Medicine › Surgery

Testicular diseases and treatments

Works Count: 60466

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Description

This cluster of papers focuses on testicular germ cell tumors, covering topics such as diagnosis, treatment, long-term survival, chemotherapy, risk factors, and genetic aspects. It also explores complications, including cardiovascular disease, associated with the treatment of testicular cancer.

Keywords

Testicular Cancer; Germ Cell Tumors; Survivors; Chemotherapy; Diagnosis; Treatment; Risk Factors; Cryptorchidism; Long-Term Complications; Genetic Factors

Guidelines on Testicular Cancer: 2015 Update

2015-08-18

Peter Albers , Walter Albrecht , Ferrán Algaba +7 more

Sonography of the Scrotum

2003-04-01

Vikram S. Dogra , Ronald H. Gottlieb , Mayumi Oka +1 more

Ultrasonography (US) with a high-frequency (7.5–10-MHz) transducer has become the imaging modality of choice for examination of the scrotum. US examination can provide information valuable for the differential diagnosis of … Ultrasonography (US) with a high-frequency (7.5–10-MHz) transducer has become the imaging modality of choice for examination of the scrotum. US examination can provide information valuable for the differential diagnosis of a variety of disease processes involving the scrotum that have similar clinical manifestations (eg, pain, swelling, or presence of mass). The pathologic condition that may be at the origin of such symptoms can vary from testicular torsion to infection to malignancy. The ability of color and power Doppler US to demonstrate testicular perfusion aids in reaching a specific diagnosis in patients with acute scrotal pain. This review covers the anatomy of the scrotum and the scanning protocol for scrotal US, as well as detailed descriptions of disease processes and their US appearances. Newly described conditions such as intratesticular varicoceles and other benign intratesticular cystic lesions are also discussed. © RSNA, 2003

Cryptorchidism in mice mutant for Insl3

1999-07-01

Serge Nef , Luis F. Parada

Treatment of testicular cancer: a new and improved model.

1990-11-01

Lawrence H. Einhorn

Testicular cancer has become a model for a curable neoplasm. Prior to the advent of cisplatin combination chemotherapy, standard chemotherapy consisted of dactinomycin, alone or in combination with chlorambucil and … Testicular cancer has become a model for a curable neoplasm. Prior to the advent of cisplatin combination chemotherapy, standard chemotherapy consisted of dactinomycin, alone or in combination with chlorambucil and methotrexate. Disseminated germ cell tumors were chemosensitive to these older regimens, with a 50% objective response rate and a 10% to 20% complete remission rate; however, the cure rate was only 5% to 10%. In 1974, we began our initial cisplatin plus vinblastine plus bleomycin (PVB) chemotherapy. Thirty-three of 47 patients with disseminated germ cell tumors treated from 1974 to 1976 achieved a complete remission (CR), and an additional five (11%) were rendered disease-free with post-PVB resection of teratoma or carcinoma. Twenty-seven (57%) of these patients are continuously disease-free with a minimal follow-up of 13 + years. Thus, cisplatin-based chemotherapy produced a one-log increase in the cure rate compared with dactinomycin. A subsequent phase III study performed from 1976 to 1978 demonstrated that the vinblastine dosage could be reduced 25% from 0.4 mg/kg to 0.3 mg/kg with a reduction in toxicity but without any decrement in therapeutic efficacy. A third-generation PVB study from 1978 to 1981 documented that optimal cure rates were achieved with 12 weeks of induction therapy with PVB and that long-term maintenance therapy with vinblastine was unnecessary. In 1978, we initiated salvage therapy with cisplatin plus etoposide (VP-16) in patients not cured with PVB, and 25% of these patients were subsequently cured with this regimen. This represented the first time an adult solid tumor had been cured with a second-line regimen. In 1983, we began studies with third-line therapy with cisplatin plus ifosfamide combination chemotherapy, and even in this refractory setting, approximately 20% of patients are curable. From 1981 to 1984, we compared cisplatin plus VP-16 plus bleomycin (PVP16B) with PVB as first-line chemotherapy. There was a significant reduction in neuromuscular toxicity favoring the VP-16 arm, and furthermore, 78% of these patients were continuously disease-free compared with 66% with PVB. Approximately 75% of patients with disseminated germ cell tumors will be cured with PVP16B, and an additional 10% are curable with salvage chemotherapy. This represents the highest cure rate in any adult malignancy.

Vinblastine plus ifosfamide plus cisplatin as initial salvage therapy in recurrent germ cell tumor.

1998-07-01

Patrick J. Loehrer , R Gonin , Craig R. Nichols +2 more

PURPOSE This study was designed to assess the effectiveness of vinblastine, ifosfamide, and cisplatin (VeIP) as second-line therapy in patients with recurrent germ cell tumors with previous treatment with cisplatin … PURPOSE This study was designed to assess the effectiveness of vinblastine, ifosfamide, and cisplatin (VeIP) as second-line therapy in patients with recurrent germ cell tumors with previous treatment with cisplatin plus etoposide, usually in combination with bleomycin. PATIENTS AND METHODS From July 1984 through December 1989, 135 patients with progressive, disseminated germ cell tumors after cisplatin-etoposide-based combination therapy induction chemotherapy were treated with VeIP. Patients who progressed within 3 weeks of previous cisplatin therapy were not eligible. Progression was documented by biopsy or increasing serum markers. No exclusion was made on the basis of metastatic site or performance status. The dosages were vinblastine 0.11 mg/kg/d (days 1 and 2), ifosfamide 1.2 gm/m2/d (days 1 through 5), and cisplatin 20 mg/m2/d (days 1 through 5), with courses repeated every 21 days for four cycles. RESULTS Sixty-seven (49.6%) patients achieved a disease-free status after chemotherapy with or without surgical resection of residual carcinoma or teratoma. Overall, 42 (32%) patients are alive and 32 (23.7%) are continuously free of disease. None of the 32 patients with nonseminomatous extragonadal tumors are disease-free compared with 30 of 100 patients with gonadal primaries. Two of three extragonadal seminomas are continuously disease-free. CONCLUSION VeIP is capable of producing durable complete remissions in patients with disseminated germ cell cancer who relapse after cisplatin-etoposide-based induction therapy. Long-term disease-free survival is not seen in those patients with extragonadal nonseminomatous germ cell tumors.

