A case of Sertoli cell tumor of the testis

A 24-year-old man was admitted to our hospital with the complaint of a painless mass in the left testis. Gynecomastia was not present. The serum levels of alpha fetoprotein and human chorionic gonadotropin-beta were not elevated. Ultrasound sonography showed a hypoechoic lesion in the left testis. There was no evidence of retroperitoneal lymph node enlargement or distant metastasis on computerized tomography. With a diagnosis of left testicular tumor, left high orchiectomy was done. The tumor measured 10 x 11 mm in size within the testis and was histologically diagnosed as benign Sertoli cell tumor. Immunohistochemcal analysis revealed negative findings with the tumor markers inhibin, CAM 5.2, pancytokeratin, EMA, and PLAP. No adjuvant therapy was performed. Twenty-six cases of Sertoli cell tumor of the testis in the Japanese literature are reviewed.     

Testicular pure teratoma: a case report

A 46-year-old man visited our hospital, complaining of fever and painful swelling of the right scrotum contents. The symptoms and signs suggested epididymitis, but testicular tumor could not be excluded. Therefore, high inguinal orchiectomy was performed. Macroscopic findings were compatible with the testicular teratoma, containing hair, and epididymitis. Histological findings revealed that the tumor was composed of mature epidermis with skin appendages, cartilage, hair, bone and adipose tissue, and that many leucocytes infiltrated in the epididymis, resulting in the diagnosis of pure mature teratoma with epididymitis. For 6 months after the operation, no evidence of recurrence has been observed. Despite its histologically benign appearance, primary pure teratoma of the testis has a metastatic and recurrent potential. Therefore, primary pure teratoma should be man aged in the same way as other nonseminomatous germ cell tumors.     

Bilateral asynchronous metastatic carcinoid tumor of the testis

Carcinoid tumor of the testis represents only 0.23% of all testicular malignancies. We report the first case of bilateral asynchronous carcinoid tumor of the testis with a primary site in the small bowel. A 49-year-old man presented with several months of painless enlargement of the left testis. Orchiectomy revealed carcinoid tumor. The patient presented to the emergency room 2 weeks later and was found to have small bowel obstruction due to an ileal mass. The resected mass was the primary source of the carcinoid tumor. Four years later, examination revealed carcinoid tumor in his remaining testis.     

Malignant lymphoma of the testis: report of two cases and review of the literature

Two cases of malignant lymphoma arising from the testis are reported. Case 1: A 70-year-old man presented with a painless swelling of the right scrotal contents. Right radical orchiectomy was done and histological examination revealed malignant lymphoma of the testis (diffuse lymphoma, mixed type). Bipedal lymphangiography and CT scan showed metastatic lesion in the right retroperitoneal lymph-nodes. Postoperative irradiation to the inverted Y field encompassing the para-aortic, pelvic and inguinal lymph-nodes bilaterally was given to a total dose of 5,000 rad, and treatment with anti-cancer agents was subsequently started. The patient, however, died of liver failure about 6 months after the operation. Case 2: A 74-year-old man presented with painless right scrotal swelling. Right orchiectomy was performed and the tumor histologically appeared to be anaplastic seminoma. The patient received 3,000 rad of irradiation to the retroperitoneal space. There was no evidence of metastasis, until he developed swelling of the right inguinal lymph-nodes about 5 months after the operation. Afterwards, multiple skin tumors in the legs appeared. Biopsy of the skin lesions showed metastasis of malignant lymphoma (diffuse lymphoma, large cell type). The right testis removed previously was then reviewed in detail, and primary malignant lymphoma of the testis was strongly suggested. The patient responded poorly to additional irradiation or cancer chemotherapy and died about one year and 3 months after the right orchiectomy. A statistical survey was made on 117 cases of malignant lymphoma of the testis reported in Japan and the discussion is focused on the significance of new histological classification in relation to the prognosis.     

