Metastatic testicular rhabdomyosarcoma--a report of two cases

Rhabdomyosarcoma is the most common type of soft tissue sarcoma in children. The tumor spreads by local extension, to regional lymph nodes, or by distant metastases. Metastatic spread to the testicle has been rarely described. The authors describe 2 boys who were found to have intratesticular metastases after presenting with primary tumors in their extremities. The first patient, an 11-year-old boy presented with primary disease in his left foot and an enlarged testicle. Rhabdomyosarcoma was found histologically in both the foot and the testicle. A second boy 17 years of age had a primary tumor involving the left upper extremity treated with amputation, chemotherapy, and radiotherapy. A relapse was noted 2 years later in the left testicle and was treated with orchiectomy. The authors discuss the implications and the management of this rare presentation of metastatic rhabdomyosarcoma.     

Segmental infarction of testicle presenting as right acute scrotum: a case report

We report a case of segmental infarction of a testicle seen in a 28-year-old man with right lower abdominal pain who visited our hospital. On physical examination, the right testicle was slightly elevated and Prehn's sign was positive. As torsion of the right spermatic cord was suspected, ultrasonography and color Doppler sonography were performed, revealing sufficient blood supply in the right spermatic cord and in the most part of the right testicle. However, a low echogenic area without blood flow was noted in the upper pole of testicle. Since CT and MRI findings couldn't rule out a testicular tumor, right high orchiectomy was performed. The specimen revealed a hemorrhagic area, histologically proved to be segmental hemorrhagic infarction of the testicle. Segmental infarction of a testicle is rare and our case is the 31st case in the world literature (the 7th case in Japan).     

Aligamentous testicle. New clinicopathologic entity in genesis of male infertility and its treatment by orchiopexy.

Absent scrotal ligament or the aligamentous testicle is a clinicopathologic entity which plays an important role in the genesis of male infertility. Twenty-four cases of aligamentous testicle, collected from 300 idiopathic infertile subjects, were studied. Clinical, endocrine, semen, and testicular biopsies were performed. The criteria of diagnosis of the aligamentous testicle are outlined and the role in infertility is discussed. Eighteen infertile patients with aligamentous testicle were treated by orchiopexy aiming to create an artificial scrotal ligament. The technique is described. The results were satisfactory. Failures were due to bad selection of patients.     

Avoidance of inguinal incision in laparoscopically confirmed vanishing testis syndrome

PURPOSE: Nonpalpable testicles may be due to the vanishing testis syndrome, intra-abdominal position, examination obscured by obesity or scar tissue and rarely testicular agenesis. Laparoscopy is an excellent means of distinguishing these entities without the need for open abdominal exploration. We investigated whether laparoscopy affects the need for an inguinal incision and exploration when no testicle is palpable and the vas and vas deferens are visualized exiting the internal inguinal ring on laparoscopy. MATERIALS AND METHODS: In 34 boys 6 to 18 months old (mean age 41) physical examination demonstrated a nonpalpable testicle, including on the right side in 12, on the left side in 17 and bilaterally in 5. The vanishing testis syndrome was diagnosed after laparoscopy when no testicle was palpable despite physical examination done with the patient under anesthesia, spermatic vessels were visualized exiting the internal inguinal ring or spermatic vessels were visualized in the abdomen with or without an identifiable intra-abdominal testicular nubbin. RESULTS: Laparoscopy confirmed the vanishing testis syndrome in 16 patients, intra-abdominal testicles in 13 and peeping testes in 1. Adequate examination using anesthesia was not possible in 4 patients with obesity, or previous inguinal or lower abdominal surgery. These boys underwent inguinal exploration after laparoscopy showed the vas and vessels exiting a closed internal inguinal ring. Of the 16 cases of the vanishing testis syndrome orchiectomy with contralateral scrotal orchiopexy was performed in 14 through a median raphe scrotal incision and in 1 through an inguinal incision for an associated inguinal hernia. In the remaining patient who underwent laparoscopy only a blind ending vas and vessels were visualized in the abdomen without an identifiable nubbin. The infraumbilical and median raphe incisions healed without obvious scars. Followup was at least 1 year. CONCLUSIONS: When spermatic vessels are visualized exiting the internal inguinal ring on laparoscopy in the setting of a nonpalpable testicle, a median raphe scrotal incision can be made to remove the testicular nubbin associated with the vanishing testicle syndrome. Orchiectomy is possible through this median raphe incision even when the testicle is in the inguinal canal because this distance in young children is small. Cosmesis is excellent since 1 incision is within the umbilicus and the other is on the median scrotal raphe.     