Prognostic Factors for Relapse in Stage I Seminoma Managed by Surveillance: A Pooled Analysis

2002-11-14

Padraig Warde , Lena Specht , A. Horwich +4 more

Several management options are available to patients with stage I seminoma, including adjuvant radiotherapy, surveillance, and adjuvant chemotherapy. We performed a pooled analysis of patients from the four largest surveillance … Several management options are available to patients with stage I seminoma, including adjuvant radiotherapy, surveillance, and adjuvant chemotherapy. We performed a pooled analysis of patients from the four largest surveillance studies to better delineate prognostic factors associated with disease progression.Individual patient data were obtained from each center (Princess Margaret Hospital, Danish Testicular Cancer Study Group, Royal Marsden Hospital, and Royal London Hospital) for 638 patients. Tumor characteristics (size, histologic subtype, invasion of rete testis, and tumor invasion into small vessels [SVI]) as well as age at diagnosis were analyzed for prognostic importance for relapse.With a median follow-up of 7.0 years (range, 0.02 to 17.5 years), 121 relapses were observed for an actuarial 5-year relapse-free rate (RFR) of 82.3%. On univariate analysis, tumor size (RFR: <or= 4 cm, 87%; > 4 cm, 76%; P =.003), rete testis invasion (RFR: 86% [absent] v 77% [present], P =.003), and the presence of SVI (RFR: 86% [absent] v 77% [present], P =.038) were predictive of relapse. On multivariate analysis, tumor size (<or= 4 cm v > 4 cm, hazard ratio 2.0; 95% confidence interval [CI], 1.3 to 3.2) and invasion of the rete testis (hazard ratio 1.7; 95% CI, 1.1 to 2.6) remained as important predictors for relapse.We have identified size of primary tumor and rete testis invasion as important prognostic factors for relapse in patients with stage I seminoma managed with surveillance. This information will allow patients and clinicians to choose management based on a more accurate assessment of an individual patient's risk of relapse. In addition, it will allow clinicians to tailor follow-up protocols based on risk of occult disease.