Metastases from testicular carcinoma Study of 78 autopsied cases

The necropsy records of 78 patients with histologically proved germ cell tumors of the testis, who died as a direct result of their malignant disease, were reviewed to determine the usual modes of spread, distribution of metastasis, the histologic characteristics of the metastatic foci as compared with the morphology of the primary tumor and the specific cause of death. The sites of metastases in order of decreasing frequency for all cases were lung, retroperitoneal lymph nodes, liver, mediastinal lymph nodes, brain, kidney, gastrointestinal tract, bones, adrenals, peritoneum, and spleen. The absence of metastases solely in the anterior mediastinum without involvement of other mediastinal nodes (middlelposterior) strongly supports the premise for a primary extragonadal origin whenever the anterior mediastinum alone is involved with malignant disease having the histologic appearance of a primary germ cell tumor. The histologic features of the metastatic lesions were usually similar in nature to those of the primary tumor except for seminoma in which the metastatic lesions proved to be of a different histologic pattern in almost one third of the patients dying from the disease. It should be axiomatic that whenever a patient with seminoma fails to respond appropriately to radiotherapy thet his treatment be immediately discontinued and that appropriate biopsies be obtained to substantiate the histologic pattern present.     

Orchiectomy in advanced germ cell cancer following intensive chemotherapy: a comparison of systemic to testicular response

A total of 16 patients with advanced germ cell cancer underwent initial chemotherapy that was followed by a delayed orchiectomy for an unrecognized primary in 3 and for life-threatening distant metastatic cancer in 13. Of these patients 13 had a complete and 3 had a partial remission at the time of the delayed orchiectomy. Of the former 13 patients 3 (23 per cent) had persistent viable tumor in the testis. To date all 3 patients have remained free of disease for more than 12, 20 and 30 months, respectively, without further therapy. One early relapse (1 month) was found in the remaining 10 patients with a complete remission and without viable disease in the testis. Of the 3 patients with a partial remission 1 had residual tumor in the testis and disease progressed despite further therapy. There was no evidence of tumor in the testis in the other 2 patients. These data document the presence of a differential response of germ cell tumors in the primary and metastatic sites. Post-chemotherapy orchiectomy for a suspicious primary tumor of the testis is necessary because of the risk of persistent primary disease. The post-chemotherapy pathological findings in the resected primary tumor do not reflect the systemic response.     

Plasmacytoma of testis presenting as primary testicular tumor

Two cases of plasmacytoma of the testis presenting as primary testicular tumors are presented. This lesion may be confused both clinically and histologically with other more common pathologic conditions.     

The seminoma decoy: measurement of serum human chorionic gonadotropin in patients with seminoma.

Serum human chorionic gonadotropin levels were determined in 20 patients with histologically proved seminoma. The test was positive in 2 of the 20 patients and was predictive of non-seminomatous metastasis in each case. Serum human chorionic gonadotropin is a useful tumor marker in detecting and following non-seminomatous metastases in men with pure seminoma of the testis.     

Three types of spindle cell tumors of the pleura. Fibroma, sarcoma, and sarcomatoid mesothelioma

The clinicopathologic features of 17 fibrous tumors of the pleura are presented. Eight were benign localized fibrous tumors; all of these were negative when stained with antibodies to keratin. Eight were diffuse malignant tumors that demonstrated intense immunohistochemical staining of the spindle cells with antibodies to keratin. One case presented as a histologically malignant spindle cell tumor that was initially localized but recurred subpleurally three times in 12 years. This spindle cell tumor was consistently negative when stained for keratin. We conclude that there are three types of fibrous tumors of the pleura: (a) a localized, histologically benign, keratin-negative spindle cell tumor that might be termed "fibroma," (b) a diffuse, histologically malignant, keratin-positive neoplasm that might appropriately be termed a "sarcomatoid mesothelioma," and (c) a histologically malignant, keratin-negative, spindle cell tumor with the potential to spread under the pleura that might appropriately be termed a "sarcoma." Immunohistochemistry proved to be useful in distinguishing the sarcomatoid mesothelioma from the sarcoma.     

