National Cancer Institute®
Last Modified: October 1, 2002
UI - 10774080
AU - Opot EN; Magoha GA
TI - Testicular cancer at Kenyatta National Hospital, Nairobi.
SO - East Afr Med J 2000 Feb;77(2):80-5
AD - Department of Surgery, College of Health Sciences, University of Nairobi.
OBJECTIVE: To determine the prevalence, clinical characteristics, management methods and prognosis of testicular cancer at Kenyatta National Hospital. DESIGN: Retrospective case study of testicular cancer patients over a fifteen year period. SETTING: Kenyatta National Hospital, a referral and teaching hospital. PARTICIPANTS: All histologically confirmed testicular cancer patients recorded at the Histopathology Department of Kenyatta National Hospital between 1983 and 1997. RESULTS: The mean age was 34.8 years with a peak incidence in the 30-44 year age group. History of cryptochirdism was obtained in 10.26% of the patients. Thirty one patients (79.49%) presented with painless testicular swellings, eleven (28.08%) with pain, nine (23.08%) with scrotal heaviness, six (15.38%) with abdominal swellings and one (2.56%) each with gynaecomastia and eye swelling. On examination 32 patients (82.05%) had testicular masses, ten (25.64%) had abdominal masses, seven (17.91%) had supraclavicular and cervical lymphadenopathy, and one each (2.56%) had gynaecomastia and eye mass respectively. More than eighty nine per cent had germ cell cancers with seminoma accounting for 67.35%, teratoma 12.24%, embroyonal carcinoma 8.16%, rhabdomyosarcoma 6.12% and malignant germ cell tumour, orchioblastoma and dysgerminoma each accounted for 2.04%. Three patients (7.7%) had orchidectomy and radiotherapy and chemotherapy, sixteen (41.03%) had orchidectomy and radiotherapy, six (15.38%) had orchidectomy and chemotherapy, ten (25.64%) had radiotherapy and chemotherapy, three (7.7%) and two (5.13%) had only chemotherapy and radiotherapy respectively. No cisplastin based chemotherapy regime was used. Follow up was effected for eighteen patients (46.15%) and seven patients (38.89%) were alive after five years. CONCLUSION: Prognosis with current regimes was poor with survival of only 38.89% after five years. Cisplastin based chemotherapy with up to 90% cure rates should be included as a component of testicular cancer management at Kenyatta National Hospital.
UI - 12175407
AU - Geldart TR; Simmonds PD; Mead GM
TI - Orchidectomy after chemotherapy for patients with metastatic testicular germ cell cancer.
SO - BJU Int 2002 Sep;90(4):451-5
AD - Wessex Medical Oncology Unit, Southampton University Hospitals, Southampton, UK. email@example.com
OBJECTIVE: To evaluate the contribution of routine orchidectomy in the management of patients who present with advanced, metastatic, testicular germ cell cancer and who are treated with initial chemotherapy. PATIENTS AND METHODS: Sixty consecutive patients presenting with metastatic testicular germ cell cancer and treated with initial chemotherapy followed by orchidectomy were identified. The results from a clinical and pathological review of these patients are presented. The pathological findings at orchidectomy were compared with the pathological findings from metastatic masses resected after chemotherapy, and are reviewed with the clinical outcome. RESULTS: Of the 60 orchidectomy specimens after chemotherapy, 24 (40%) contained significant histological abnormalities comprising residual invasive germ cell cancer, intratubular germ cell neoplasia and/or mature teratoma. The remaining 36 (60%) orchidectomy specimens contained fibrous scarring with or with no necrosis. Six (10%) orchidectomy specimens contained residual invasive germ cell cancer, three nonseminomatous germ cell cancer (NSGCT) and three seminoma. The patients with residual invasive NSGCT present within the testis had evidence of residual invasive NSGCT within extragonadal masses resected after chemotherapy; all three have relapsed and died from chemorefractory progressive disease. CONCLUSION: Orchidectomy after chemotherapy is recommended in all patients undergoing primary chemotherapy, as a significant proportion (40%) are left with histological abnormalities that predispose to subsequent relapse. Persistence of invasive NSGCT at the site of the primary tumour after chemotherapy is associated with persistence of invasive disease at other metastatic sites and is a poor prognostic finding.
UI - 2319701
AU - Mori M; Davies TW; Miyake H; Masuoka H; Kumamoto Y; Tsukamoto T
TI - Maternal factors of testicular cancer: a case-control study in Japan.
SO - Jpn J Clin Oncol 1990 Mar;20(1):72-7
AD - Department of Public Health, Sapporo Medical Cllege.
A case-control study was undertaken in Japan to clarify maternal or prenatal factors associated with testicular cancer. Information was obtained from 37 mothers of testicular cancer patients, recruited from the discharge records of nine hospitals in Hokkaido, the northern island of Japan. Thirty-seven mothers forming a control group were then surveyed at five public health centers. Each control was selected by individually matching the sex and birth year to a testicular cancer case. Univariate analysis revealed that there were no statistically significant differences in the variables surveyed. Multivariate logistic regression analysis, however, showed that case mothers had significantly fewer live-births than control mothers when the following four variables were adjusted (adjusted relative risk per live-birth = 0.43, P = 0.025): age at indexed birth, duration of breast-feeding for indexed child, birth order, experience of induced abortion.
