Fatherhood in testicular cancer patients with carcinoma in situ in the contralateral testicle

We report paternity by assisted fertilization in 3 highly oligospermic patients with stage-I unilateral testicular germ cell tumor and contralateral carcinoma in situ. If such patients plan future paternity, surveillance is the optimal treatment allowing maximal recovery of spermatogenesis after orchiectomy. Multiple semen cryopreservations should be done during the first post-orchiectomy year.     

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.     

Experimental testicular torsion and its effects on the contralateral testicle

Objective Following experimental unilateral torsion of the testis the histologic effects of unilateral testicular torsion on the contralateral testis were investigated. Materials and methods Utilizing detorsion or orchiectomy at 4 hours and 8 hours after torsion, the effects of early and late treatment modalities on the contralateral testicle were observed. Results Morphometry of the contralateral testis revealed some alterations including focal sclerosis, decrease in mean seminiferous tubular diameter and a marked increase of the Leydig cells in some subgroups. Conclusion In spite of some changes, definite evidence for contralateral damage due to ipsilateral torsion contributing to male infertility was hardly observed.     

Experimental testicular torsion: its effect on the contralateral testicle

The purpose of this project is to determine the lesion in contralateral testis after unilateral testicular torsion. For that is reproduced the lesion in an experimental model animal using 35-45 days old Wistar rats. The study of the contralateral testis is performed 30-35 days after lesion, once orchiectomy with histopathological and ultrastructural analysis, was made. We observed zonal tubular atrophy, alteration of spermatogenesis, abnormal formation of spermatozoa and death cellular by apoptosis.     

Early detection of a contralateral second carcinoma in patients with testicular tumors caused by testicular carcinoma in situ

Carcinoma in situ (CIS) of the testis is considered to be a precursor of germ cell cancer. Diagnosis is made by the conventional biopsy technique. Only for patients at risk is a screening biopsy justifiable. This group includes patients with testicular cancer in whom the incidence of contralateral second germ cell tumors is increased. In a prospective study we found three cases of testicular CIS in biopsies from the contralateral testes of 61 such patients. All cases with a diagnosis of CIS presented with testicular atrophy (volume less than 12 ml), associated with necrozoospermia in one patient and with azoospermia in two patients. Treatment consisted in local irradiation (20 Gy) of the remaining testis to preserve Leydig cell function. In control biopsies no evidence of CIS or germ cells was found. More than 3 months after therapy, plasma testosterone levels were normal and LH and FSH levels were increased. None of the patients with negative biopsy (n = 49) who were followed up was found to have a second cancer of the contralateral testis. The average observation time so far is 17.2 months.     

The effect of unilateral testicular torsion on the contralateral testicle in prepubertal Chinese hamsters

Recent studies of experimental testicular torsion in rats, rabbits, and guinea pigs have demonstrated conflicting evidence regarding contralateral testicular damage. Those studies in which cellular damage has been found are postulated to result from an immunological mechanism whereby the blood-testis barrier is disrupted with subsequent autoantibody formation. In this study, the histologic and immunologic effects of testicular torsion on the contralateral testicle were investigated in prepubertal Chinese hamsters. Four study groups were established; (1) Left orchiectomy only, (2) sham surgery (scrotal incision), (3) 720 degrees left testicular torsion with left orchiectomy 24 hours later, (4) 720 degrees torsion of left testicle with detorsion after 24 hours. The initial procedure was performed at 1 month of age with subsequent biopsies of the contralateral testicle at 1 week, 1 month, and 6 months after the initial procedure. Testicular tissue was examined for immunofluorescent activity using fluorescent labeled goat anti-hamster IgG. Positive controls were established by rabbit immunization (rabbit anti-hamster immunoglobulin) which was subsequently combined with fluorescent labeled goat antirabbit IgG. There was no appreciable difference in immunologic activity between control and experimental animals. Representative sections were examined histologically and no tubular damage was demonstrated and active spermatogenesis was noted at 6 months in all groups. We believe that our results support the premise that testicular torsion in the prepubertal period has no effect on the contralateral testicle.     

