Bilateral testicular germ cell tumours: a systematic review

What's known on the subject? and What does the study add? Bilateral testicular germ cell tumours (BTGCTs) are rare neoplasms. Most previously published studies consist of case reports or small retrospective case series. Little is known about their epidemiological and clinicopathological characteristics. BTGCT corresponded to 1.82% of testicular tumours. Metachronous disease was about twice as frequent as synchronous disease. The primary tumour histology, chemotherapy use and the interval between metachronous tumours influenced the histology of the second tumour. Overall, synchronous tumours were associated with more advanced disease and presented less favourable survival rates than metachronous tumours. Testicular cancer is the most common tumour in young men. It is known that a second primary contralateral testis tumour may occur in up to 5% of men with a proior tumour. About 35% of these men present with synchronous tumours, and 65% present with metachronous tumours. However there is little data about bilateral testicular germ cell tumours (BTGCT) in the literature and the most published articles are case reports on a small series of men, which makes it difficult to draw conclusions about therapeutic strategies for the treatment of BTGCTs. In fact, current guidelines for the treatment of testicular cancer contain little information related to bilateral disease. Therefore, the aim of our study is to provide a broad overview of BTGCT and to update data focusing on incidence, pathological features, and clinical outcomes of men with BTGCTs. Thus, an extensive review containing 94 studies and more than 50,000 patients was conducted.     

Bilateral testicular germ cell tumors: a report of 20 cases

Of 412 patients with unilateral testicular cancer 20 (4.3 per cent) suffered a second primary germ cell tumor: 1 had a simultaneous bilateral tumor and in the remaining 19 the second tumor was diagnosed after an interval of 2 months to 32 years. Patients with clinical stages III and IV disease were found only in the group with a second tumor. In 5 patients known risk factors for the development of testicular tumors were found and in 2 prior testicular biopsies showed carcinoma in situ. Effective chemotherapy was used more often in the treatment of the second primary tumor. Of the 20 patients 18 (90 per cent) are free of disease after a mean observation of 5.7 years. A long followup of testicular cancer patients with sonographic evaluation of the remaining testis as well as periodic self-examination by the patient is required.     

Prepubertal testicular tumors: A 20‐year experience with 40 cases

Testicular tumors are rare in children. In addition, prepubertal testicular tumors (PTT) are fundamentally different from their postpubertal counterparts. We reviewed our 20‐year experience with 40 cases to suggest an algorithm for the appropriate surgical approach for patients with PTT. All tumors ultrasonographically suspected of being benign were confirmed to be benign postoperatively. There was a significant difference between median preoperative α‐fetoprotein (AFP) levels of infants with yolk sac tumor and teratoma. The majority of our cases were benign, with the most common histopathological subtype being teratoma, as recently reported. Testis‐sparing surgery was carried out in five patients with teratoma and three patients with epidermoid cyst. Other than one patient with teratoma, none of the patients developed recurrence or testicular atrophy after testis‐sparing surgery. When testis‐sparing surgery is considered, our algorithm based on ultrasonographic findings and preoperative AFP levels might be helpful.     

Idiopathic benign bilateral testicular enlargement in a pubertal boy: a case report and review of literature

We present a case of 12-year-old boy with idiopathic benign bilateral testicular enlargement. We eliminated precocious puberty, juvenile hypothyroidism, adrenal rest tumors, X-linked mental retardation, and bilateral testicular neoplasms. The clinical and laboratory features and differential diagnosis of benign bilateral testicular enlargement are discussed.     