UI - 2106990
AU - Cale AR; Farouk M; Prescott RJ; Wallace IW
TI - Does vasectomy accelerate testicular tumour? Importance of testicular examinations before and after vasectomy.
SO - BMJ 1990 Feb 10;300(6721):370
AD - Bangour General Hospital, West Lothian.
UI - 1571679
AU - Nienhuis H; Goldacre M; Seagroatt V; Gill L; Vessey M
TI - Incidence of disease after vasectomy: a record linkage retrospective cohort study.
SO - BMJ 1992 Mar 21;304(6829):743-6
AD - Unit of Clinical Epidemiology, University of Oxford.
OBJECTIVE--To determine whether vasectomy is associated with an increased risk of several diseases, and in particular testicular cancer, after operation. DESIGN--Retrospective cohort study using linked medical record abstracts. SETTING--Six health districts in Oxford region. SUBJECTS--13,246 men aged 25-49 years who had undergone vasectomy between 1970 and 1986, and 22,196 comparison subjects who had been admitted during the same period for one of three specified elective operations, appendicitis, or injuries. MAIN OUTCOME MEASURES--Hospital admission and death after vasectomy or comparison event. RESULTS--The mean durations of follow up were 6.6 years for men with a vasectomy and 7.5 years for men with a comparison condition. The relative risk of cancer of the testis in the vasectomy cohort (4 cases) compared with that in the other cohorts (17 cases) was 0.46 (95% confidence interval 0.1 to 1.4), that of cancer of the prostate (1 v 5 cases) 0.44 (0.1 to 4.0), and that of myocardial infarction (97 v 226 cases) 1.00 (0.8 to 1.3). There was no evidence of an increase associated with vasectomy in the incidence of a range of other diseases. CONCLUSIONS--Vasectomy was not associated with an increased risk of testicular cancer or the other diseases studied. With respect to prostatic cancer, while we found no cause for concern, longer periods of observation on large numbers of men are required.
UI - 8518871
AU - Hewitt G; Logan CJ; Curry RC
TI - Does vasectomy cause testicular cancer?
SO - Br J Urol 1993 May;71(5):607-8
AD - Department of Surgery, Ulster Hospital, Belfast.
Between 1975 and 1990, 330 men developed testicular tumours in Northern Ireland. Their names were cross matched with a sample of 2904 men who had undergone vasectomy between 1970 and 1985. The expected numbers of tumours in vasectomised patients was 2, while the actual number was 1. Our experience does not indicate that vasectomy causes testicular cancer.
UI - 6140323
AU - Depue RH; Pike MC; Henderson BE
TI - Estrogen exposure during gestation and risk of testicular cancer.
SO - J Natl Cancer Inst 1983 Dec;71(6):1151-5
In this case--control study of 108 cases of testicular cancer in men under 30 years of age, cryptorchidism was a major risk factor [relative risk (RR) = 9.0]. Low birth weight was also associated with increased risk (RR = 3.2). Having severe acne at puberty was protective (RR = 0.37). Interviews with mothers of cases revealed that exposure of the mother to exogenous estrogen during pregnancy created a significant risk in the son (RR = 8.0). In first pregnancies, excessive nausea indicated an increased risk of testicular cancer (RR = 4.2). Increased body weight in the mother also increased the risk. The relation between these factors and testicular hypoplasia is discussed. Severe perimenopausal menorrhagia was a factor in the mother associated with reduced risk of testicular cancer in the son (RR = 0.10). A modified hormonal milieu in the mother appears to be important in the later development of testicular cancer in her sons.
UI - 2837898
AU - Strader CH; Weiss NS; Daling JR
TI - Vasectomy and the incidence of testicular cancer.
SO - Am J Epidemiol 1988 Jul;128(1):56-63
AD - Hanford Environmental Health Foundation, Richland, WA.
Adult male residents of 13 counties of western Washington state in whom testicular cancer had been diagnosed during 1977-1983 (n = 333) were interviewed over the telephone regarding their history of genital tract conditions, including vasectomy. For comparison, the same interview was given to a sample of 729 men selected from the population of these counties by dialing telephone numbers at random. A higher proportion of cases than controls reported having had a vasectomy (relative risk = 1.5, 95 per cent confidence interval = 1.0-2.2). However, the association was restricted entirely to Catholic men. Whereas a history of vasectomy was reported with approximately equal frequency by Catholic and non-Catholic cases, only 6.3 per cent of Catholic controls reported such a history in contrast to 19.7 per cent of other controls. While the authors cannot rule out the possibility that there is a true difference of the effect of vasectomy on the incidence of testicular cancer as a function of religion, it seems more plausible that selective underreporting by Catholic controls has produced a spurious relation.
UI - 3177126
AU - Mori M; Miyake H; Kumamoto Y; Tsukamoto T; Saitoh S; Enatsu C; Tamiya T;
TI - Tanda H; Fujita M; Honma A; et al [A case-control study of testicular cancer]
SO - Hinyokika Kiyo 1988 May;34(5):832-8
AD - Department of Public Health, Sapporo Medical College.