Immunologic aspect of testicular torsion: detection of antisperm antibodies in contralateral testicle

OBJECTIVE: To evaluate the immunologic etiology in unilateral testicular torsion, an experimental study in rats was carried out. MATERIALS AND METHODS: 75 adult Wistar rats included in the study program were divided into six different groups according to a torsion-detorsion procedure. Torsion degree was kept constant for all animals (720 degrees ). Anti-rat immunoglobulin G (IgG) antibodies against spermatozoa antigens were identified in contralateral testicular tissue after 1 month following detorsion and/or orchiectomy of the twisted testicle. RESULTS: We revealed antibody formation in animals subjected to unilateral torsion for 12 and 24 h, which then followed by detorsion of the testicle. IgG was identified especially on basal membrane of the tubules. CONCLUSIONS: As the controversy on the exact mechanism of testicular damage in unilateral torsion still continues, our findings showed that a possible immunological etiology may play an important role in this respect.     

A rare diagnosis： testicular dysgenesis with carcinoma in situ detected in a patient with ultrasonic microlithiasis

A rare case is presented where a dysgenetic testis with microinvasive carcinoma in situ （CIS, also known as intratubular germ cell neoplasm of unclassified type [IGCNU] and testicular intraepithelial neoplasia [TIN]） with microinvasion to rete testis and the interstitial tissue was found in a 32-year-old man presenting with mild scrotal pain and ultrasonic testicular microlithiasis. Knowledge of the association of ultrasound and CIS is important to diagnose patients at the stage prior to development of an overt germ cell tumor. The patient had three of four disorders considered symptoms of the testicular dysgenesis syndrome （TDS）： a dysgenetic left testicle with CIS, a mild left-sided cryptorchidism （high positioned scrotal hypotrophic testis） and a slightly reduced semen quality. Therefore, it should be kept in mind that a patient with one TDS symptom may harbour the other, even CIS or testicular cancer. Accordingly, patients with one TDS symptom ought to be examined for the presence of the others, and if more that one is present, extra concern is warranted.     

Torsion and the contralateral testicle

The histologic effect of unilateral torsion on the contralateral testicle in adult Noble rats was examined. Utilizing detorsion or orchiectomy at 3 hours and 24 hours after torsion, the effect of early and late treatment of these changes was reviewed. The histologic changes consisted of loss of tubular spermatozoa, clumping of chromatin within the spermatocytes, the presence of Sertoli-only cells, evacuolization of Sertoli cytoplasm and germinal epithelial sloughing. Depression of spermatogenesis and decrease in the mean seminiferous tubular size was seen in the "normal" testicle after unilateral torsion. This effect was negated by early treatment with either orchiectomy or detorsion. Late detorsion does not negate these effects and late orchiectomy only partially negates them. Despite the depressed tubular function, the presence of early spermatogenic elements seen in the majority of the tubules in the "normal" testicle implies the possible reversibility of these changes.     

Significance of testicular microlithiasis

INTRODUCTION: Testicular microlithiasis is an uncommon condition characterized by calcifications within the seminiferous tubules. The true prevalence in a normal population has not been defined. METHODS: A review of the literature with emphasis on the connection between testicular microlithiasis and testicular malignancy was carried out. RESULTS: Testicular microlithiasis is associated with different testicular pathologies, including testicular cancer. However, a direct causative connection between testicular microlithiasis and testicular pathologies is not supported by the literature. CONCLUSIONS: Patients with testicular microlithiasis should be followed up regularly. Further investigations concerning the etiology of testicular microlithiasis remain to be done.     

睾丸微石症的临床研究进展

随着人们对男性健康意识的提高和超声影像技术不断发展,临床上对睾丸微石症的认识正日益加深。本文就睾丸微石症的概述、病因与发病机制、影像学特点、对男性生殖功能的影响、与睾丸肿瘤及其他相关疾病之间的关系以及治疗、随访等方面,将近年来的研究成果作一总结。由于睾丸微结石症与男性不育、睾丸肿瘤以及身体其他疾病相关,病因、发病机制缺乏深入细致的研究,且尚无特效的治疗方法,仍需要进行充分的探讨,目前研究成果可为临床进一步认识和诊治该病提供一定的参考。     

Clinicopathological study of the testicular microlithiasis

PURPOSE: Testicular microlithiasis (TM) is a relatively rare condition characterized by calcific concref1p4 within the seminiferous tubules. Little has been reported on the incidence or the clinical implication of TM among Japanese. To address the problem, we evaluated pathologic specimens from biopsies and orchiectomies, of testes with various conditions. MATERIALS AND METHODS: Pathologic specimens of the testes of 200 cases, 56 from orchiectomy and 144 from testicular biopsy, were investigated. RESULTS: The pathological diagnosis of TM was confirmed in seven (3.5%) cases, four of which were associated with germ cell tumors and the other three were obtained from testicular biopsies performed for examination of infertile men. Of the 41 patients with germ cell tumors, four (9.8%) were found to have TM, and another three (2.5%) were identified among 122 patients with infertility. The prevalence of TM is significantly higher in specimen with germ cell tumors than those without germ cell tumors (p < 0.05). CONCLUSIONS: Although TM is rarely encountered, this condition is relatively often accompanied by testicular malignancy. Further investigation would be fundamental to ascertain the relationship between TM and testicular malignancy.     

