A case of bilateral testicular germ cell tumors of different cell types with maturation in the metastatic region

A case of bilateral testicular germ cell tumors of different cell types and maturation in the metastatic region is described. A 42-year-old man with bilateral testicular swelling visited our clinic. Bilateral high orchiectomy was performed. Subsequent histological examination revealed seminoma and embryonal carcinoma in the right testis and seminoma and mature teratoma in the left. Then bilateral retroperitoneal lymphadenectomy was performed and 7 metastatic regions were found in the para-aortic lymph nodes. One of these revealed histopathologically a mature teratoma containing cartilage constituents. After the operation, multiple drug treatment with Cis-DDP, vinblastine and pepleomycin was started. The patient has been in complete remission for about 1.5 year. In addition, we reviewed the literature about bilateral testicular germ cell tumors and maturation in the metastatic region.     

Bilateral successive testicular cancer of different cell types

The fourth case of bilateral successive testicular tumors of different cell types is reported (seminoma and embryonal carcinoma), and the English literature on bilateral testicular tumors from 1965 to 1975 is reviewed. The absence of direct organ extension or demonstrable metastatic lymphatic or vascular involvement points to the primary origin of these lesions.     

Wilms' tumor with metastasis to the left testis

Wilms' tumors account for the vast majority of renal neoplasms in infants and children. Common areas for metastases include the lung, liver, and contralateral kidney. Less common sites include the bone, skin, brain, and orbit. We report a case of Wilms' tumor in a 13-month-old boy who, after radical left nephrectomy, developed a left testicular mass that turned out to be metastatic Wilms' tumor. The epidemiology, case history, review of the literature, and possible etiology of this rare site of metastatic Wilms' tumor are discussed.     

Primitive neuroectodermal tumor with Wilms' tumor. Case report]

Occurrence of embryonal kidney tumors in patients with primitive neuroectodermal tumors, so-called central nervous system-renal neoplasia has been reported. An infant who presented with masses in the right lateral ventricle and the cerebellar vermis is reported. Histological examination showed primitive neuroectodermal tumors. Further investigation revealed tumors in the bilateral kidneys, which were removed subtotally and pathologically shown to be Wilms' tumors. The patient was then treated with anticancer drugs and irradiation. However, he developed lung metastases from the renal tumors and expired. At autopsy, a small tumor was found in the inferior horn of the left lateral ventricle. Histological finding showed a primitive neuroectodermal tumor. Also, bilateral large masses of recurrent Wilms' tumors, multiple metastases to the lungs and peritoneal dissemination were found. There is no evidence that this association is based on the selective neoplastic transformation of embryonal cells of similar histogenetic or cytogenetic origin. Several reports demonstrate the presence of embryonal cells in the nervous tissue which could imply a neuroepithelial origin for Wilms' tumors.     

Synchronous bilateral testicular tumors

Synchronous bilateral testicular tumors are a rare entity. One such case of an elderly male is reported who presented with bilateral painless testicular swellings of 3 months duration. After clinical workup, provisional diagnosis of bilateral testicular tumors was made and bilateral orchidectomy was performed. Histopathology report revealed bilateral seminoma.     

Unbalanced translocation of chromosome 3p in Wilms' tumor.

Genetic studies in Wilms' tumor have most commonly shown a deletion involving band 13 on the p arm of chromosome 11 in association with aniridia. Structural rearrangements of chromosome 3p have been found in carcinoma of renal cell and lung origin but have not been previously reported in Wilms' tumors. We present two phenotypically normal, unrelated patients with Wilms' tumors, one of which was bilateral, in which cytogenetic analysis of the tumors showed an unbalanced translocation of the p arm of chromosome 3. Two biopsies were done in the patient with bilateral Wilms' tumor. The first biopsy specimen showed a translocation between chromosome 3 and 13 with partial trisomy of 3p and loss of material from 13q. The second biopsy three and a half months later again showed trisomy of chromosome 3p. The unilateral Wilms' tumor showed trisomy of 3p with partial loss of 7p. Neither patient showed a constitutional chromosomal abnormality and neither tumor showed any cytogenetic abnormality involving chromosome 11p. Quantitative DNA analysis was performed in the tumors of both patients. The bilateral Wilms' tumor was nearly diploid with a DNA index of 1.284 (mean ploidy, 2.45; SD, 0.854) while the unilateral Wilms' tumor was aneuploid with a DNA index of 1.531 (mean ploidy, 3.35; SD, 0.976). DNA analysis results are discussed in relationship to the chromosome abnormality seen on the karyotype analysis. These cytogenetic findings suggest that genetic oncogenesis in Wilms' tumor is heterogenous.     

Inguinal node metastases from testicular tumors in patients with prior orchiopexy

Testicular tumors in patients who have had the lymphatics disrupted by prior scrotal or inguinal surgery can metastasize primarily to the ipsilateral inguinal nodes in addition to the usual retroperitoneal pattern. Whether routine inguinal node dissection along with retroperitoneal node dissection is warranted in patients with testicular tumors and prior scrotal surgery is controversial due to the small numbers of such cases reported in the literature. We report on 2 patients who had undergone previous orchiopexy and who presented with inguinal and testicular masses. Both patients underwent retroperitoneal lymph node dissection and inguinal node dissection with hemiscrotectomy and metastatic tumor was in each lymphatic area. Ipsilateral inguinal along with bilateral retroperitoneal node dissection should be considered in the primary therapy of any patient with a nonseminomatous testicular tumor who has had prior scrotal and certain inguinal procedures.     