HISTOPATHOLOGY IN THE PREDICTION OF RELAPSE OF PATIENTS WITH STAGE I TESTICULAR TERATOMA TREATED BY ORCHIDECTOMY ALONE

1987-08-01

Laurence S. Freedman , William G. Jones , Michael Peckham +5 more

Evaluation and Treatment of Cryptorchidism: AUA Guideline

2014-05-20

Thomas F. Kolon , C.D. Anthony Herndon , Linda A. Baker +7 more

You have accessJournal of UrologyAUA Guideline1 Aug 2014Evaluation and Treatment of Cryptorchidism: AUA Guidelineis companion ofAUA Guideline on the Diagnosis and Treatment of Cryptorchidism Thomas F. Kolon, C.D. Anthony Herndon, … You have accessJournal of UrologyAUA Guideline1 Aug 2014Evaluation and Treatment of Cryptorchidism: AUA Guidelineis companion ofAUA Guideline on the Diagnosis and Treatment of Cryptorchidism Thomas F. Kolon, C.D. Anthony Herndon, Linda A. Baker, Laurence S. Baskin, Cheryl G. Baxter, Earl Y. Cheng, Mireya Diaz, Peter A. Lee, Carl J. Seashore, Gregory E. Tasian, and Julia S. Barthold Thomas F. KolonThomas F. Kolon More articles by this author , C.D. Anthony HerndonC.D. Anthony Herndon More articles by this author , Linda A. BakerLinda A. Baker More articles by this author , Laurence S. BaskinLaurence S. Baskin More articles by this author , Cheryl G. BaxterCheryl G. Baxter More articles by this author , Earl Y. ChengEarl Y. Cheng More articles by this author , Mireya DiazMireya Diaz More articles by this author , Peter A. LeePeter A. Lee More articles by this author , Carl J. SeashoreCarl J. Seashore More articles by this author , Gregory E. TasianGregory E. Tasian More articles by this author , and Julia S. BartholdJulia S. Barthold More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.05.005AboutAbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Abstract Purpose: Cryptorchidism is one of the most common pediatric disorders of the male endocrine glands and the most common genital disorder identified at birth. This guideline is intended to provide physicians and non-physician providers (primary care and specialists) with a consensus of principles and treatment plans for the management of cryptorchidism (typically isolated non-syndromic). Materials and Methods: A systematic review and meta-analysis of the published literature was conducted using controlled vocabulary supplemented with key words relating to the relevant concepts of cryptorchidism. The search strategy was developed and executed by reference librarians and methodologists to create an evidence report limited to English-language, published peer-reviewed literature. This review yielded 704 articles published from 1980 through 2013 that were used to form a majority of the guideline statements. Clinical Principles and Expert Opinions were used for guideline statements lacking sufficient evidence-based data. Results: Guideline statements were created to inform clinicians on the proper methods of history-taking, physical exam, and evaluation of the boy with cryptorchidism, as well as the various hormonal and surgical treatment options. Conclusions: Imaging for cryptorchidism is not recommended prior to referral, which should occur by 6 months of age. Orchidopexy (orchiopexy is the preferred term) is the most successful therapy to relocate the testis into the scrotum, while hormonal therapy is not recommended. Successful scrotal repositioning of the testis may reduce but does not prevent the potential long-term issues of infertility and testis cancer. Appropriate counseling and follow-up of the patient is essential. Cryptorchidism or undescended testis is one of the most common pediatric disorders of the male endocrine glands and the most common genital disorder identified at birth. Cryptorchidism is defined as failure of a testis to descend into a scrotal position. This situation most commonly refers to a testis that is present but in an extrascrotal position, but may also lead to identification of an absent testis. In the latter situation, the testis is most commonly referred to as vanishing (or vanished); consistent with evidence suggesting that it was present initially but disappeared during development most likely due to spermatic cord torsion or vascular accident. The main reasons for treatment of cryptorchidism include increased risks of impairment of fertility potential, testicular malignancy, torsion and/or associated inguinal hernia. The current standard of therapy in the United States is orchidopexy (orchiopexy is the preferred term), or surgical repositioning of the testis within the scrotal sac, while hormonal therapy has fewer advocates. Successful scrotal relocation of the testis, however, may reduce but does not prevent these potential long-term sequelae in susceptible individuals. The purpose of this guideline is to provide physicians and non-physician providers (primary care and specialists) with a consensus of principles and treatment plans for the management of cryptorchidism (typically isolated nonsyndromic; intensive discussion of disorders of sex development is beyond the scope of this guideline). The panel members are representative of various medical specialties (pediatric urology, pediatric endocrinology, general pediatrics). Methodology The primary source of evidence for this guideline was the systematic review conducted as part of the Agency for Healthcare Research and Quality Comparative Effectiveness Review titled Evaluation and Treatment of Cryptorchidism (2012). That report included systematic searches of MEDLINE®, Cumulative Index to Nursing and Allied Health Literature, and EMBASE® for English-language studies published from January 1980 through February 2012 relevant to cryptorchidism. To capture more recently published manuscripts to augment and broaden the body of evidence provided in the original AHRQ report, the American Urological Association conducted additional supplementary searches of PubMed® and EMBASE for relevant articles published between January 1980 and March 2013 that were systematically reviewed using a methodology developed a priori. In total, these searches yielded 704 studies, after exclusions, that were used to inform the statements presented in the guideline as Standards, Recommendations or Options and the accompanying treatment algorithm (see figure). When sufficient evidence existed, the body of evidence for a particular clinical action was assigned a strength rating of A (high), B (moderate) or C (low). In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions. The AUA nomenclature system explicitly links statement type to body of evidence strength and the Panel's judgment regarding the balance between benefits and risks/burdens. For a complete discussion of the methodology and evidence grading, please refer to the unabridged guideline available at http://www.auanet.org/education/guidelines/cryptorchidism.cfm. Guideline Statements Diagnosis 1. Providers should obtain gestational history at initial evaluation of boys with suspected cryptorchidism. (Standard; Evidence Strength: Grade B) Testicular descent occurs in two phases: transabdominal descent and inguinoscrotal migration. Initial transabdominal descent occurs in the first trimester of gestation. At approximately 22–25 weeks of gestational age, the testes are located at the internal ring. The inguinoscrotal phase of testicular descent, which is androgen dependent, occurs between 25–30 weeks.1,2 Given the relatively late migration of testes through the inguinal canal into the scrotum, the prevalence of cryptorchidism is higher in premature boys in the first months of life (1–3% in full-term and 15–30% in premature male infants).3 Descent of the testes into the scrotum is probable in premature boys during the first months of life, but is unlikely after six months of corrected age.4,5 Obtaining the gestational age is thus critical to the proper and timely referral of a child with persistent undescended testes to a surgical specialist. In addition to gestational age, low birth weight for gestational age has also been closely associated with cryptorchidism: the prevalence of cryptorchidism in infants <900g is approximately 100%. The prevalence of cryptorchidism decreases as the birth weight of the infant increases, and is approximately 3% in infants weighing 2,700–3,600 g.3,6 Spontaneous postnatal testicular descent may be lower in boys with cryptorchidism and a history of small-for-gestational age compared to boys with cryptorchidism and normal birth weight.4,6 2. Primary care providers should palpate testes for quality and position at each recommended well-child visit. (Standard; Evidence Strength: Grade B) A UDT may be located in the abdomen, the inguinal canal, the superficial inguinal pouch, the upper scrotum, or, may rarely be in an ectopic location (perineum, contralateral scrotum, or femoral). Approximately 70% of UDTs are palpable.7 For testes that are not palpable, approximately 30% will be found in the inguinal-scrotal area, 55% will be intra-abdominal, and 15% will be absent or vanishing.8 Testicular position may change as infants and children grow. Spontaneous descent of testes may occur in the first six months of life.4,5 Additionally, testes may “ascend” out of the scrotum (acquired cryptorchidism). Given the potential for change in testicular position throughout childhood, careful evaluation of the scrotum should be performed at every scheduled well-child check. A genital examination should be performed at every well-child check as outlined by the Bright Futures of the American Academy of Pediatrics.9 Documentation of testes in the dependent scrotum in the first few years of life should not preclude continued examination of the genitals at every scheduled clinic visit. Systematic genital examination will allow identification and referral of boys with acquired cryptorchidism (see Guideline Statement 4). Acquired cryptorchid testes are at risk for developing the same adverse histologic changes seen in primary cryptorchid testes and contribute to the number of orchiopexies performed.10 Continued genital examinations will also allow identification of boys with retractile testes. While retractile testes do not require surgical correction, the risk of testicular ascent may be higher in boys with retractile testes than in boys whose testes are always positioned in the dependent scrotum.11 Therefore, children with retractile testes should be monitored for “ascent” of the affected testis. 