A case of retroperitoneal bulky tumor with cryptorchidism

A 37-year-old male was presented with an upper abdominal mass. A retroperitoneal bulky tumor was detected and operative biopsy revealed seminoma. The right testis was undescended and atrophic which was located at the left inguinal lesion. Pathologically, the primary tumor cells were not found in the left orchiectomied testis, but only scar and fibrosis were compatible with a burned-out testicular tumor. This patient showed partial regression by multidisciplinary therapy including combined chemotherapy with CDDP, etoposide and peplomycin, and is still on the same condition and alive for 3 years. In case of extragonadal germ cell tumor without apparent testicular involvement, it is a problem to differentiate primary extragonadal germ cell tumor from occult and burned-out testicular tumor. Testis should be examined by all means available including careful exploration.     

睾丸鞘膜恶性间皮瘤一例报告

目的 探讨睾丸鞘膜恶性间皮瘤临床表现、病理特征、治疗方法和预后情况.方法 睾丸鞘膜恶性间皮瘤患者1例,34岁,因右侧阴囊肿大5年,进行性增大15d入院.查体:右侧阴囊肿大、囊性,于睾丸上方可触及质硬肿物,表面光滑、轻压痛,与睾丸、附睾界限尚清.β-人绒毛膜促性腺激素和甲胎蛋白检测正常.阴囊超声于右侧睾丸鞘膜上方探及2.05 cm×1.97 cm混合回声的实性肿物,边界毛糙,内部回声欠均匀.结果蛛网膜下腔麻醉下手术切除鞘膜及肿物.病理报告:肿物切面灰白色,质硬,边界欠清晰.镜下可见鞘膜间皮细胞向上皮细胞和间质细胞双向分化,以上皮细胞增殖为主,上皮细胞有明显异形性,可见有丝分裂相;免疫组化染色角蛋白和波形蛋白呈强阳性.病理诊断为低度恶性的睾丸鞘膜间皮瘤.1个月后行右侧睾丸根治加右侧阴囊切除术,肿瘤未浸润临近的精索、睾丸、微血管和淋巴管等.随访38个月,患者生存良好,肿瘤无复发.结论睾丸鞘膜恶性间皮瘤多表现为鞘膜积液,确诊需依靠病理检查,本病易发生浸润和远处转移,患者生存期较短,术后需密切随访.低度恶性的间皮瘤患者经早期治疗生存期可明显延长. :肿物切面灰白色,质硬,边界欠清晰.镜下可见鞘膜间皮细胞向上皮细胞和间质细胞双 分化,以上皮细胞增殖为主,上皮细胞有明显异形性,可见有丝分裂相;免疫组化染色角蛋白和波形蛋白呈强阳性.病理诊断为低度恶性的睾丸鞘膜间皮瘤.1个月后行右侧睾丸根治加右侧阴囊切除术,肿瘤未浸润临近的精索、睾丸、微血管和淋巴管等.随访38个月,患者生存良好,肿瘤无复发.结论睾丸鞘膜恶性间皮瘤多表现为鞘膜积液,确诊需依靠病理检查,本病易发生浸润和远处转移,患者生存期较短,术后需密切随访.低度恶性的间皮瘤患者经早期治疗生存期可明显延长. :肿物切面灰白色,质硬,边界欠清晰.镜下可见鞘膜间皮细胞向上皮细胞和间质细胞双 分化,以上皮细胞增殖为主,上皮细胞有明显异形性,可见有丝分裂相;免疫组化染色角蛋白和波形蛋白呈强阳性.病理诊断为低度恶性的睾丸鞘膜间皮瘤.1个月后行右侧睾丸根治加右侧阴囊切除术,肿瘤未浸润临近的精索、睾丸、微血管和淋巴管等.随     

Juvenile granulosa cell tumor of the testis

Juvenile granulosa cell tumor of the testis is a rare type of intermediate stromal cell tumor. Only 11 cases of juvenile granulosa cell tumor of the testis have been reported to the national tumor registry as of December 2001. We report an additional case of primary juvenile granulosa cell tumor of the testis. The benign lesion was managed successfully with orchiectomy, and follow-up computed tomography revealed no evidence of recurrence at 6 months. The histopathologic features, treatment, and prognosis of this unusual tumor are reviewed.     