A rare variant of testicular teratoma

Tumors arising in human embryo from embryonic laying of an organ can be considered anomalies. Such tumors are renal adenomyosarcoma (Wilms' tumor), mesenchymoma and sarcoma botryoides of the prostatic gland, embryonal cancer of the testis, leydigocellular tumors of the testis and teratomas. Such anomaly as testicular teratoma occurs not rarely. However, testicular teratoma containing brain tissue is a rare finding. A case of teratoma of the left testis is reported in an 11-month-old infant. The tumor contained skin, appendages of the skin, cartilage, bone tissue, brain tissue, hair, fat.     

Teratoid Wilms' tumor: the St Jude experience

The term "teratoid" Wilms' tumor has been used recently to describe an unusual type of tumor in which, although classic nephroblastoma tissue is present, there is a significant diversity of cell types and tissues present. Examination of tissue samples from 290 patients treated at St Jude Children's Research Hospital from 1964 to 1987 disclosed that three children had teratoid Wilms' tumor. All three children had renal tumors and two of them presented with bilateral pyeloureteral obstruction, uremia, and hypertension. When compared with classic nephroblastoma, two of the children with teratoid elements responded poorly to chemotherapy and irradiation, although no metastatic disease was identified. One child died with sepsis and renal failure; the other two are surviving disease-free for 7 1/2 years and 26+ months since diagnosis. Because of the tendency for bilateral involvement, ureteral obstruction, and uremia, and their relative resistance to chemotherapy and irradiation, surgery is the principal form of therapy for patients with these tumors.     

Testicular metastasis from hepatocellular carcinoma

We document a case of testicular metastasis from hepatocellular carcinoma. The patient suffered from bilateral testicular painful swelling for 6 months. Scrotal ultrasonography showed bilateral testicular tumors and the whole abdominal computed tomography revealed a huge tumor in the left lobe of the liver. Bilateral orchiectomy and postoperative ultrasound-guided liver biopsy were done. Pathological examination revealed metastatic hepatocellular carcinoma. Hepatocellular carcinoma with testicular metastases is a very rare disease.     

A case of bilateral testicular tumors showing remarkable regression of huge metastatic tumors after VAB-6 combined chemotherapy

A case of bilateral testicular seminomas with abdominal huge metastatic tumors is presented. The patient is a 23-year-old male. An abdominal huge mass was found incidentally by a physician. CT scan and ultrasonography revealed the presence of the tumor in the left retroperitoneal space and biopsy specimen of the abdominal tumor was diagnosed as seminoma. On March 7, 1985, he was referred to our clinic. Bilateral testicular tumors were detected on palpation and ultrasonography. Bilateral orchiectomy was performed. Histological diagnosis was pure seminoma. After four sessions of VAB-6 combined chemotherapy, the abdominal tumor, 14.1 x 12.3 cm in size, decreased to 5.7 x 4.4 cm ( a regression rate of 85.5%). Retroperitoneal lymph-node dissection was undertaken, but the abdominal tumor could not be resected completely. Histological examination of the resected tumor revealed complete necrosis of the tumor tissue. After the operation, one session of the chemotherapy and irradiation were added. A total of 109 cases of bilateral testicular germ cell tumors in Japan was reviewed.     

Bilateral multifocal Wilms' tumor

A three-year-old boy who presented with symptoms of peritonitis was found to have four Wilms' tumors affecting both kidneys. Individual enucleation of three tumors in the right kidney plus left lower nephrectomy were performed. Chemotherapy was administered for one year. The diagnosis of Wilms' tumor was confirmed on each specimen by the histologic studies. The child remains asymptomatic and developing normally six years after the initial surgical treatment. Bilateral partial nephrectomies is the most conservative of the surgical treatments available for bilateral Wilms' tumor.     

Seminoma associated with bilateral cryptorchidism in Down's syndrome: A case report

BACKGROUND: A case of testicular typical seminoma associated with bilateral undescended testes in Down's syndrome is reported. A 42-year-old institutionalized male patient developed left testicular seminoma with retroperitoneal metastasis. METHODS/RESULTS: Neither adjuvant chemotherapy nor radiotherapy were performed due to his severe mental retardation. He died as a result of the cancer 2 years after a left radical orchiectomy and an autopsy was carried out. DISCUSSION: Recently an increase in the incidence of the association of testicular tumors and Down's syndrome has been repeatedly documented. Thirty-six cases of testicular tumors associated with Down's syndrome have been reported and of these 17.1% had cryptorchidism. This is a much lower percentage considering the high risk of cryptorchidism in males with Down's syndrome. The relationship between testicular germ cell tumors associated with cryptorchidism and Down's syndrome is discussed.     