Inguinal orchiectomy for the extra testis with suspected tumor in a polyorchidic patient: a case report

A 29-years-old male patient presented with complaint of the small size of his left testicle. The physical examination revealed a normal right testicle with 15 cc volume, a small left testicle (5 cc) and a 4 cc mass under the left testicle, which was thought to be a spermatocele. Ultrasonographic imaging was performed and the mass was defined as a third testicle with a heterogenic epididymis. Scrotal magnetic resonance imaging (MRI) confirmed the diagnosis. An inguinal exploration was performed, which resulted in a left orchiectomy and biopsy of the superior left testicle. The pathologic examination revealed hyperplasia with microcystic changes in the orchiectomy specimen and severe hypospermatogenesis in the biopsy sample. There were no significant changes in semen analysis after the operation.     

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.     

Laparoscopic single-stage Fowler-Stephens orchidopexy in a case of orchidogastric fusion

This report describes laparoscopic Fowler-Stephens orchidopexy for cryptorchidism resulting from orchidogastric fusion in an infant born with gastroschisis. At 11 months of age, the left testicle remained impalpable, and diagnostic laparoscopy was performed. Intraoperatively, a normal-appearing testicle was found attached to the stomach. The testicle was dissected, mobilized down to the left inguinal ring, exteriorized through a transscrotal trocar, and subsequently fixated in the lower left scrotum. On follow-up 5 months later, both testicles were normal in size and location. Single-stage laparoscopic Fowler-Stephens orchidopexy is easily accomplished in cases of orchidogastric fusion resulting from a long vas deferens.     

Does every retroperitoneal mass associated with undescended testicle represent testicular tumor or its metastasis?

We are presenting a 36 year old male patient who was diagnosed to have a right pararenal mass on CT scan taken for evaluation of his long lasting urinary stone disease and accompanying undescended right testicle. He subsequently underwent a retroperitoneal lymph node dissection for possible testicular tumor or its metastasis in the undescended testicle or retroperitoneal primary tumor, which came out to be non malignant tissue. We confirmed that the highest possible location of the testicle when undescended is at the level of the internal inguinal ring, and paracaval masses associated with undescended testicles do not necessarily represent a testicular tumor in the retained testicle, its metastasis or an extragonadal germ cell tumor (EGT), and further work should be done to illuminate the nature of such cases.     

Unilateral renal agenesia associated with partial epididymis and vas deferens agenesia in a patient with abdominal testicle

This study considers a unilateral renal agenesia associated with agenesia of the epididymis body and tail and the vas deferens and non-palpable left testicle in a 20-month-year-old patient. During laparoscopic procedure, the testicle was positioned at approximately 5 cm above the inguinal ring. The size was appropriate for the age and the head of the epididymis was situated in its normal position. The decision was made to perform the first step of the Fowler-Stephens' surgery and the patient presented a good evolution. The association of male duct system agenesia with unilateral renal agenesia in a patient with cryptorchidism diagnosed by laparoscopy is an extremely rare event, however generally in these cases the testicle is of normal size, presents unaltered hormonal function, and must be preserved.     

Les torsions sur testicules cryptorchides

Purpose:

Cryptorchidism is a rather frequent pathology in urology. It is associated with a high risk of infertility and degeneration. It also seems to be associated with a high risk of torsion. This entity is poorly studied in the literature. We studied the cases of torsion on cryptorchid testicles hospitalized at our service, to better characterize this pathology and reduce the rate of orchidectomy.

Methods:

We underwent a retrospective study of all the cases of torsion on a cryptorchid testicle hospitalized in our service of urology between 1999 and 2007.

Results:

The age of patients was between 7 months and 39 years. Torsion touched the right testicle in 53% of the cases. Patients experienced a brutal pain of the inguinal area with an under cutaneous mass inflammatory and a painful and empty homolateral scrotum. In 60% of the cases, the diagnosis was late and an orchidectomy was carried out. In the other cases, a lowering of the testicle was done with the controlateral orchidopexy.

Conclusion:

Even though torsions on a cryptorchid testicle are rare, we should not ignore them. The early diagnosis will make it possible to save and lower the testicle, and track a possible degeneration.     

Retro-umbilical ectopic testicle: report of a case.

A case of a retro-umbilical ectopic testicle in a 13-year-old cryptorchid boy is reported. To our knowledge this has not been reported previously. There is no definite explanation for this highly aberrant ectopia. During the neonatal period the boy had an umbilical suppuration that required drainage. This may offer a possible explanation since the consequent healing process could have pulled the peritoneum upwards, dragging the testicle with it. Despite the high position of this testicle (and previous operation on the other side) it was easy to cross over both testes successfully to the heterolateral scrotum.     

Infarto testicular segmentario: un pseudotumor infrecuente

ObjectiveTo review the morphologic features of the segmental infarct of testicle with special insistence in the differential diagnosis with a testicular tumor.Material and methodsRetrospective revision of the cases with pathologic diagnostic of segmental infarct of testicle diagnosed and treated in our institution. In the selected cases, we review the histological slides and we collected the clinical and radiological features.ResultsWe reported 6 cases with the following clinic-pathological features: the average age was 42 years old, both right and left testicles were affected with the same frequency, and the aetiology was idiopathic, trauma or inflammation. All of them with pathological diagnosis of segmental infarct of testicle, either acute or chronic, and in all of them a testicular tumor was suspected.ConclusionSegmental infarct of testicle is an unfrequent cause of testicular pseudotumor. It must be considered in the clinical differential diagnostic of testicular masses in order to avoid unnecessary orchiectomies.     