Primary testicular amyloidosis mimicking tumor in a cryptorchid testis

We present a case of primary testicular amyloidosis mimicking tumor in a cryptorchid testis. Examination revealed the absence of a palpable testis in the left hemiscrotum. The laboratory evaluation showed azoospermia and a low testosterone level. The radiologic investigation demonstrated a heterogeneous left inguinal mass suspicious for tumor in a cryptorchid testis. After radical orchiectomy, the histologic evaluation revealed primary amyloidosis of the testis. The pathogenesis and clinical presentation of testicular amyloidosis are reviewed.     

A case of very rare tuberculosis of the testis]

A 61-year old man visited our hospital with a painless swelling of right scrotal contents as the chief complaint. Transillumination test of the right scrotal contents was negative, and a quail's egg sized, elastic hard and smooth induration in the right testis was palpable. The laboratory data were normal except for slightly elevated E.S.R and CRP. Urine examination was normal. Although not only tumor marker, beta-hCG, AFP and LDH but also Plain lung X-ray, DIP and CT were normal, ultrasonography and MRI revealed a well-defined nodule in the right testis. Under the diagnosis of right testicular tumor, right high orchiectomy was performed. A yellowish white nodule of 2.5 cm in diameter was found in the slightly enlarged right testis. Pathologically, the patient was diagnosed as having tuberculotic granuloma with necrotic caseation. However, the epididymis was histologically normal. After operation, an antitubercular medication was started. Subsequently, E.S.R and CRP became normalized. At present, 12 months after surgery, the recurrence is not found. Tuberculosis of testis which shows no lesion in the epididymis is very rare, and ours is the first reported case in the Japanese literature. The importance of tuberculosis as a revival infection should be recognized in social circumstance in which tuberculosis is beginning to spread again.     

ICRF-159 in treatment of germinal testicular tumor in animals

A comparison of therapeutic regimens used in the treatment of testicular tumor was carried out utilizing a murine genital ridge graft model (Stevens) which provides an unlimited number of tumor foci of precisely known age, histologically similar to germinal testis tumor in human beings, and highly predictable in size and degree of differentiation. They arise de novo in vivo. The four drug combination of 5- fluorouracil, cyclophosphamide, methotrexate, and vincristine gave the greatest objective response of currently used regimens. The use of ICRF-159 was suggested by the incidental findings of damage to the spermatogenic cell line in early laboratory experiments. It was shown to be considerably more effective against murine testicular tumor using the Stevens model than all other regimens and acted synergistically with the four-drug regimen.     

Metastatic seminoma with regression of testicular primary: ultrasonographic detection

We report a case of seminoma of the testis metastatic to the retroperitoneum. Biopsy of the retroperitoneal mass revealed anaplastic seminoma. No testicular mass could be palpated. Testicular ultrasonography showed a hypoechoic 3 X 2 cm. area in the left testis suggestive of a primary testicular tumor, most likely a seminoma. Histological evaluation of the resected testis revealed fibrous tissue but no definable tumor.     

Bilateral testicular tumors of germ cell origin.

Four cases of primary testicular tumor of germ cell origin are reported. Three cases were bilateral, while the remaining case involved a unilateral tumor in a non-twin brother of 1 patient with bilateral tumors. Because of the increased likelihood of a second primary tumor developing in a patient who has had a malignant germinal cell tumor and because the changes may be subtle, localized to the testis and occur after a tumor-free interval of many years, careful examination of the contralateral testis and long-term followup are indicated even when systemic chemotherapy for malignancy has been used. This is the seventh time familial occurrence of testis tumors in non-twin brothers has been reported but the first time that one of the brothers had bilateral tumors.     