临床Ⅰ期睾丸非精原细胞瘤的监视治疗16例报告

１６例临床Ⅰ期睾丸非精原细胞瘤（ＮＳＧＣＴＴ）患者在单纯切除睾丸肿瘤后,不按常规行腹膜后淋巴结清扫,放疗,化疗,而采取监视治疗方案,即术后两周开始复查血清ＨＣＧ,ＡＦＰ,两月开始复查胸腹部ＣＴ、每两个月一次,连续２年以上,结果１２例无复发,复发的４例中有２例术后瘤标持续升高,另２例瘤标下降后分别在第４月、第８月再次升高,给予ＰＶＢ化疗后,４例患者瘤标恢复正常,病灶消失,认为监视治疗对临床Ｉ期ＮＳＧ     

Brain metastases from testicular germ cell tumors: A retrospective analysis

Objectives:   To review our series of testicular germ cell tumors with brain metastases and to establish an optimal treatment strategy for them.
Methods:   Twenty-seven cases of testicular germ cell tumors from three institutions were retrospectively reviewed.
Results:   Twenty-six were non-seminomatous tumors and only one was a seminoma. Based on the International Germ Cell Consensus Classification, two cases were classified as good prognosis, seven as intermediate prognosis and 18 as poor prognosis. Chemotherapy was carried out in all patients. Additionally, whole-brain radiotherapy was performed in 10 cases, stereotactic radiosurgery in six, whole-brain radiotherapy combined with stereotactic radiosurgery in three and complete surgical resection in five. Three patients received chemotherapy only. Cancer-specific 5- and 10-year survival rates were both 35.9%. The prognosis of those with brain metastases at the time of diagnosis tended to be better than those developing brain metastases during treatment. Those with a single brain metastasis showed significantly better survival than those with multiple brain metastases. No other significant prognostic factor was found at multivariate analysis.
Conclusion:   Testicular germ cell tumors with brain metastases can be managed with the combination of whole-brain radiotherapy, stereotactic radiotherapy, and/or surgical resection in combination with chemotherapy.     

Clinical features of testicular tumors in children

AIM: Testicular tumors are not common pediatric solid tumors, especially in Asian children. There have been few reviews of cases in Japan to date. We present the clinical features of 14 pediatric testicular tumor patients. METHODS: Clinical features of 14 testicular tumor patients, such as chief complaints, age at diagnosis, pathology, stages, treatments and prognosis, were examined from medical records. Two patients had their semen tested at adolescence. RESULTS: Of the 14 prepubescent patients, 12 (85.7%) patients were diagnosed before 3 years of age. Ten cases (71.4%) were diagnosed as yolk sac tumors, three (21.4%) as mature teratomas and one case as an epidermoid cyst. Nine cases (90.0%) among the 10 cases of yolk sac tumor were diagnosed as stage I and one case was stage IV. One stage I yolk sac tumor patient developed lung metastasis later. Eventually, two yolk sac tumor patients died, despite chemotherapy. While all the cases with a diagnosis before 2 years of age survived, 67% (2/3) of cases with a diagnosis after the age of 2 died of tumors. Semen analysis in two patients showed normospermia. CONCLUSION: In the present study, the most common testicular tumors were yolk sac tumors and the patients diagnosed before 2 years of age showed favorable results. Age could be a relapse risk factor in yolk sac tumors. Guidelines for handling testicular tumors in children is not yet well established in Japan. An organized system seems necessary to gather and accumulate the results of the cases in Japan in order to develop better guidelines for treatment.     

Management and outcome of bilateral testicular germ cell tumors: A 25‐year single center experience