3. Providers should refer infants with a history of cryptorchidism (detected at birth) who do not have spontaneous testicular descent by six months (corrected for gestational age) to an appropriate surgical specialist for timely evaluation. (Standard; Evidence Strength: Grade B) Testes that remain undescended by six months (corrected for gestational age) are unlikely to descend spontaneously.4 In order to facilitate timely orchidopexy, boys whose testicle(s) remain undescended by six months (corrected for gestational age) should be referred to an appropriate surgical specialist.12 The rationale for referral by six months (corrected for gestational age) is the low probability of spontaneous descent and the probable continued damage to testes that remain in a non-scrotal location. 4. Providers should refer boys with the possibility of newly diagnosed (acquired) cryptorchidism after six months (corrected for gestational age) to an appropriate surgical specialist. (Standard; Evidence Strength: Grade B) Acquired cryptorchidism is the ascent of a previously descended testis and subsequent inability to manipulate the testis back into the scrotum. Acquired cryptorchidism is a clinical condition distinct from primary UDT and is easily differentiated from congenital cryptorchidism if scrotal testicular position has been documented since birth. The prevalence of acquired cryptorchidism is 1–7% and peaks around 8 years of age.13 The observation that acquired cryptorchidism is more common in boys with a history of proximal hypospadias suggests that a common mechanism, such as aberrant androgen signaling, may predispose to both anomalies in otherwise normal boys.14 Additionally, boys with a history of retractile testes may be at increased risk for testicular ascent.11,14 Reports indicate that the same adverse histologic features (e.g. loss of germ cells) found in primary UDTs are also found in acquired cryptorchid testes.15 5. Providers must immediately consult an appropriate specialist for all phenotypic male newborns with bilateral, nonpalpable testes for evaluation of a possible disorder of sex development. (Standard; Evidence Strength: Grade A) Approximately 20–30% of all patients with cryptorchidism have bilateral UDTs.4 In this situation, it is critical to determine if the gonads are palpable or nonpalpable. A newborn with a male phallus and bilateral nonpalpable gonads is potentially a genetic female (46 XX) with congenital adrenal hyperplasia until proven otherwise. Failure to diagnose congenital adrenal hyperplasia can result in serious harm, as a high proportion of patients with this condition are unable to regulate their electrolyte levels and may present with shock, hyponatremia and hyperkalemia.16 Thus, serum electrolytes should be monitored. Additionally, karyotype and a hormonal profile (including 17-hydroxyprogesterone levels, luteinizing hormone, follicle-stimlating hormone, testosterone and androstenedione) must be obtained with simultaneous consultation with pediatric endocrinology and pediatric urology. Although the initial electrolyte evaluation can be obtained by the first-line provider, consultation with above specialists should be obtained due to the complexity of the condition and the need for coordinated multi-specialty care. 6. Providers should not perform ultrasound or other imaging modalities in the evaluation of boys with cryptorchidism prior to referral, as these studies rarely assist in decision making. (Standard; Evidence Strength: Grade B) In the hands of an experienced provider or specialist, more than 70% of cryptorchid testes are palpable by physical examination and need no imaging. In the remaining 30% of cases with a nonpalpable testis, the challenge is to confirm absence or presence of the testis. At this time, there is no radiological test that can conclude with 100% accuracy that a testis is absent. Therefore, a surgical exploration, such as diagnostic laparoscopy (or open exploration), must be performed on all nonpalpable unilateral and most bilateral cryptorchid patients. US is non-contributory in routine use, with sensitivity and specificity to localize a nonpalpable testis at 45% and 78%, respectively.17 US cannot reliably localize a nonpalpable testis or confirm an absent/vanished testis. The cost and ionizing radiation exposure associated with CT scanning precludes its use. MRI with or without angiography has been more widely used with greater sensitivity and specificity but is deterred by cost, low availability and need for anesthesia.18 7. Providers should assess the possibility of a disorder of sex development (DSD) when there is increasing severity of hypospadias with cryptorchidism. (Recommendation; Evidence Strength: Grade C) A newborn boy with bilateral nonpalpable testes must be evaluated for disorder of sexual development and should not be circumcised until after the workup is complete, even if a completely normal phenotypic penis is documented on examination. A 46 XX individual with severe congenital adrenal hyperplasia can be mistaken for a boy with bilateral cryptorchidism. The possibility of DSD, or other syndromes should also be entertained when unilateral or bilateral cryptorchidism is present with phallic anomalies, such as hypospadias or micropenis. 8. In boys with bilateral, nonpalpable testes who do not have congenital adrenal hyperplasia, providers should measure müllerian inhibiting substance or anti-müllerian hormone and consider additional hormone testing to evaluate for anorchia. (Option; Evidence Strength: Grade C) Masculinized infants with bilateral nonpalpable testes require prompt careful consideration and testing. Partially or completely masculinized infants with bilateral nonpalpable testes must be rapidly evaluated for 46 XX DSD due to life-threatening congenital adrenal hyperplasia (discussed above). In contrast, if the infant with bilateral nonpalpable testes has normal penile development or micropenis and 46 XY karyotype, an evaluation to distinguish vanishing testis syndrome (bilateral congenital anorchia) versus bilateral abdominal testes is warranted. The latter is approximately 20 times more frequent than bilateral anorchia.19 In order to avoid surgical exploration in the 46 XY male with anorchia, studies to assess for the presence of any viable testicular tissue should include serum MIS and additional hormone testing (inhibin B, FSH, LH, and testosterone) should be considered. Within the testis, Leydig cells respond to endogenous LH or exogenous hCG by producing testosterone, while Sertoli cells respond to endogenous FSH by producing MIS and inhibin B. In infants with anorchia, the postnatal testosterone surge will be absent. In the recent past, intramuscular injections of hCG with serum testosterone levels (hCG stimulation test) were recommended in the evaluation of bilateral nonpalpable testes to assess for Leydig cell function or absence. The failure of testosterone to increase after hCG stimulation alone is not diagnostic of anorchia; testicular dysgenesis with UDT may fail to respond to hCG stimulation. If the hCG stimulation test is used, it must be confirmed with a significant elevation in serum FSH and LH. If the patient has anorchia and is less than 12 months of age, serum LH is high, FSH is high, MIS and inhibin B are undetectable, and testosterone is low. While the utility of hCG stimulation testing remains disputed, most recent studies suggest that a phenotypic 46 XY male with bilateral nonpalpable testes has isolated anorchia if undetectable levels of MIS and inhibin B with an elevated FSH level are present,20 making neither hCG stimulation testing nor surgical exploration necessary for the diagnosis of isolated anorchia.21 If the endocrine markers of Sertoli and Leydig cell function are normal, then testicular tissue is present despite being not palpable and surgical exploration is necessary. 