单侧睾丸扭转引发对侧睾丸生精损伤免疫机制的实验研究

目的探讨单侧睾丸扭转对侧睾丸生精功能损伤的机理。方法雄性SD大鼠24只,随机分为3组,建立睾丸扭转动物模型。第1组为假手术组,第2、3组扭转左侧睾丸720°并固定维持,分别于12 h和24 h后复位固定。术后1个月留取对侧睾丸称重。应用流式细胞术(FCM)检测各组生精细胞凋亡和各级生精细胞计数,免疫组化SABC法检测抗精子抗体免疫复合物(IgG)在睾丸组织中的沉积。结果第1、2、3组对侧睾丸重量分别为(1555.73±72.34)、(1184.20±101.02)、(783.60±117.93)mg,凋亡细胞数依次为53.25±8.61、1622.00±129.31、3401.25±179.75,抗精子抗体阳性染色率为0、0.55±0.02、0.69±0.03,组间两两比较差异均有统计学意义(P<0.01)。与第1组相比,第2、3组对侧睾丸单倍体、二倍体和四倍体细胞群计数明显减少,同时可见抗精子抗体免疫复合物在睾丸组织中明显沉积,其差异均有统计学意义(P<0.01)。第2、3组间(除四倍体细胞群计数外)差异亦有统计学意义(P<0.01)。结论单侧睾丸扭转导致对侧睾丸生精细胞广泛凋亡,自体免疫反应可能在对侧睾丸生精功能损伤中起重要作用。     

Incidence of testicular microlithiasis.

In adults polytopic intratubular calcifications of the testes are rare. Known as testicular microlithiasis, they manifest themselves in a characteristic echo pattern on sonography with high-frequency transducers (5 to 10 MHz). This consists of multiple echogenic specks in an otherwise normal testicular parenchyma. In a retrospective analysis of 1,710 testicular sonograms of adults, bilateral intratesticular microliths were found in 11 cases (0.6%). In 5 of them, the microliths were associated with a testicular tumor. One patient with a tumor in the contralateral testis had undergone radiotherapy and another one presented with hypogonadism. Four patients with noncontributory histories presented with varicocele or epididymal cyst. Sonographic findings were confirmed histologically in 6 patients. Multiple intratubular calcifications were found in all of them. The pathogenesis of testicular microliths is still poorly understood. Their clinical relevance is unclear, but their incidence in adults appears to be higher than reported in the literature.     

睾丸微石症的临床研究

目的 认识睾丸微石症(TM)的特点,提高临床诊治水平.方法 回顾性分析15例TM的临床资料,并结合文献进行讨论.结果 所有病例均通过阴囊高频彩超准确诊断,14例患者为双侧睾丸同时存在TM,1例为左侧单发;4例又反复出现睾丸疼痛症状,予以抗炎止痛治疗后好转,其余11例无任何临床症状,均因其他疾病而偶然发现.其中1例患者为...     

睾丸微结石症对睾丸功能的影响分析

目的了解睾丸微结石症(TM)对睾丸功能的影响,评估TM患者精液质量和血浆性激素水平。方法生育年龄要求生殖健康体检者为对象,通过物理检查,精液分析、生殖系统超声和性激素检查评估睾丸功能,其中诊断TM患者43例,精索静脉曲张(VC)45例和健康人(NC)45例作为对照组。结果本研究TM、VC和NC3组平均年龄分别为(33.25±5.81)岁、(31.85±7.26)岁和(30.13±6.09)岁,3组年龄比较无显著性差异(P>0.05)。TM组睾丸体积、精子密度、活力、活率和血清游离睾酮水平均显著低于NC组(P<0.05),但与VC组比较无显著差异(P>0.05)。结论TM显著影响睾丸功能包括生精功能和睾酮分泌功能,其机制有待于进一步研究。     

Metastatic carcinoma to testicle

Metastatic carcinoma to the testicle, epididymis, and their tunics is unusual and adenocarcinoma of the small bowel is extremely rare. The combination of primary adenocarcinoma of the jejunum with metastasis to the tunica vaginalis of the testis has not been reported previously. An unusual case of a scrotal mass in a twenty-seven-year-old black man is presented and the literature reviewed.