A study on the possible association of maternal factors with testicular cancer was undertaken. Information was obtained from the mothers of testicular cancer cases (N = 37) and the mothers of men without the disease (N = 37). Comparisons were made between the two groups. The cases were collected from the records of nine hospitals, and the controls were selected from five Public Health Centers by individually matching the sex and the year of birth with the testicular cancer cases. The mothers of the cases had significantly fewer live births than the mothers of the controls (the adjusted odds ratio per live birth = 0.4, p = 0.02), when the five following variables had been simultaneously adjusted by the logistic regression analysis. Those five variables included the Quetelet's Index of mothers before pregnancy, the age at an index birth, the duration of breastfeeding for an index child, the birth order of an index child, and the number of induced abortions. The endogenous hormonal milieu of a mother may be associated with the occurrence of testicular cancer in her child.
UI - 12201940
AU - Harper M; Arya M; Peters JL; Buckingham S; Freeman A; O'Donoghue EP
TI - Intratesticular lipoma.
SO - Scand J Urol Nephrol 2002;36(3):223-4
AD - Institute of Urology & Nephrology, University College London, London, UK. firstname.lastname@example.org
Benign intratesticular lesions are rare. We describe the second reported case of an intratesticular lipoma and discuss the limitations of ultrasonography in differentiating benign from malignant conditions occurring within the testis.
UI - 11925418
AU - Schrader M; Muller M; Sofikitis N; Straub B; Miller K
TI - Testicular sperm extraction in azoospermic cancer patients prior to treatment--a new guideline?
SO - Hum Reprod 2002 Apr;17(4):1127-8
UI - 11957559
AU - Lim LP; Tan AM; Chan MY; Rajalingam V; Lou J; Tan CL
TI - Paediatric extracranial germ cell tumours: a retrospective review.
SO - Ann Acad Med Singapore 2002 Mar;31(2):206-11
AD - Haematology/Oncology Service, Department of Paediatric Medicine, KK Women's & Children's Hospital, 100 Bukit Timah Road, Singapore 229899. email@example.com
INTRODUCTION: Germ cell tumours (GCTs) are rare, constituting 3% of all childhood malignancies. The aim of this study was to analyse the epidemiology and outcome of these patients. MATERIALS AND METHODS: A retrospective, cohort study was conducted on 38 paediatric patients presenting with extracranial GCTs, treated at the Singapore General Hospital, Tan Tock Seng Hospital and Kandang Kerbau Women's and at diagnosis was 1.7 years (0 to 13 years). RESULTS: There was no sex or racial preponderance. Eighteen patients (47.3%) had teratomas, 16 (42.1%) had yolk sac tumours, 1 (2.6%) had dysgerminoma and 3 (7.9%) had mixed GCTs. Thirty-four patients (89.5%) had Stage I disease, 1 (2.6%) had Stage II disease, 1 (2.6%) had Stage III disease and 2 (5.3%) had metastatic disease. Complete tumour resection was achieved in 36 of the 38 patients (95%). Cisplatin-based combination chemotherapy was given to 11 patients (28.9%). None of the patients received radiotherapy. Complications from chemotherapy included anaemia requiring packed red cell transfusion (n = 3), Port-a-cath sepsis requiring removal (n = 1), febrile neutropenia (n = 1) and nephropathy (n = 1). CONCLUSION: Using the Kaplan-Meier life tables, the overall and event-free survivals at 10 years for the patients with malignant GCTs were 96% and 88%, respectively, with a mean follow-up period of 5.1 years (0.7 to 10 years). The majority of the patients presented with early Stage I disease and this contributed to our high survival rate.
UI - 11896104
AU - Kersemaekers AM; Mayer F; Molier M; van Weeren PC; Oosterhuis JW;
TI - Bokemeyer C; Looijenga LH Role of P53 and MDM2 in treatment response of human germ cell tumors.
SO - J Clin Oncol 2002 Mar 15;20(6):1551-61
AD - Department of Pathology/Laboratory for Experimental Patho-Oncology, University Hospital Rotterdam/Daniel, Josephine Nefkens Institute, Erasmus University Rotterdam, Rotterdam, The Netherlands.
PURPOSE: Testicular germ cell tumors (TGCTs) of adolescents and adults are very sensitive to systemic treatment. The exquisite chemosensitivity of these cancers has been attributed to a high level of wild-type P53. MATERIALS AND METHODS: To clarify the role of P53 in treatment sensitivity and resistance of TGCTs, we performed immunohistochemistry and Western blotting analysis on a series of 39 fresh-frozen primary TGCTs before therapy (unselected series). In a series of formalin-fixed paraffin-embedded TGCTs of patients with fully documented clinical course, including treatment-sensitive (n = 17) and -resistant (n = 18) tumors, P53 status was assessed by immunohistochemistry and mutation analysis. In addition, the involvement of MDM2, a P53 antagonist, was investigated by immunohistochemistry, reverse transcriptase polymerase chain reaction, and in situ hybridization. RESULTS: Immunohistochemistry demonstrated absence of staining for P53 in 36%, 41%, and 17% of the unselected, responding, and nonresponding TGCTs, respectively. Of the positive TGCTs, most tumors, ie, 49%, 41%, and 33%, showed 1% to 10% positive nuclei. This overall low level of P53 was confirmed by Western blotting. Mutation analysis revealed only one silent P53 mutation in one of the responding patients. All embryonal carcinomas were homogeneously positive for MDM2, encoded by the full length mRNA, while a heterogeneous pattern was found for the other histologic components. Amplification of MDM2 was detected in one out of 12 embryonal carcinomas. CONCLUSION: Although our results are in line with previous findings of the presence of wild-type P53 in TGCTs, they show that a high level of P53 does not relate directly to treatment sensitivity of these tumors, and inactivation of P53 is not a common event in the development of cisplatin resistance.