9. In boys with retractile testes, providers should assess the position of the testes at least annually to monitor for secondary ascent. (Standard; Evidence Strength: Grade B) Studies have reported an extremely broad range of incidence of testicular ascent out of the scrotum (between 2-45%) in boys with retractile testes.11,22 It has been well documented that retractile testes are at increased risk for testicular ascent22 which may be mechanistically related to the presence of a hyperactive cremasteric reflex, foreshortened patent processus vaginalis or entrapping adhesions. Treatment 10. Providers should not use hormonal therapy to induce testicular descent as evidence shows low response rates and lack of evidence for long-term efficacy. (Standard; Evidence Strength: Grade B) Hormones to induce descent Primary hormonal therapy with hCG or luteinizing hormone-releasing hormone or gonadotropin-releasing hormone has historically been used for many years, mostly in countries other than the United States. hCG stimulates production of androgens by the Leydig cells. The action of hCG is virtually identical to that of pituitary LH although hCG appears to have a small degree of FSH activity as well. It stimulates production of androgens by the Leydig cells. Although an individual study on the efficacy of hCG may show a reasonable effect in inducing testicular descent, the overall review of all available studies fails to document long-term efficacy, and a significant risk of recurrence.23,24 Success rates for descent into the scrotum are 25–55% in uncontrolled studies, but decrease to only 6–21% in randomized, blinded studies. Distal inguinal testes in older boys are more likely to descend in response to hormonal treatment than abdominal testes. Side effects of hCG treatment seen in up to 75% of boys include increased scrotal rugae, pigmentation, pubic hair, and penile growth, which may regress after treatment cessation. A total dose of more than 15,000 IU of hCG must be avoided since it may induce epiphyseal plate fusion and retard future somatic growth.25 LHRH analogs stimulate the release of the pituitary gonadotropins LH and FSH, resulting in a temporary increase of gonadal steroidogenesis. Success rates in uncontrolled studies range from 13-78% while better controlled investigations resulted in 6-38% success.26,27 The recognized side effects of LHRH/GnRH (increased androgens, including increased penile or testicular size, scrotal erythema, or erections) seem to be less than seen with hCG. No long-term evaluation of LHRH treatment was done. For hCG and GnRH it has been reported that hormonal treatment may harm the germ cells in one to three-year old cryptorchid boys who did not respond to the hormones used to induce testicular descent.28 Hormones to improve fertility No reports on long-term fertility outcomes following isolated hormonal therapy (no surgery at any time) were found in our literature search. Hormonal therapy may have value to optimize germ cell maturation and/or sperm production. LHRH or hCG administration prior to orchidopexy has been shown to improve the fertility index on biopsies obtained at the time of orchidopexy.29 11. In the absence of spontaneous testicular descent by six months (corrected for gestational age), specialists should perform surgery within the next year. (Standard; Evidence Strength: Grade B) In a 10-year, retrospective study of 1,235 consecutive boys with cryptorchidism referred to pediatric urology practice, all patients with eventual spontaneous descent initially presented by six months (corrected for gestational age). Of those boys initially presenting beyond age six months no patient had spontaneous testicular descent.4 Orchidopexy in the first 18 months of life is recommended to preserve available fertility potential. In the majority of cases the total number of germ cells is within the normal range in cryptorchid testes during the first six months of life, but about 25% of the cryptorchid boys are born with a reduced number of germ cells.30 After 15-18 months of age, some cryptorchid boys lack germ cells in the testes and the number of boys without germ cells in a testicular biopsy increases to about 40% in bilateral cryptorchid boys at 8–11 years of age. 12. In prepubertal boys with palpable, cryptorchid testes, surgical specialists should perform scrotal or inguinal orchidopexy. (Standard; Evidence Strength: Grade B) While it is optimal to perform surgery for the cryptorchid testis by 18 months of age, there are clear benefits to performing orchidopexy in all prepubertal boys at the time of diagnosis of a cryptorchid testis.31 With regard to fertility, there has not been any direct assessment or long-term follow-up of patients with early v. late orchidopexy. Even though progressive and adverse histologic changes will occur in the cryptorchid testis prior to puberty, there may be fertility benefits that can still be realized with surgical correction of the cryptorchid testis prior to puberty.32,33 It is widely recognized that the cryptorchid testis is associated with an inherent risk of malignant degeneration. Early reports of this increased risk were likely overestimated and recent review of the literature suggests that the overall relative risk is 2.75–8.31 Prepubertal orchidopexy results in a two- to six- fold reduction in the relative risk compared with postpubertal orchidopexy. In the post pubertal child with cryptorchidism, consideration should be given to performing an orchiectomy or biopsy, although there needs to be careful consideration of other factors including associated medical conditions, anesthetic risk, and status of the contralateral testis.31 Further discussion of the adult with cryptorchidism is beyond the scope of this guideline. Recent studies that have evaluated open surgical intervention for the cryptorchid testis, even with inclusion of testes that are intra-abdominal, the overall success has been documented to be greater than 96% (range from 89–100%) (table 1). Subsequent atrophy of the testis is very uncommon and reported to be less than 2% (table 2). Table 1. Success rates after orchidopexy for nonpalpable testes (open or laparoscopic, mixed techniques-primary, 1 or 2-stage Fowler-Stephens) References/Country Quality Total No. Participants/Techniques Total No. Testicles % Success (No. testicles treated) Stec et al/United States35 Good 136/open or laparoscopic 156 89.1 (92) Baker et al/United States36 Poor 226/laparoscopic 263 97.2 (178) Chang et al/United States37 Poor 80/laparoscopic 92 100 (66) Denes et al/Brazil8 Poor 46/laparoscopic 54 96 (26) Dhanani et al/United States38 Poor 74/open or laparoscopic 83 100 (28) Kim et al/South Korea39∗ Poor 67/laparoscopic 86 98 (49) Moursy et al/Egypt40 Poor 66/laparoscopic 76 100 (28) Total: 695 Total: 810 Pooled % 96.4 ∗ Controlled for location, and all studies were of retrospective cohorts. Table 2. Atrophy rates after orchidopexy for nonpalpable testes References/Country Quality Total No. Participants Total No. Testicles % Atrophy (No. testicles treated) Baker et al/United States36 Poor 226 263 2.2 (178) Denes et al/Brazil8 Poor 46 54 4 (26) Humphrey et al/United Kingdom41 Poor 48 20 0 (8) Moursy et al/Egypt40 Poor 66 76 0 (33) Radmayr et al/Austria42 Poor 84 57 0 (28) Total: 470 Total: 470 Pooled % 1.83 For the palpable testis that is low lying, single incision orchidopexy is also a viable option. This primary scrotal approach was introduced by Bianchi and Squire34 and has since gained widespread use and has been documented in retrospective studies to be equally effective as two incision orchidopexy in selected patients with testes located distal to the external inguinal ring that can be mobilized adequately via a scrotal incision. 13. In prepubertal boys with nonpalpable testes, surgical specialists should perform examination under anesthesia to reassess for palpability of testes. If nonpalpable, surgical exploration and, if indicated, abdominal orchidopexy should be performed. (Standard; Evidence Strength: Grade B) A thorough examination should be performed following induction of general anesthesia to further determine if a testis is palpable. If the testis is palpable, open orchidopexy should be undertaken. However, if the testis remains nonpalpable, then a decision needs to be made to either pursue laparoscopic or open exploration. Previous studies evaluating laparoscopy for determining the location of the testicle have reported similar findings to open exploration.43 Depending on the training and comfort level of the individual surgeon with laparoscopic techniques, open surgical management of the intra-abdominal testis is also appropriate given the lack of evidence to demonstrate that laparoscopic techniques have distinct advantages over open techniques with respect to success of the orchidopexy itself.44,45 If an intra-abdominal testis is found with anatomy that is felt to be appropriate for salvage, one of three surgical options can be chosen. The three types of surgical repair that one may consider are primary orchidopexy, one-stage Fowler-Stephens orchidopexy, and two-stage FS orchidopexy. Extensive review of previous studies evaluating the effectiveness of these procedures reveals that the success rate for all three approaches exceeds 75%, with an overall reported rate of 96.4% for primary orchidopexy, 78.7% for one-stage FS, and 86% for two-stage FS. While initial review of these success rates may suggest that primary orchidopexy is superior to the two other FS approaches, one must take into account that all of these studies are observational cohorts and are limited by selection bias, confounding by indication and lack of randomization of the surgical techniques in many of the studies. 14. At the time of exploration for a nonpalpable testis in boys, surgical specialists should identify the status of the testicular vessels to help determine the next course of action. (Clinical Principle) The identification of the testicular vessels should be the objective of any exploration for a nonpalpable testis. As previously mentioned in the guideline, radiologic imaging is typically not helpful in this situation because of its lack of both sensitivity and specificity for the identification of an