Bilateral primary germ cell tumors of testis

Bilateral primary germ cell tumors of the testis are rare, but their incidence is likely to rise since the prognosis of metastasized nonseminoma tumors of the testis has improved with polychemotherapy and surgery. Every patient with a tumor of the testis requires lifelong frequent follow-up. Delay in diagnosis and treatment can be prevented. The treatment of bilateral primary germ cell tumors of the testis is highly individual and depends on the histologic diagnosis of the first and the second tumors, metastaticgrowth, and previous treatment.     

Improved Management of Abdominal Undescended Testicular Tumors with Bulky Confluent Retroperitoneal Nodal Metastases

Purpose

Germ cell tumors of the abdominal undescended testis associated with confluent bulky retroperitoneal metastases are challenging problems. We report the results of neoadjuvant cisplatin based chemotherapy after diagnosis of germ cell tumors by fine needle aspiration cytology of the abdominal testicular mass. After chemotherapy all patients underwent abdominal orchiectomy with retroperitoneal lymph node dissection for residual nonseminomatous germ cell tumors or radiotherapy for pure seminomas.

Materials and Methods

Between 1980 and 1991, 57 of 425 patients (13.4 percent) with germ cell tumors of the testicle had malignancy in an undescended testis, while 39 (68.4 percent) had tumor in an abdominal testis with confluent bulky metastasis. Metastatic evaluation included tumor marker studies, chest x-ray and computerized tomography of the abdomen. Among the tumors 29 (74.4 percent) were large volume seminomas (stages IIc, III and IV) and 10 (25.6 percent) were large volume nonseminomas. All 39 patients received 3 cycles of induction chemotherapy, and orchiectomy was deferred until its completion (14 received vinblastine, actinomycin D and bleomycin-6, and 25 received bleomycin, etoposide and cisplatin). After evaluation of response, the testis was excised. Overall followup was 2 to 12 years (median 4.6).

Results

Of 29 seminomas 14 (48.3 percent) showed a complete and 11 (37.9 percent) showed a partial response. The latter tumors were treated subsequently with radiotherapy. Four patients with progressive disease died, for an actuarial survival rate of 86 percent. Of the 10 patients with nonseminomatous germ cell tumor 2 (20 percent) had a complete response and 4 had a partial response. All patients with a partial response underwent retroperitoneal lymph node dissection. Overall, 4 patients with progression and 2 with a partial response died, for an actuarial survival rate of 39 percent. Of 39 post-chemotherapy orchiectomy specimens 24 (61.5 percent) showed viable tumor cells. Furthermore, 16 of 39 patients (41 percent) had additional ilioinguinal metastases requiring adjuvant radiotherapy or surgery.

Conclusions

Surgical removal of the primary tumor in an undescended testis with bulky metastasis is difficult. We believe that initial chemotherapy followed by 1-stage surgical removal of the primary and residual metastasis is a favorable option to improve compliance and decrease the incidence of loss to followup. Atypically altered ilioinguinal metastases may necessitate a change in radiotherapy ports and/or retroperitoneal lymph node dissection boundaries.The significantly poorer survival with nonseminomatous germ cell tumor could be due to the fact that 50 percent of the lesions were stage IV at presentation. However, multivariate analysis showed only tumor histology to be the significant parameter and not initial stage at presentation.     

A case of bilateral reticulum cell sarcoma of the testis

A case of reticulum cell sarcoma of bilateral testis is described. The patient was a 58-year-old man who complained of painless swelling of the right scrotal contents. He was treated by bilateral high orchiectomy. The right testicular tumor was histologically diagnosed as reticulum cell sarcoma, and the left testicular tumor was also diagnosed as RCS. Chemotherapy (vincristin, Endoxan, 6-MP and prednisolone) was performed, and the patient has been doing well without any clinical evidence of recurrence. The literature is reviewed briefly.