considered as a disturbance in fertility to the highest degree. X-ray therapy impairs spermiogenesis more than chemotherapeutics. After chemotherapy we observed a recovery of spermiogenesis, after x-ray therapy only then if there were no irreversible damages of the germinal epithelium.     

Four moral questions for human embryonic stem cell research

Human embryonic stem cell research offers great promise for the treatment of many serious disease conditions in a variety of medical areas, including wound healing. Before this promise can be realized, society and individual researchers, clinicians, and patients will have to answer four ethical questions: 1) Can we ever intentionally destroy a human embryo? 2) Can we benefit from others' destruction of embryos? 3) Can we create an embryo to destroy it? 4) Can we clone human embryos? After outlining the issues raised by each question, the author concludes by indicating his own affirmative answer to each of these questions.     

碘-125粒子对胃癌细胞核因子κB表达影响的作用机制

［摘要］ 目的 探讨I?125粒子对胃癌细胞核因子κB（NF?κB）的表达及其抑制肿瘤细胞增殖的作用机制。方法 建立人类胃癌细胞株（SGC?7901）裸鼠皮下移植瘤模型,随机分3组,分成实验组30只、空白对照组30只和对照组30只;对照组荷瘤裸小鼠不进行干预,空白对照组小鼠植入空白粒子（0 MBq）,实验组小鼠植入I?125粒子,放射剂量为14.8MBq;观察粒子植入后瘤体生长情况,粒子植入28 d时处死所有裸鼠获取肿瘤标本。对标本进行测量分析,得到裸小鼠肿瘤抑制率。用RT?PCR方法进行测定瘤组织NF?κB基因的表达水平,Western blot方法进行测定肿瘤组织内NF?κB蛋白的表达水平。结果 I?125粒子植入小鼠后,与对照组相比,实验组小鼠的肿瘤生长变慢,两组抑瘤率分别为38%和43%。实验组中肿瘤组织的NF?κB基因mRNA及蛋白表达明显降低,差异有统计学意义。结论 碘?125粒子抑制胃癌细胞增殖重要分子生物学机制之一是其抑制胃癌细胞NF?κB基因和蛋白的表达。     

复发性肝癌诊治的几个焦点问题

复发性肝癌是临床治疗肝癌病人的常见问题。目前，缺乏针对复发性肝癌的分期方案和治疗体系，缺少高水平的临床研究，在治疗上有较多争议。复发性肝癌的治疗争议主要体现在是否需要积极采用手术再切除或肝移植等创伤大的治疗手段。针对多克隆起源的复发肿瘤，临床治疗决策基本参照初发肝癌的分期和治疗体系，预后不劣于初发肿瘤。而对于短期内出现的单克隆起源的复发肿瘤，临床治疗更趋于介入、消融、放疗或靶向药物等创伤小的治疗手段。制定肝癌治疗方案必须综合考虑治疗创伤、安全性、有效性和费用等多个因素，复发性肝癌的治疗既类似于初发肝癌，又不同于初发肝癌。因此，其治疗不能完全参考初发肝癌的治疗体系。     

Resection of hepatic metastases from colorectal cancer. Biologic perspective.

During the past decade the results of slightly fewer than 1000 resections of liver metastases from colorectal carcinoma have been analyzed, retrospectively reanalyzed, and reviewed. The following are confirmed conclusions: major liver resection can be performed safely (less than a 5% operative mortality rate); 20% to 25% of these patients are cured; no other regional therapy options have any curative potential. The following caveats are also obvious: most patients who are operated on are not cured; although predictors have been proposed to select patients most likely to benefit from surgery, none is discriminating in and of itself; most therapy questions in this group of patients have not been addressed in any formal way; surgery for isolated regionally recurrent colon and rectum carcinoma remains an important stopgap only until effective systemic therapy is discovered. This review of our own and other single and multi-institutional prospective and retrospective data will be framed by the following questions. (1) Does resection of liver metastases cure patients or simply select those who would have survived in the long-term without any therapy? (2) In the absence of any formalized, properly designed trial, how can one judge the benefit of resection? (3) Why do metastases recur only in the liver? (4) What new therapies should focus on the predominant secondary failure sites in the majority of patients who do not benefit from hepatic metastasis resection?     

Hepatobiliäre Tumorchirurgie

Surgical R0 resection of primary and secondary hepatobiliary tumors, such as colorectal liver metastases, hepatocellular carcinoma, cholangiocellular carcinoma and gall bladder carcinoma, remains the only potentially curative treatment option. The extent of involvement of lymph node metastases seems to be an independent prognostic factor in these tumors. The prognostic value of a systematic lymph node dissection in hepatobiliary tumors still remains unclear as there is a lack of prospective randomized trials. However, local lymphadenectomy (hepatoduodenal ligament and retropancreaticoduodenal lymph nodes) can be easily performed with low mortality and morbidity rates and may be helpful in better staging of the patients. Further randomized trials are necessary in order to define the relevance of lymph node dissection in hepatobiliary surgery     

Intrascrotal metastasis of renal cell carcinoma. Case reports and review of the literature

In a series of 235 patients with testicular tumors 2 elderly patients (0.9%) had secondary testicular tumors: 1 from a renal cell carcinoma and 1 from an unclassified anaplastic neoplasm. The pathogenesis of intrascrotal metastases of renal carcinoma is demonstrated by angiography of the dilated spermatic vein. In a literature survey the incidence rate of secondary testicular tumors is found to range from 0.3 to 3.6%. 30 cases of intrascrotal secondaries of renal cell carcinoma have been identified in the literature.     

HPV-related squamous cell carcinoma variants in the head and neck

The great majority of HPV-related carcinoma of the oropharynx is nonkeratinizing squamous cell carcinoma. More recently, an increasing number of squamous cell carcinoma variants that are HPV positive are being reported in the oropharynx, as well as in other head and neck sites. As a result, several clinical and pathologic questions have emerged. Importantly, questions raised include whether the virus is biologically active and involved in the pathogenesis of these tumors, and whether there are clinical implications with regard to patient outcome and treatment modality changes that may be needed in HPV-related variants. Examples of HPV-related squamous cell carcinoma variants that will be addressed here include: basaloid squamous cell carcinoma, undifferentiated carcinoma, adenosquamous carcinoma, papillary squamous carcinoma, and small cell carcinoma. Some investigations have suggested a favorable prognosis in some variants, analogous to that of the conventional nonkeratinizing (basaloid) carcinoma, while others showed poorer outcome. So far, the number of studies on this subject is limited and the number of cases evaluated in each investigation is few. Because of this, it is prudent at this stage not to alter management protocols as a result of identification of HPV in these variants and to await additional studies.     

Tiny nodule in the testicle: Case report of a sertoli cell tumor

Sex cord-stromal tumors of the testis are rare. We report on a small Sertoli cell tumor in the testicle. According to published reports, a nodular lesion on the testicle has a variety of differential diagnoses. Preoperatively, it is very difficult to differentiate between a tumorous lesion and an inflammatory change. When a tiny nodule in the testicle is encountered, we propose limited, testicular-sparing surgery according to the frozen section diagnosis.