Testicular cancer in nine northern european countries

1994-10-01

Hans‐Olov Adami , Reinhold Bergström , Matthias Möhner +7 more

Abstract The incidence of testicular cancer was examined in the Nordic and Baltic countries, Poland and Germany by collaboration among 10 cancer registries. Population‐based registers were used to analyze a … Abstract The incidence of testicular cancer was examined in the Nordic and Baltic countries, Poland and Germany by collaboration among 10 cancer registries. Population‐based registers were used to analyze a total of 34,309 cases, diagnosed from the start of registration (varying from 1943 in Denmark to 1980 in Latvia and Lithuania) through 1989. An approximately 10‐fold geographical variation was found in 1980, with the highest age‐standardized incidence rate (7.8 per 10 5 ; world standard population) in Denmark and the lowest (0.9) in Lithuania. During the entire period of registration, incidence increased rapidly in all countries, by 2.3 to 3.4 per cent annually in the Nordic countries and by about 5 per cent in Poland and Germany; there was some evidence of a slower increase in Denmark and Poland after 1975. The rising trend was more pronounced for ages below 30. The age‐specific incidence peaked in all countries at ages 25 to 34, but the geographical variation was considerable. Our data indicate that environmental influences on testicular cancer are strong. Exposure to causal factors mostly takes place early in life, shows substantial geographical variation, and increases over time, so that the age‐standardized incidence doubles every 15 to 25 years. New aetiological hypotheses are needed to accommodate these salient features of the descriptive epidemiology, since risk factors considered so far cannot explain the observed pattern.