Objectives: To analyze risk factors, management, histology, and outcome of bilateral testicular germ cell tumors (TGCT) based on a 25‐year single center experience. Methods: Out of 612 patients treated for TGCT between 1982 and 2007, 17 (3%) were found to have bilateral disease. Data of these patients were reviewed and analyzed. Results: Eleven patients (65%) were identified with metachronous and 6 (35%) with synchronous bilateral TGCT. One patient had a cryptorchism in childhood. Patients with metachronous bilateral disease presented at lower stages than those with synchronous bilateral disease (stage I: 82% vs 33%, P = 0.02). In metachronous bilateral TGCT, the interval between the tumors ranged from 4 months to 25 years with a median of 47 months. The risk of developing a TGCT in the contralateral testicle was 26‐fold higher than the a‐priori risk for a healthy individual to develop TGCT. Overall, 74% of the bilateral tumors were seminomas and >50% of the patients had similar histology on both sides. After a median follow up of 121 months for patients with synchronous and 95 months for patients with metachronous bilateral TGCT, all patients were alive with no evidence of disease. Conclusions: Most bilateral TGCT develop metachronously and are seminomas. Although patients with synchronous bilateral disease present at higher stages, both synchronous and metachronous bilateral TGCT carry a similar, excellent prognosis. Patients with unilateral TGCT require careful long‐term monitoring of the remaining testicle due to a 26‐fold increased risk of contralateral disease and a potentially long risk interval of up to 25 years.     

A case of testicular angiomyolipoma

Abstract:   The majority of testicular tumors are germ cell tumors, which are the most prevalent solid malignancies in young adult males. Non-germ cell tumors of the testis are rare. Here, we report a case of testicular angiomyolipoma (AML). A 22-year-old male underwent left orchiectomy under a diagnosis of testicular tumor. Pathological analysis demonstrated that it was composed of adipose tissue and vasculature with foci of myomatous component. The tumor demonstrated neither cytological atypia nor widespread mitotic activity. In addition, the tumor cells showed intense expression of CD34 and smooth muscle actin, whereas HMB-45 was entirely negative. Although the true cellular origin and its clinical implications remain unknown, pathological and immunohistochemical studies strongly indicated benign testicular AML with a non-germ cell origin. To our knowledge, this is only the second case of a primary testicular AML in the published reports and the detailed pathological findings are first described in this report.     

Bilateral Wilms' tumors: a single-center experience with 19 cases

Background/Purpose

Bilateral Wilms' tumors present a therapeutic challenge, particularly with delay in presentation, when there is poor response to chemotherapy and when associated with nephroblastomatosis. The primary aim of management is eradication of neoplasm, while at the same time preserving of renal function.

Methods

Nineteen bilateral Wilms' tumors were seen in our service between 1981 and 2003. This represented 10% of the 190 patients with Wilms' tumors seen during this period. There were 12 female and 7 male patients ranging in age from 7 months to 8 years. Fourteen had synchronous presentation, one of whom had liver metastasis at diagnosis. Of the 5 patients with metachronous tumors, 3 had their initial nephrectomies done elsewhere. Nephroblastomatosis was identified in 18 (95%) of the patients. Treatment was, in most cases, according to National Wilms Tumor Study Group protocols, with initial bilateral biopsy, neoadjuvant chemotherapy, and tumorectomy. Where indicated, nephrectomy (partial or complete) involved using ice dam topical cooling and vascular control, and in one case, bench surgery and extensive renal reconstruction with orthotopic autotransplantation. Revision tumorectomy was used on 3 occasions for recurrence in areas of nephroblastomatosis. There were 6 extrarenal relapses.

Results

Ten patients are alive and free of disease 1 to 15 years after treatment, all with well preserved renal function (lowest recorded glomerular filtration rate was 85 mL/min per 1.73 m²). Nine have died (2 of unrelated disease), including 6 of the 7 with spread outside the kidney. All 3 with unfavorable histology are alive. Of the 5 with metachronous presentations, 4 are alive, as are 7 of 10 who presented in the last decade.

Conclusions

Appropriate chemotherapy and conservative nephron-sparing and innovative surgery can achieve good results with preservation of adequate renal function in nearly all cases. Nephroblastomatosis was an almost universal finding and requires close monitoring because Wilms' tumors developed in residual suspect areas. Revision surgery was effective. Unfavorable histology did not have a reduced survival in our series. Metastatic spread outside the kidney had a poor prognosis.     