Intramural hematoma of the small bowel: a possible lethal complication of herniography.

A severe and possible lethal complication of herniography is reported. A 3-year-old child who was born with an undescended testicle on the right side and a normal descended testicle on the left underwent a herniography study. Twelve hours following the procedure, he developed lower abdominal pain which progressed over the next 72 hours. A diagnosis of mesenteric hematoma was entertained and he underwent abdominal surgery. At operation a large intramural hematoma was found in a segment of nonviable bowel. This segment was resected with an end-to-end anastomosis. The postoperative course was uneventful.     

Microsurgical transvaso-vasostomy

We report a case of an infertile man treated successfully with microsurgical transvaso-vasostomy. The patient had a normal testicle with an obstructed vas deferens on one side and an atrophied testicle with a normal vas on the other side. We anastomosed the proximal vas from the functioning testicle to the opposite intact vas through the median scrotal raphe. As a result, the patient fathered a child 16 months after operation.     

The efficacy of methods for the surgical lower repositioning of the undescended testicle depending on the level of its location]

The results of 22 section investigations performed are indicative of the limited effectiveness of the existing methods for mobilization of a vascular pedicle of the undescended testicle with the aim of its transposition into the scrotum. Bringing down without stretching of a vascular pedicle is possible only in location of an undescended testicle in the middle or lower third of the inguinal canal. In higher level of location of a testicle, its bringing down by conventional methods is inevitably associated with stretching of a vascular pedicle.     

Obturator foramen approach. II. A new surgical approach for management of the short-pedicled undescended testicle

A new approach for the management of the short-pedicled undescended testicle is presented. It was used in four patients with the testicle lying deep to the internal inguinal ring after all methods of cord elongation failed to bring the testicle down to the scrotum. The technique consists of passing the testicle through the obturator foramen to the scrotum. No complications were encountered, and the results have been satisfactory. Normally the vas deferens and testicular vessels describe a loop along their inguinal and pelvic course. The obturator foramen approach shunts this loop, which may be lacking in the undescended testicle lying deep to the internal inguinal ring.     

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.     

Primary testicular lymphoma. Report of a case

Case report of a primary testicular lymphoma in a sixty-two years old man, presenting initially as an enlargement of the testicle as the only symptom. Orchiectomy of left testicle was performed, with the diagnosis of Non-Hodgkin B lymphocytic lymphoma. The treatment applied was CHOP, presenting poor evolution with cerebral metastasis. He dead twenty-five months later diagnosis.     

转录因子E2F1在非梗阻性无精症睾丸组织中的表达

目的旨在探讨E2F1核转录因子在人类睾丸组织中的表达与生精功能的关系。方法选取32例人类非梗阻性无精子症睾丸组织石蜡标本，采用HE染色观察曲细精管病理变化，同时用免疫组化SP法检测睾丸组织中核转录因子E2F1的表达;对照组选取13例人类正常睾丸组织。通过分析病理组HE染色，比较E2F1阳性染色范围及程度，评价E2F1核转录因子与生精功能的关系。结果非梗阻性无精子症睾丸组织HE染色显示精曲小管中无或仅少量精子，精曲小管的生精上皮脱落、排列紊乱，精曲小管壁部分有玻变、纤维变，生精细胞萎缩。32例非梗阻性无精子症睾丸组织中E2F1阳性表达8例，阴性表达24例，阳性率25%;13例正常睾丸组织中E2F1的阳性表达9例，阴性表达4例，阳性率69.23%;x2=7.694，差异有显著性（P〈0.01）。结论（1）E2F1核转录因子表达缺失与睾丸生精功能障碍密切相关;（2）非梗阻性无精子症睾丸组织精曲小管的生精上皮脱落、排列紊乱，生精阻滞。     

Transverse ectopia of the right testicle and tumor of the left testicle with immature uterus and fallopian tubes: report of a case

A case of transverse ectopia of the right testicle and the left testicular tumor with the immature uterus and the fallopian tubes is reported. The patient, a 27-year-old married man, was admitted to our hospital with the suspicion of left testicular tumor and right undescended testicle. In his left scrotum, a double hen-egg-sized tumor was palpable and the right scrotum was empty. Exploration of the left inguinal canal disclosed double testicles with hernia uteri inguinalis. The right testicle showed transverse ectopia, and the histological finding of the left testicle was choriocarcinoma. In our review of the Japanese literature, we discovered 67 reported cases of transverse testicular ectopia. 33 (49.3%) out of 67 cases had a uterus and 9 cases (13.4%) had testicular tumor.