Testicular germ-cell tumours in a broader perspective

2005-03-01

J. Wolter Oosterhuis , Leendert H. J. Looijenga

TERATOMA WITH MALIGNANT TRANSFORMATION: DIVERSE MALIGNANT HISTOLOGIES ARISING IN MEN WITH GERM CELL TUMORS

1998-01-01

Robert J. Motzer , Alison Amsterdam , Víctor G. Prieto +6 more

No AccessJournal of UrologyClinical Urology: Original Articles1 Jan 1998TERATOMA WITH MALIGNANT TRANSFORMATION: DIVERSE MALIGNANT HISTOLOGIES ARISING IN MEN WITH GERM CELL TUMORS Robert J. Motzer, Alison Amsterdam, Victor Prieto, Joel … No AccessJournal of UrologyClinical Urology: Original Articles1 Jan 1998TERATOMA WITH MALIGNANT TRANSFORMATION: DIVERSE MALIGNANT HISTOLOGIES ARISING IN MEN WITH GERM CELL TUMORS Robert J. Motzer, Alison Amsterdam, Victor Prieto, Joel Sheinfeld, V.V.V.S. Murty, Madhu Mazumdar, George J. Bosl, R.S.K. Chaganti, and Victor E. Reuter Robert J. MotzerRobert J. Motzer More articles by this author , Alison AmsterdamAlison Amsterdam More articles by this author , Victor PrietoVictor Prieto More articles by this author , Joel SheinfeldJoel Sheinfeld More articles by this author , V.V.V.S. MurtyV.V.V.S. Murty More articles by this author , Madhu MazumdarMadhu Mazumdar More articles by this author , George J. BoslGeorge J. Bosl More articles by this author , R.S.K. ChagantiR.S.K. Chaganti More articles by this author , and Victor E. ReuterVictor E. Reuter More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)64035-7AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Teratoma with malignant transformation refers to a form of germ cell tumor in which a somatic teratomatous component becomes morphologically malignant and develops aggressive growth. We evaluated the spectrum of histologies, chromosomal abnormalities and clinical outcome in patients with teratoma with malignant transformation. Materials and Methods: We identified 46 patients with germ cell tumor meeting morphologic criteria for malignant transformation. Histology, disease extent and treatment were correlated with survival. Tumors in 12 patients were studied by conventional cytogenetics or molecular genetic techniques for the isochromosome 12p [i(12p)], a marker for germ cell tumor, as well as other chromosomal abnormalities. Results: The site of first detection of malignant transformation occurred in the primary tumor of 21 cases (44%), at a metastatic site in 20 (43%) and in both sites in 5 (10%). Sarcoma was the most frequent histology, identified in 29 patients (63%) with rhabdomyosarcoma the most common subtype. Seventeen tumors (37%) contained a solid tumor histology other than sarcoma, with adenocarcinoma and primitive neuroectodermal tumor as the most common histologies. Four patients with mediastinal germ cell tumor containing sarcoma also had hematological malignancies, including a focus of nonHodgkin's lymphoma in the mediastinal primary tumor (1) and nonlymphocytic leukemia in spleen or bone marrow (3). Patients who had teratoma with malignant transformation components confined to the testis or retroperitoneum completely resected experienced a longer survival than those with distant metastases or incompletely resected tumors (p = 0.003). Chromosomal abnormalities associated with germ cell tumor (i [12p]) were identified in 11 of 12 tumors containing adenocarcinoma, primitive neuroectodermal tumor, sarcoma and leukemia. In addition to i (12p), chromosomal rearrangements characteristic of the transformed histology were detected in 4 tumors. Conclusions: A variety of nongerm cell histologies, including sarcoma, adenocarcinoma, primitive neuroectodermal tumor and leukemia, may occur in association with germ cell tumor. Chromosomal abnormalities in these tumors include i (12p), reflecting germ cell tumor clonality, as well as chromosomal abnormalities associated with the transformed histology. These tumors do not respond like germ cell tumor to cisplatin-containing chemotherapy regimens. Treatment should be tailored according to that used in standard management of the transformed histology, and surgical resection is the mainstay of therapy. References 1 : VAB-6: an effective chemotherapy regimen for patients with germ-cell tumors.. J. Clin. Oncol.1986; 4: 1493. Google Scholar 2 : Teratoma with malignant transformation in germ cell tumors in men.. Cancer1985; 56: 860. Google Scholar 3 : Evaluation of survival data and two new rank order statistics arising in its consideration.. Cancer Chem. Rep.1966; 50: 163. Google Scholar 4 : Molecular cytogenetic analysis of i (12p) negative human male germ cell tumors.. Genes, Chromosomes Cancer1993; 8: 230. Google Scholar 5 : Cytogenetic and molecular analysis of human male germ cell tumors: chromosome 12 abnormalities and gene amplification.. Genes, Chromosomes Cancer1990; 1: 289. Google Scholar 6 : Abnormalities of 2q: a common genetic link between rhabdomyosarcoma and hepatoblastoma.. Genes, Chromosomes Cancer1991; 3: 122. Google Scholar 7 : Catalog of Chromosome Aberrations in Cancer. New York: Wiley-Liss1994. Google Scholar 8 : Clinical and cytogenetic correlations in 63 patients with therapy-related myelodysplastic syndromes and acute nonlymphocytic leukemia: further evidence for characteristic abnormalities of chromosomes no.. 5 and 7. J. Clin. Oncol.1996; 4: 325. Google Scholar 9 : Treatment of disseminated germ-cell tumors with cisplatin, bleomycin, and either vinblastine or etoposide.. New Engl. J. Med.1987; 316: 1435. Google Scholar 10 : Ifosfamide-based chemotherapy for patients with resistant germ cell tumors: the Memorial Sloan-Kettering Cancer Center Experience.. Sem. Oncol.1992; 19: 8. Google Scholar 11 : High-dose carboplatin, etoposide, and cyclophosphamide for patients with refractory germ cell tumors: treatment results and prognostic factors for survival and toxicity.. J. Clin. Oncol.1996; 14: 1098. Google Scholar 12 : Unusual neoplasms detected in testis cancer patients undergoing post-chemotherapy retroperitoneal lymphadenectomy.. J. Urol.1994; 152: 1144. Abstract, Google Scholar 13 : Clinical relevance of the i (12p) marker chromosome in germ cell tumors.. J. Natl. Cancer Inst.1994; 86: 349. Google Scholar 14 : Cytogenetic and immunohistochemical evidence for the germ cell origin of a subset of acute leukemias associated with mediastinal germ cell tumors.. J. Natl. Cancer Inst.1990; 82: 221. Google Scholar 15 : Hematologic neoplasia associated with primary mediastinal germ-cell tumors.. New Engl. J. Med.1990; 322: 1425. Google Scholar 16 : Association between mediastinal germ cell tumors and hematologic malignancies: an update.. Hum. Path.1990; 21: 699. Google Scholar 17 : Acute lymphoblastic leukemia. Possible origin from a mediastinal germ cell tumor.. Cancer1984; 53: 441. Google Scholar 18 : Sarcoma arising in a residual testicular teratoma after cytoreductive chemotherapy.. Cancer1984; 54: 2015. Google Scholar 19 : The growing teratoma syndrome.. Cancer1982; 50: 1629. Google Scholar 20 : Etoposide and cisplatin adjuvant therapy for patients with pathologic stage II germ cell tumors.. J. Clin. Oncol.1995; 13: 2700. Google Scholar 21 : The effect of age at diagnosis on outcome in rhabdomyosarcoma.. Cancer1996; 73: 109. Google Scholar 22 : Very-high-dose short-term chemotherapy for poor-risk peripheral primitive neuroectodermal tumors, including Ewing's sarcoma, in children and young adults.. J. Clin. Oncol.1996; 13: 2796. Google Scholar 23 : Extracranial primitive neuroectodermal tumors: the Memorial Sloan-Kettering Cancer Center experience.. Cancer1996; 67: 1825. Google Scholar From the Genitourinary Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Department of Pathology (Surgical Pathology and Cytogenetic Services), Department of Biostatistics, and Division of Urology, Department of Surgery, Memorial Hospital, New York, and Cell Biology and Genetics Program, Sloan-Kettering Institute, New York, New YorkAccepted for publication June 20, 1997© 1998 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited bySheinfeld J, Becerra M and Feldman D (2016) Are Some Cases of Somatic Type Malignancy Potentially Avoidable?Journal of Urology, VOL. 196, NO. 1, (11-13), Online publication date: 1-Jul-2016.Giannatempo P, Pond G, Sonpavde G, Albany C, Loriot Y, Sweeney C, Salvioni R, Colecchia M, Nicolai N, Raggi D, Rice K, Flack C, El Mouallem N, Feldman H, Fizazi K, Einhorn L, Foster R, Necchi A and Cary C (2015) Treatment and Clinical Outcomes of Patients with Teratoma with Somatic-Type Malignant Transformation: An International CollaborationJournal of Urology, VOL. 196, NO. 1, (95-100), Online publication date: 1-Jul-2016.Silberstein J (2014) Outcomes of Retroperitoneal Lymph Node Dissection for the Most Challenging CasesJournal of Urology, VOL. 192, NO. 5, (1320-1321), Online publication date: 1-Nov-2014.Rice K, Magers M, Beck S, Cary K, Einhorn L, Ulbright T and Foster R (2014) Management of Germ Cell Tumors with Somatic Type Malignancy: Pathological Features, Prognostic Factors and Survival OutcomesJournal of Urology, VOL. 192, NO. 5, (1403-1409), Online publication date: 1-Nov-2014. (2018) Reply by AuthorsJournal of Urology, VOL. 177, NO. 3, (942-943), Online publication date: 1-Mar-2007.Carver B, Bianco F, Shayegan B, Vickers A, Motzer R, Bosl G and Sheinfeld J (2018) Predicting Teratoma in the Retroperitoneum in Men Undergoing Post-Chemotherapy Retroperitoneal Lymph Node DissectionJournal of Urology, VOL. 176, NO. 1, (100-104), Online publication date: 1-Jul-2006.SHEINFELD J, MOTZER R, RABBANI F, McKIERNAN J, BAJORIN D and BOSL G (2018) Incidence and Clinical Outcome of Patients with Teratoma in the Retroperitoneum Following Primary Retroperitoneal Lymph Node Dissection for Clinical Stages I and IIA Nonseminomatous Germ Cell TumorsJournal of Urology, VOL. 170, NO. 4 Part 1, (1159-1162), Online publication date: 1-Oct-2003.POHAR K, RABBANI F, BOSL G, MOTZER R, BAJORIN D and SHEINFELD J (2018) Results of Retroperitoneal Lymph Node Dissection for Clinical Stage I and II Pure Embryonal Carcinoma of the TestisJournal of Urology, VOL. 170, NO. 4 Part 1, (1155-1158), Online publication date: 1-Oct-2003.GANJOO K, FOSTER R, MICHAEL H, DONOHUE J and EINHORN L (2018) GERM CELL TUMOR ASSOCIATED PRIMITIVE NEUROECTODERMAL TUMORSJournal of Urology, VOL. 165, NO. 5, (1514-1516), Online publication date: 1-May-2001.STEELE G, CLANCY T, DATTA M, WEINSTEIN M and RICHIE J (2018) ANGIOSARCOMA ARISING IN A TESTICULAR TERATOMAJournal of Urology, VOL. 163, NO. 6, (1872-1873), Online publication date: 1-Jun-2000. Volume 159Issue 1January 1998Page: 133-138 Advertisement Copyright & Permissions© 1998 by American Urological Association, Inc.MetricsAuthor Information Robert J. Motzer More articles by this author Alison Amsterdam More articles by this author Victor Prieto More articles by this author Joel Sheinfeld More articles by this author V.V.V.S. Murty More articles by this author Madhu Mazumdar More articles by this author George J. Bosl More articles by this author R.S.K. Chaganti More articles by this author Victor E. Reuter More articles by this author Expand All Advertisement PDF downloadLoading ...