UI - 12149951
AU - Drognitz O; Pfeiffenberger J; Schareck W; Adam U; Nizze H; Hopt UT
TI - [Primary aortoduodenal fistula as a late complication of para-aortic radiation therapy. A case report]
SO - Chirurg 2002 Jun;73(6):633-7
AD - Abteilung fur Allgemeine Chirurgie und Visceralchirurgie, Klinik und Poliklinik fur Chirurgie, Albert-Ludwigs-Universitat Freiburg i.Br., Hugstetter Strasse 55, 79106 Freiburg i.Br. firstname.lastname@example.org
Primary aortoenteric fistulae (AEFs) are rare vascular entities. More than 75% of primary AEFs involve the duodenum, with the overwhelming majority located in the third or fourth portion. Atherosclerosis, leading to formation of an aortic aneurysm, remains the most common etiology, accounting for more than 3/4 of the cases reported. Primary aortoenteric fistulae following radiotherapy are rare. The case of a 49-year-old man with aortoduodenal fistula 22 years after para-aortic hematemesis and melena. Endoscopy suggested the presence of an ulcus but no definitive bleeding source could be seen. Bleeding stopped spontaneously. Six hours later he developed massive hematemesis and was transferred to our department. An emergency operation was performed. We found an aorto-duodenal fistula in the third portion of the duodenum without an aortic aneurysm. We directly sutured the aortic wall laceration and resected the third and fourth part of the duodenum. Histology revealed typical signs of radiation damage. The patient is alive and well 2 years after surgery. To our knowledge, this is the sixth case of a primary aorto-duodenal fistula following radiotherapy ever to be reported in world literature.
UI - 12188077
AU - Kok KY; Telesinghe PU
TI - Lymphangioma of the epididymis.
SO - Singapore Med J 2002 May;43(5):249-50
AD - Department of Surgery, Ripas Hospital, Brunei Darussalam. email@example.com
We report herein a 39-year-old man with a left scrotal swelling.The clinical and ultrasonographic appearances were suggestive of epididymal cyst. Histopathology of the excised lesion was shown to be lymphangioma of the epididymis.The differential diagnoses of a swelling in the scrotum of a young man include both benign and malignant conditions. Lymphangioma of the epididymis is, however, a rare and unusual cause.
UI - 12196237
AU - Hruby G; Choo R; Jackson M; Warde P; Sandler H
TI - Management preferences following radical inguinal orchidectomy for Stage I testicular seminoma in Australasia.
SO - Australas Radiol 2002 Sep;46(3):280-4
AD - Department of Radiation Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia. firstname.lastname@example.org
A survey to evaluate the preferred patterns of management of Stage I distributed by the Royal Australian and New Zealand College of Radiologists to all qualified radiation oncologists, 74 out of 170 responded. All performed a staging CT scan of the abdomen and pelvis. Thoracic imaging consisted of either chest X-ray (29%) or chest CT (38%) while 33% performed both. Fifty-four percent of radiation oncologists discussed surveillance with their patients but estimated that 5% or less would choose this option. The most commonly prescribed dose was 25 Gy in 15 or 20 fractions (79%). Sixty-five percent of respondents treated the para-aortic (PA) nodes alone. Forty-two of 48 clinicians treating the PA field reported a change in practice after publication of the Medical Research Council study in 1999. Of these, 40 and 23% perform CT scans of the pelvis annually and every 6 months. Thirty-one percent did no follow-up CT scan. Compared to a similar survey from North America, we are more likely to use PA fields and less likely to discuss surveillance. As in the USA, and in contrast to Canada, few patients choose surveillance. There is no consensus regarding the frequency of follow-up scans in either North America or Australasia.
UI - 12237987
AU - Wynd CA
TI - Testicular self-examination in young adult men.
SO - J Nurs Scholarsh 2002;34(3):251-5
AD - University of Akron, 209 Carroll Street, Akron, OH 44325-3701, USA. email@example.com
PURPOSE: To describe patterns of testicular self-examination (TSE) in a sample of young adult men and to identify factors distinguishing between men who do and do not practice TSE. DESIGN: A comparative descriptive design with a convenience sample of 191 adult men aged 18-35 years, recruited from a large industrial complex in the U.S. Midwest. Data were collected during several occupational health fairs held from 1999-2001. METHODS: A self-report, 75-item health risk appraisal (HRA) was administered to identify health-related lifestyle habits. Men who did and did not perform TSE regularly were compared using Mann-Whitney U statistics for discrete variables and t tests for continuous data. Discriminant function analysis was used to identify factors allowing prediction of frequent or infrequent TSE performance. FINDINGS: Sixty-four percent of 191 participants reported rarely or never performing TSE, and 36% practiced TSE monthly or every few months. Men who infrequently performed TSE were more often African American or Hispanic and had less than a college education. Other significant factors associated with infrequent TSE practice included less satisfaction with current job assignment; less satisfaction with life in general; greater worries interfering with daily life; more serious family problems in dealing with spouse, children, or parents; and reduced availability of people to turn to for support. CONCLUSIONS: Demographic and socioeconomic variables were related to TSE knowledge and performance. Further investigation is required to determine why men, especially ethnic minority men, are not performing this important cancer-screening activity.