Testis sparing surgery for the treatment of a sequential bilateral testicular germ cell tumor

Standard therapy of sequential bilateral testis cancer is generally considered to be orchiectomy. We present a case of sequential bilateral testicular germ cell tumor treated with testis sparing surgery. The patient was disease free 50 months after surgery without local recurrence or distant metastases. Testis sparing surgery provides a better quality of life and may be considered a safe, feasible alternative in the treatment of carefully selected patients with bilateral testicular germ cell tumor.     

节段性睾丸梗死二例报告

节段性睾丸梗死发病率极低,通常表现为睾丸急性疼痛,需与睾丸肿瘤、睾丸扭转等鉴别,只有少数病例报告。本文报道2例,例1患者13岁,因右睾丸肿大、疼痛3 d,伴呕吐1次于2017年5月5日入院,行右侧阴囊探查+睾丸固定术,术后诊断为右侧睾丸局部梗死。术后第5日睾丸疼痛症状消失出院。术后1年查彩色多普勒超声未见明显异常。例2患者26岁,2018年3月15日因左睾丸肿痛6 d入院,彩色多普勒超声检查提示左睾丸局部梗死可能。入院诊断为左侧睾丸局部梗死,予血塞通、那曲肝素钙、迈之灵片治疗,治疗7 d后患者疼痛症状好转出院。出院后1个月患者无疼痛不适,复查彩色多普勒超声示左睾丸下极团样低-等回声,周边少量星点状血流信号。     

Bilateral testicular cancer: a report of four cases

Bilateral testicular cancer represents from 2 to 5% of all testicle tumors, even though this prevalence nowadays is increasing. The median age of presentation was from 15 to years and in approximately 75% of them occurred metachronously. There used to be concordance in histological findings between both testicles, being seminoma the most common histological type. The most important risk factor in the development of testicular cancer is the presence of intratubular germ cell neoplasia. Radical orquiectomy is the treatment to choose, although in some carefully selected patients testis-sparing surgery may be considered. We present four cases attended in our medical service, we analize the risk factors, management of tumors and a medical literature review is done.     

小儿睾丸肿瘤的诊疗现状

儿童与成人睾丸肿瘤在病理特点、治疗方案、临床预后上均存在明显差异。由于睾丸肿瘤在儿童中发病率低、病理分析较多、治疗方案差别较大,这要求临床医师要掌握丰富的相关医学知识及临床技能,以便对睾丸肿瘤及早诊断、精准分型及合理治疗。目前国内对小儿睾丸肿瘤的研究不多,患者数量相对较少导致研究的局限性和研究偏倚,因此对小儿睾丸肿瘤的认识有限。本文综述了睾丸肿瘤的诊断与治疗进展。     

Coccidioidomycosis mimicking testicular cancer: A case report

We present the case of a 48 year-old man with a history of pulmonary tuberculosis who was brought to our centre with a progressively increasing left testicular mass. Radiological findings were not conclusive on whether the mass was neoplastic or infectious in nature. Therefore, an orchiectomy was performed. Pathology examination revealed coccidioidomycosis of the left testicle, highlighting an exceedingly rare presentation of disseminated genitourinary coccidioidomycosis.     

肝门部胆管癌病理特征与术后随访结果分析(附113例报告)

目的评估肝门部胆管癌的病理特征对术后生存的影响并为临床治疗提供依据。方法回顾性分析1997年1月至2002年12月我院肝胆外科113例手术切除的肝门部胆管癌病理资料,并结合随访结果进行统计分析。结果高分化腺癌18例、中分化腺癌38例,低分化腺癌38例,黏液腺癌4例,其他类型15例。高、中、低分化腺癌术后5年生存率分别为57.0%,10.9%,18.8%,高分化与中低分化组间比较差异有显著性(P<0.05)。浸润能力高分化腺癌最弱、中低分化腺癌较强,黏液腺癌最强。分化程度,淋巴结转移、神经转移对术后生存时间均有显著影响(P<0.05)。结论肝门部胆管癌的分化程度、淋巴转移是影响预后的重要因素,神经转移对预后的影响仍需深入研究。     