Bilateral testicular tumors recurring 31 years after the initial treatment: a case report and the literature review

We herein report a case of bilateral testicular germ cell tumor recurring 31 years after right high inguinal orchiectomy. In 2003, a 62-year-old man presented with a mass in the left testis. Ultrasonography demonstrated three hypoechoic mass and microlithiasis of the left testis. Abdominal and breast computed tomography revealed no lymph adenopathy and any metastasis. The preoperative diagnosis was stage I testicular tumor and subsequently left high orchiectomy was performed. Histological examination revealed typical seminoma. At present, the patient is free from recurrence after the surgery. To our knowledge, 166 cases were reported in Japan. Approximately fifty percent of metachronal bilateral testicular tumors previously reported have been recurred after five years and more from the initial surgery. In the testicular cancer, long-term follow-up and self examination of the scrotum are of great importance. We review the metachronal bilateral testicular germ cell tumors previously reported in Japan.     

Bilateral testicular tumors of germ cell origin: a case report--a review of 136 cases in Japanese literature

A case of bilateral testicular germ cell tumors in a 23-year-old male is reported. He was admitted to the Department of Urology, Yamagata Prefecture Kahoku Hospital with the chief complaint of painless swelling in the left intrascrotal contents. Left high inguinal orchiectomy was carried out. At the same time, right hydrocele operation and right testicular biopsy were performed. Subsequent histological examination revealed anaplastic seminoma in the left testis and typical seminoma in the right. On July 21, 1988, he was referred to our clinic and right high inguinal orchiectomy was carried out. Postoperative chemotherapy was performed with CDDP, VP-16 and peplomycin, and postoperative course was uneventful with no distant metastasis or local recurrence. A total of 136 cases of bilateral testicular germ cell tumors in the Japanese literature are reviewed.     

Bilateral intrarenal pelvis Wilms' tumor with fibroepithelial polyp

Intrarenal pelvis Wilms' tumor is rare in children. A case of a 28-month-old boy with bilateral intrarenal pelvis Wilms' tumor associated with a fibroepithelial polyp is reported in this article. The tumor was evaluated by ultrasonography, computed tomography, and intravenous pyelography. The boy underwent bilateral renal pelviotomies. Now he is being treated and followed up by pediatric oncologists.     

Bilateral primary germ cell tumors of the testis: report of two cases and review of the literature

Bilateral germ cell tumors of the testis are not common. The contralateral tumor may develop simultaneously or sequentially. In both cases, bilateral involvement is postulated to represent two primary tumors. Case 1: A 47-year-old male was seen with a painless nodular mass in the right testis. Physical examination revealed hard swelling of both testes besides a nodule in the right testis. He underwent bilateral radical orchiectomy; and, microscopical both tumors proved to be seminoma. Although bipedal lymphangiography was negative for nodal metastases, postoperative irradiation to the pelvic and para-aortic lymph nodes was given to a total dose of 5,800 rad. The patient was alive 15 years after treatment for bilateral testicular tumors. Case 2: A 53-year-old male presented with painless left scrotal swelling. Physical examination showed not only an enlarged hard testis in the left scrotum but also a palpable hard mass in the right testis. Bilateral radical orchiectomy was performed and pathological examination revealed pure seminoma in both testes; a 1 cm mass in the right testis and almost completely replaced tumor in the left testis. Evaluation including retroperitoneal lymph node dissection revealed no metastatic disease. Postoperatively, the patient received 1,900 rad of irradiation to the retroperitoneal space. He is well one year after surgery and has no evidence of recurrence or metastasis. Previous reports of bilateral germ cell testicular tumors are reviewed and the incidence, age, predisposing factors, interval between the first and second tumors, histology, pathogenesis, prognosis, and management are discussed.     

Teratoid Wilms' tumor: case report of a rare variant that can mimic aggressive biology during chemotherapy

Teratoid Wilms' tumor is considered by some as a variant of Wilms' tumor containing at least 50% heterologous differentiated tissue. Fewer than 30 cases have been described. We report a 9-month-old boy with bilateral Wilms' tumors who did not respond to multiagent chemotherapy and underwent right nephrectomy that showed a teratoid Wilms' tumor. The patient continued to survive despite cessation of treatment. The overall predominance of differentiated stromal elements in this subtype of Wilms' tumor might explain the poor response to chemotherapy yet generally favorable outcome. Recognition of this subtype on biopsy might justify earlier surgical intervention that, for bilateral tumors, might allow for greater nephron sparing.     

Treatment of bilateral Wilms' tumors--a 22-yr experience

A total of 157 children with Wilms' tumors were treated at the Children's Memorial Hospital during the years 1956-1978. Fourteen (or 9%) of these children had bilateral lesions. During the early years, treatment consisted of surgical excision of one kidney with radiation to the second tumor. During the second decade of this study a more aggressive approach to bilateral tumors was used consisting of nephrectomy on the side of the large tumor, with a heminephrectomy on the contralateral side and chemotherapy. More recently, we have attempted bilateral heminephrectomy when possible, together with increasingly aggressive chemotherapy. This series of patients allows us to compare the results of various treatment modalities among our own patients as well as those reported from other pediatric surgical centers.