UI - 12240866
AU - Talwar V; Sreedharan PS; Warrier NK; Ramanan SG; Sagar TG
TI - Intracardiac metastases from a testicular germ cell tumor.
SO - J Assoc Physicians India 2002 Jun;50():855
AD - Department of Medical Oncology, Cancer Institute, Adyar, Chennai.
UI - 11763316
AU - Albanese JM; Reuter VE; Bosl GJ; Houldsworth J; Chaganti RS
TI - Expression of ID genes in differentiated elements of human male germ cell tumors.
SO - Diagn Mol Pathol 2001 Dec;10(4):248-54
AD - Cell Biology Program, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
The ID genes are members of a family of genes that encode helix-loop-helix (HLH)-containing proteins. The Id proteins, unlike other HLH proteins, lack an adjacent DNA binding domain and hence act as dominant negative regulators of HLH transcription factors that have been implicated in control of cellular differentiation. Although the role of Id genes in murine development has been documented, their roles in human embryogenesis remain unknown. In this study, human male germ cell tumors (GCTs) were used as a model for examining the expression of the ID genes in various histologies that are reflective of different temporal phases of human development. In seminomas, little or no expression of IDI, ID2, and ID3 was detected, consistent with the uncommitted germ cell-like phenotype of this tumor histology. Likewise, GCTs with histologies reflective of extraembryonic and embryonic patterns of differentiation exhibited patterns of expression of the three ID genes often similar to those noted during murine development. It was also evident, as revealed by ID expression patterns, that despite the overall aberrant spatial differentiation patterns displayed by these tumors, some tissue-tissue interactions reminiscent of those observed during normal embryogenesis are retained. Thus, adult male GCTs offer a unique system in which the role of genes such as the IDs can be studied in human embryogenesis.
UI - 12352332
AU - Ross JH; Rybicki L; Kay R
TI - Clinical behavior and a contemporary management algorithm for prepubertal testis tumors: a summary of the Prepubertal Testis Tumor Registry.
SO - J Urol 2002 Oct;168(4 Pt 2):1675-8; discussion 1678-9
AD - Section of Pediatric Urology, Cleveland Clinic Urological Institute and Cleveland Clinic Department of Biostatistics and Epidemiology, Cleveland, OH, USA.
PURPOSE: The Prepubertal Testis Tumor Registry was established by the Urologic Section of the American Academy of Pediatrics in 1980 to record data on a large number of prepubertal testis tumors regarding presentation, treatment and outcome to define appropriate management better. We reviewed the registry data in the context of other modern studies to elucidate the appropriate management of these rare tumors. MATERIALS AND METHODS: Relevant data in the prepubertal testis tumor registry were tabulated and analyzed. RESULTS: There were 395 prepubertal patients who had a primary testis tumor. Generally benign tumors accounted for 38% of cases. A significant proportion of tumors were benign regardless of patient age. alpha-Fetoprotein levels for patients with benign and malignant tumors overlapped in children younger than 6 months. Of the patients with yolk sac tumor 80% presented with stage 1 disease and overall survival was excellent. There were no metastases or deaths among the patients with teratoma. Of all patients with stromal tumors metastases developed in only 1. CONCLUSIONS: We recommend initial excisional biopsy for all amenable prepubertal testis tumors, except those with an alpha-fetoprotein level that is clearly increased for patient age. Patients with benign tumors may be released from oncological followup. Patients with stage I yolk sac tumor should be monitored closely, and those with recurrent or metastatic yolk sac tumor should be treated with chemotherapy. Retroperitoneal lymph node dissection is reserved for patients with recurrent retroperitoneal masses following chemotherapy. Aggressive treatment of metastatic Sertoli cell or undifferentiated stromal tumors is warranted.
UI - 11893462
AU - Bhalla RK; Jones TM; Errington D; Roland NJ
TI - Metastatic testicular seminoma--a case report.
SO - Auris Nasus Larynx 2002 Apr;29(2):219-22
AD - Department of Otolaryngology, University Hospital Aintree, Lower Lane, L9 7AL, Liverpool, UK. firstname.lastname@example.org
We present the case of a 42-year-old male who presented with a hot, tender swelling in the left supraclavicular fossa. He was pyrexial on presentation with a mildly elevated leucocyte count of 12.4x10(9)/l. Clinical examination, including full ear, nose and throat assessment, proved unremarkable. The medical history revealed that 2 years earlier the patient had been diagnosed with a testicular seminoma for which he underwent a right inguinal orchidectomy and abdominal radiotherapy. CT scan highlighted a 6 cm para-laryngeal mass, of mixed attenuation, with an adjacent region of inflammation. Overall appearance was suggestive of an infective mass. Ultrasound-guided fine needle aspiration cytology revealed a metastatic seminomatous deposit. Imaging of the chest and abdomen revealed this as the only site of metastasis. He is currently undergoing chemotherapy, and is responding well. We review the pathology of testicular seminoma. This case highlights the myriad of pathologies that may present as a lump in the neck.
UI - 12228753
AU - Foster R; Bihrle R
TI - Current status of retroperitoneal lymph node dissection and testicular cancer: when to operate.