69例睾丸扭转诊断与治疗

目的提高睾丸扭转诊断及治疗水平。方法对69例睾丸扭转患者的临床资料进行回顾性分析。结果8例12h内手术者，睾丸均存活；6例12—24h手术者，3例睾丸存活；39例超过24h手术者仅7例睾丸存活。未手术者16例，随访7例扭转睾丸均发生不同程度萎缩，尚未发现生育能力受影响者。结论早期诊断、及时治疗是提高疗效的关键。睾丸移植是治疗双侧睾丸扭转后功能性无睾症的一种有效方法。     

Resection of pulmonary metastases following chemotherapy for high stage testicular tumors

BACKGROUND: Our objective was to analyze retrospectively our experience with 19 patients who had metastatic germ cell testicular tumor and had undergone resection of pulmonary metastases following chemotherapy. We wished to determine the necessity of thoracic surgery on these patients. METHODS: Of 103 patients in need of postchemotherapeutic surgery for metastatic germ cell testicular tumors, 19 patients (mean age 31) underwent surgery for thoracic masses following cis-platin based chemotherapy. Resection of pulmonary metastases was performed on patients with normal tumor markers after chemotherapy, who did not achieve complete radiological remission. Histopathological findings, correlation with the pathology of abdominal surgery and probable prognostic factors for disease-free and overall survivals were evaluated. RESULTS: Disease-free and overall survival rates were 14/19 (73%) and 16/19 (84%), respectively, within a median follow-up time of 30 months (15-212 months). Patients with and without viable tumor cells in their thoracic histopathological specimen had 40% and 85% disease-free survival rates, respectively (P < 0.05). Eight patients had both abdominal and thoracic postchemotherapy surgery. Only two (25%) of these patients had the same histopathological features at both sites. CONCLUSIONS: All patients with residual thoracic masses must be considered candidates for surgery, because there are no predictive factors to determine the thoracic pathology without surgery. With the resection of the pulmonary metastases only, surgery can be performed without significant morbidity and is essential to select patients for further chemotherapy, to remove all visible masses and to provide histopathological confirmation. Patients with viable tumor cells in the thoracic surgical specimen have a poor prognosis.     

多中心骨巨细胞瘤9例

[目的]探讨多中心骨巨细胞瘤的临床、影像和组织病理学特点.[方法]9例20处肿瘤均经组织病理学证实为骨巨细胞瘤,影像学分析肿瘤发生部位和特点,组织病理学确定组织学形态特点,临床资料及随访确定肿瘤治疗方法和效果.[结果]女性多于男性,女:男为2:1.3例＜20岁,平均21岁.大部分发生于长骨,膝关节上下最常见.位于长骨的肿瘤影像学上表现为干骺端膨胀性、溶骨性破坏并延伸至骺端,3例病人3处局限于干骺端,不侵犯骨骺,1例出现成骨性肿瘤区.组织病理学上部分肿瘤区可出现纤维组织细胞、反应性骨形成及动脉瘤样骨囊肿.手术采用刮除植骨或广泛切除,3例复发,1例死于肺转移.[结论]多中心骨巨细胞瘤多发于年轻病人.常见于膝关节周围,部分肿瘤局限于干骺端.各处肿瘤之间是相互独立的而非由初次发生的肿瘤转移而来.肿瘤是否复发与外科手术方式有关.     

Transverse testicular ectopia with splenogonadal fusion: A case report

Both transverse testicular ectopia (TTE) and splenogonadal fusion (SGF) are rare congenital abnormalities. We report a case with both TTE and SGF, simultaneously. As far as we know, this is the first reported case. In order to identify a case of TTE or SGF, it is necessary to consider that the testes and ectopic spleens have similar patterns on ultrasonograph and magnetic resonance imaging.