SO - Cancer Control 2002 Jul-Aug;9(4):277-83
AD - Department of Urology, Indiana University School of Medicine, Indianapolis, IN 46202, USA. email@example.com
BACKGROUND: Historically, retroperitoneal lymph node dissection (RPLND) has been used in the therapy of both low-stage and high-stage testicular cancer after chemotherapy. As other therapies have developed, the role of RPLND has also evolved. METHODS: The authors review the current indications for RPLND in the therapy of testicular cancer. RESULTS: Metastatic testicular cancer can be cured in 50% to 75% of cases by surgical removal using RPLND, depending on the volume of metastasis. In postchemotherapy disease, the surgical removal of teratoma or carcinoma also confers a therapeutic benefit to the patient. CONCLUSIONS: The therapeutic capability of RPLND in low-stage testicular cancer is underappreciated. In postchemotherapy disease, this therapeutic capability is retained if the patient has carcinoma or teratoma in the metastatic tumor. In postchemotherapy disease, efforts continue to appropriately select patients preoperatively who have only fibrosis and necrosis in the specimen and therefore do not derive therapeutic benefit from RPLND.
UI - 12228759
AU - Shvarts O; Han KR; Seltzer M; Pantuck AJ; Belldegrun AS
TI - Positron emission tomography in urologic oncology.
SO - Cancer Control 2002 Jul-Aug;9(4):335-42
AD - Department of Urology, University of California Los Angeles School of Medicine, Los Angeles, Calif 90095, USA.
BACKGROUND: Positron emission tomography (PET) is an emerging imaging modality that is being investigated for use in urologic oncology. PET scanning using the radioactive glucose analog FDG has proven to be a highly accurate imaging test for diagnosing and staging a variety of non-urologic cancer types. This review was performed to determine the role of PET imaging in genitourinary malignancies. METHODS: A review of the literature focusing on PET and urologic oncology was performed. The role of PET imaging was reviewed in prostate, bladder, renal, and testicular cancer. RESULTS: In testicular cancer, PET has a higher diagnostic accuracy than computed tomography (CT) for both staging and re-staging and should be the test of choice for the assessment of a CT-visualized residual mass following chemotherapy. In prostate, renal, and bladder cancer, the current role of PET is still being defined, but it has a high positive predictive value and can be used for problem solving in patients with indeterminate findings on conventional imaging. Its role in the diagnosis and staging of prostate cancer is hampered by the generally low glycolytic rate of most prostate tumors and their metastases. It has shown promise for staging and re-staging patients with advanced-stage disease and aggressive tumors suspected by a high tumor grade and high prostate-specific antigen velocity. PET has also demonstrated success when applied to renal cell carcinoma in classifying indeterminate renal masses as well as residual renal fossa masses following nephrectomy, gauging response to therapy, and staging and re-staging patients with a known diagnosis of renal cell carcinoma. CONCLUSIONS: PET imaging has demonstrated great potential in certain applications, but further investigations are necessary to determine its eventual place as an imaging modality in genitourinary malignancies.
UI - 12352400
AU - Ohyama C; Chiba Y; Yamazaki T; Endoh M; Hoshi S; Arai Y
TI - Lymphatic mapping and gamma probe guided laparoscopic biopsy of sentinel lymph node in patients with clinical stage I testicular tumor.
SO - J Urol 2002 Oct;168(4 Pt 1):1390-5
AD - Department of Urology, Tohoku University School of Medicine, Sendai, Japan.
PURPOSE: We attempted to detect lymphatic drainage and sentinel lymph node with radioactive tracer in patients with testicular tumor. We then tried to determine if sentinel lymph node biopsy with gamma probe guided laparoscopic procedure was feasible as a staging tool for patients with clinical stage I testicular tumor. MATERIALS AND METHODS: Technetium-labeled phytate was injected around the tumor in 15 consecutive patients with clinical stage I testicular tumor. Lymphatic drainage and sentinel lymph nodes were imaged by a gamma camera. Localization of the sentinel lymph node was confirmed with a handheld gamma probe. After we confirmed that sentinel lymph nodes were detected in the initial 10 patients, gamma probe guided laparoscopic sentinel lymph node biopsy was performed after routine orchiectomy in the next 4. To confirm whether the radioactive node was really a sentinel lymph node the final patient in this series underwent laparoscopic retroperitoneal lymph node dissection with a unilateral template. RESULTS: Sentinel lymph nodes were detected in all patients by lymphoscintigraphy and handheld gamma probe, and each node varied. Right tumors in sentinel lymph node were detected at the inter-aortocaval, paracaval or common iliac region. Para-aortic lymph nodes were detected as sentinel lymph node in cases of left tumor. In the 4 patients who underwent gamma probe navigated laparoscopic procedure sentinel lymph nodes were easily detected and safely removed for pathological examination. In the last patient who underwent laparoscopic lymph node dissection micrometastasis was found only at the sentinel lymph node. CONCLUSIONS: Sentinel lymph node can be detected by lymphoscintigraphy and handheld gamma probe. Gamma probe guided laparoscopic biopsy of sentinel lymph node is technically possible. These techniques may have a role in the management of clinical stage I testicular tumor but further trials are required for establishment of the concept of sentinel lymph node in testicular tumor.
UI - 12352401
AU - Langenstroer P; Rosen MA; Griebling TL; Thrasher JB
TI - Ejaculatory function in stage T1 nonseminomatous germ cell tumors: retroperitoneal lymph node dissection versus surveillance--a decision analysis.
SO - J Urol 2002 Oct;168(4 Pt 1):1396-401
AD - University of Kansas Medical Center, Kansas City, USA.
PURPOSE: Ejaculatory function remains a major concern for patients with low stage nonseminomatous germ cell tumors of the testis. Whereas, it has been extensively studied in patients undergoing retroperitoneal lymph node dissection, preservation of ejaculatory function on surveillance protocols has not been studied. To compare ejaculatory function for surveillance protocols to primary retroperitoneal lymph node dissection appropriately, we constructed a decision analysis model mimicking the standard treatment algorithm for stage 1 nonseminomatous germ cell tumor of the testis. MATERIALS AND METHODS: The primary clinical payoff for this study is ejaculatory function. Based on this model, we established that a primary nerve sparing retroperitoneal dissection must be performed with a 96.8% ejaculatory function rate to be recommended as the appropriate therapy. However, if a highly skilled surgeon routinely performs post-chemotherapy dissection with an ejaculatory function rate of 69.2% or greater, surveillance should be offered as the primary treatment modality. This result simply demonstrates a high skill level to allow the surgeon to salvage ejaculatory function in post-chemotherapy retroperitoneal lymph node dissection settings. If this level cannot be achieved, primary retroperitoneal lymph node dissection is the best choice. If we account for a 10% loss of ejaculatory function from primary chemotherapy, the minimum ejaculatory function rate for primary retroperitoneal dissection decreases to 95.7%. RESULTS: In the post-chemotherapy setting an 85.7% ejaculatory function rate must be achieved for surveillance to be considered the optimal choice. Clearly, less surgical rigor is needed with a primary retroperitoneal lymph node dissection when correcting for the effects of chemotherapy on ejaculatory function. Despite this fact, 1-way sensitivity analysis revealed that our model is insensitive to the ejaculatory function effects of chemotherapy. Furthermore, if the likelihood of recurrence on surveillance is greater than 16%, primary nerve sparing retroperitoneal lymph node dissection should again be recommended. CONCLUSIONS: Thus, to maximize ejaculatory function for patients with stage 1 nonseminomatous germ cell tumor a nerve sparing primary retroperitoneal lymph node dissection should always be performed, unless the likelihood of recurrence on surveillance is low or the surgical skill level allows for a highly successful post chemotherapy nerve sparing dissection.
UI - 12352402
AU - Beck SD; Foster RS; Bihrle R; Ulbright T; Koch MO; Wahle GR; Einhorn LH;
TI - Donohue JP Teratoma in the orchiectomy specimen and volume of metastasis are predictors of retroperitoneal teratoma in post-chemotherapy nonseminomatous testis cancer.
SO - J Urol 2002 Oct;168(4 Pt 1):1402-4
AD - Department of Urology, Indiana University School of Medicine, Indianapolis, USA.
PURPOSE: Patients who require post-chemotherapy retroperitoneal lymph node dissection after induction chemotherapy for metastatic testis cancer derive therapeutic benefit from resection of teratoma but resection of necrosis is not beneficial. We determine if the absence of teratoma in the orchiectomy specimen is a reliable predictor of the absence of teratoma in the retroperitoneum at post-chemotherapy retroperitoneal lymph node dissection. MATERIALS AND METHODS: A retrospective review of the Indiana University testis cancer data base was performed. A total of 644 patients who underwent retroperitoneal lymph node dissection after induction chemotherapy only were selected for study. The presence or absence of teratoma in the orchiectomy specimen and volume of retroperitoneal tumor were analyzed as predictors of retroperitoneal teratoma at post-chemotherapy retroperitoneal lymph node dissection. RESULTS: Of the patients with teratoma in the orchiectomy specimen 85.6% had an element of teratoma in the retroperitoneum, and of those without teratomatous elements in the orchiectomy specimen 48% had teratoma in the retroperitoneum (p <0.00001). Increasing volumes of retroperitoneal tumor were associated with a higher probability of discovering teratoma at post-chemotherapy retroperitoneal lymph node dissection. CONCLUSIONS: The absence of teratoma in the orchiectomy specimen does not reliably predict the absence of teratoma in the surgical specimen at post-chemotherapy retroperitoneal lymph node dissection. Post-chemotherapy surgery is indicated if retroperitoneal tumor remains after chemotherapy irrespective of the presence or absence of teratoma in the orchiectomy specimen.
UI - 12352451
AU - Granata C; Rizzo A; Carlini C; Gambini C; Magnano G; Conte M
TI - Primary paratesticular neuroblastoma.
SO - J Urol 2002 Oct;168(4 Pt 1):1530-1
AD - Department of Surgery, Giannini Gaslini Children's Hospital, Genoa, Italy.
UI - 11425975
AU - Bach AM; Hann LE; Hadar O; Shi W; Yoo HH; Giess CS; Sheinfeld J; Thaler
TI - H Testicular microlithiasis: what is its association with testicular cancer?
SO - Radiology 2001 Jul;220(1):70-5
AD - Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA. firstname.lastname@example.org
PURPOSE: To determine the prevalence of testicular microlithiasis in patients who were referred for scrotal ultrasonography (US) at a tertiary care cancer center and to evaluate the association between microlithiasis and cancer. MATERIALS AND METHODS: Testicular sonograms obtained in 528 men were retrospectively reviewed to identify patients with US findings suggestive of microlithiasis, intratesticular masses, and intratesticular heterogeneous changes. The association of US findings with medical records and with histopathologic findings that were available in 95 patients was evaluated. Statistical analysis was performed to determine the relationship of testicular cancer, intratesticular mass, and microlithiasis. RESULTS: Forty-eight (9%) of the 528 patients had microlithiasis; 13 of these (27%) had testicular cancers. Of the 480 patients without microlithiasis, 38 (8%) had testicular cancer. Ninety patients had an intratesticular mass, of whom 23 (26%) had microlithiasis. Forty-three (12 with microlithiasis) patients with a mass had testicular cancer, 43 (10 with microlithiasis) had benign findings or nontesticular malignant histopathologic findings, and four (one with microlithiasis) had no pathologic findings. CONCLUSION: Intratesticular microlithiasis is highly associated with confirmed testicular cancer, as well as with US evidence of testicular mass.
UI - 12218862
AU - Thoumas D; Caty A; Gobet F; Lemaitre L
TI - [Imaging of testicular tumors]
SO - J Radiol 2002 Jun;83(6 Pt 2):883- 93, discussion 894-6
AD - CHU de Rouen, Hopital Charles Nicolle, Service de Radiologie, Departement central d'imagerie, 1, rue de Germont, 76031 Rouen cedex, France.
Testicular cancer is the most common malignancy in young men and its incidence is increasing. The overall rate of cure can exceed 90% when management is optimal. Ultrasonography for diagnosis and thoraco-abdominal CT for staging are the optimal imaging modalities. In this paper we analyze technical parameters as well as findings and the strategy of examinations in testicular neoplasm.
UI - 12237772
AU - Berney DM; Shamash J; Gaffney J; Jordan S; Oliver RT
TI - DNA topoisomerase I and II expression in drug resistant germ cell tumours.
SO - Br J Cancer 2002 Sep 9;87(6):624-9
AD - Department of Histopathology and Morbid Anatomy, St Bartholomew's Hospital, Queen Mary's School of Medicine and Dentistry, London EC1 7BE, UK. D.Berney@bartsandthelondon.nhs.uk
A small number of testicular germ cell tumours are refractory to current chemotherapy regimens. DNA topoisomerase I is the target for several new drugs and a potential candidate treatment for chemorefractory germ cell tumours. DNA topoisomerase II alpha is the target for etoposide, which is currently used regularly in germ cell tumour treatment. The expression of DNA topoisomerase I and II alpha were therefore assessed immunohistochemically in a range of testicular tumours, especially those with persistent malignant elements on retroperitoneal lymph node dissection. Pre-chemotherapy orchidectomy specimens were matched with post-chemotherapy retroperitoneal lymph node dissections to examine changes in expression. There was considerable variation in the expression of topoisomerase I in different tumour types. Both yolk sac tumours and teratoma, mature showed universal expression of topoisomerase I, while 38% of seminomas and 30% of embryonal carcinomas were positive. Strong topoisomerase II alpha expression was found in embryonal carcinoma. There was a negative correlation between topoisomerase I and II alpha expression (P=0.004) and downregulation of topoisomerase II alpha after chemotherapy (P=0.02). Topoisomerase I expression appears to increase in those cases with residual teratoma, mature, but is largely unchanged in those cases remaining as embryonal carcinoma. These results suggest that topoisomerase I inhibitors may be useful in chemorefractory germ cell tumours, especially yolk sac tumours and where there are unresectable residual teratoma, mature deposits.
UI - 11796908
AU - Woodward PJ; Sohaey R; O'Donoghue MJ; Green DE
TI - From the archives of the AFIP: tumors and tumorlike lesions of the testis: radiologic-pathologic correlation.
SO - Radiographics 2002 Jan-Feb;22(1):189-216
AD - Department of Radiologic Pathology, Armed Forces Institute of Pathology, 6825 16th St, NW, Bldg 54, Rm M-121, Washington, DC 20306-6000, USA. email@example.com
Testicular carcinoma represents only 1% of all neoplasms in men, but it is the most common malignancy in the 15-34-year-old age group. Germ cell tumors constitute 95% of all testicular tumors. Germ cell tumors are a varied group of neoplasms whose imaging features reflect their underlying histologic characteristics. Seminomas are generally well-defined homogeneous lesions, whereas the nonseminomatous tumors (embryonal carcinoma, yolk sac tumor, choriocarcinoma, teratoma, and mixed germ cell tumor) have a much more varied appearance. Germ cell tumors follow a predictable pattern of spread via the lymphatic drainage to the retroperitoneal nodes. Choriocarcinoma, which has a proclivity for early hematogenous spread, is a notable exception. Testicular tumors may also arise from the sex cords (Sertoli cells) and stroma (Leydig cells). Although 90% of these tumors are benign, there are no reliable imaging criteria to differentiate them from malignant masses. Some benign testicular masses can be recognized, obviating an unwarranted orchiectomy. A dilated rete testis is a normal variant and appears as a series of small tubules near the mediastinum testis. Other benign lesions that can be suspected on the basis of imaging findings and history include intratesticular cysts, epidermoid cysts, congenital adrenal hyperplasia, and sarcoidosis. Copyright RSNA, 2002