Germ cell tumors of the gonads: a selective review emphasizing problems in differential diagnosis, newly appreciated, and controversial issues

2005-02-01

Thomas M. Ulbright

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Increasing Incidence of Testicular Cancer Worldwide: A Review

2003-07-01

É. Huyghe , Tomohiro Matsuda , Patrick Thonneau

No AccessJournal of UrologyCLINICAL UROLOGY: Review Articles1 Jul 2003Increasing Incidence of Testicular Cancer Worldwide: A Review ERIC HUYGHE, TOMOHIRO MATSUDA, and PATRICK THONNEAU ERIC HUYGHEERIC HUYGHE More articles by this … No AccessJournal of UrologyCLINICAL UROLOGY: Review Articles1 Jul 2003Increasing Incidence of Testicular Cancer Worldwide: A Review ERIC HUYGHE, TOMOHIRO MATSUDA, and PATRICK THONNEAU ERIC HUYGHEERIC HUYGHE More articles by this author , TOMOHIRO MATSUDATOMOHIRO MATSUDA More articles by this author , and PATRICK THONNEAUPATRICK THONNEAU Requests for reprints: Fertility Research Group, Urology and Andrology Unit, La Grave Hospital, Toulouse 31052, France. More articles by this author View All Author Informationhttps://doi.org/10.1097/01.ju.0000053866.68623.daAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Testicular cancer (TC) is the most common malignancy in 20 to 34-year-old men. Numerous publications have shown an increase in the incidence of testis cancer in the last 40 years with substantial differences among countries. We evaluated worldwide variations in testicular cancer incidence and compared trends in different regions in the world. Materials and Methods: We reviewed 441 studies provided by a MEDLINE search using the key words testis/testicular, cancer/tumor and incidence that were published between 1980 and 2002. From these articles we selected only those devoted to testis cancer incidence and of them only the most recent studies from each country or region. Nevertheless, articles using the same data base but providing new and additional information, for example differences among ethnic groups or controversial explanations for trends, were also retained. We selected 30 articles and analyzed their methodological approach and main results. Results: Worldwide we observed a clear trend toward an increased TC incidence in the last 30 years in the majority of industrialized countries in North America, Europe and Oceania. Nevertheless, surprising differences in incidence rates were seen between neighboring countries (Finland 2.5/100,000 cases versus Denmark 9.2/100,000) as well as among regions of the same country (2.8 to 7.9/100,000 according to various regional French registers). In addition, substantial differences in the TC incidence and trends were observed among ethnic groups. The increase in the TC incidence was significantly associated with a birth cohort effect in the United States and in European countries. To date except for cryptorchidism no evident TC risk factor has been clearly demonstrated, although the environmental hypothesis with a key role of endocrine disrupters has been put forward by several groups. Conclusions: Such a recent increase in the TC rate in most industrialized countries should lead urologists and andrologists to give more attention to testicular cancer symptoms in adolescents and young adults. In a public health perspective further research using cases collected through national and regional population based registers and case-control studies must be strongly encouraged if we wish to be able to assess future trends in TC incidence rates and also identify risk factors. References 1 : Testicular germ-cell cancer. N Engl J Med1997; 337: 242. Google Scholar 2 : Testis cancer. Curr Opin Oncol1997; 9: 287. Google Scholar 3 : Summarizing indices for comparison of cancer incidence data. Int J Cancer1967; 2: 269. Google Scholar 4 : Birth cohort effects underlying the increasing testicular cancer incidence in Canada. Can J Public Health1999; 90: 176. Google Scholar 5 : Trends in the incidence of testicular germ cell cancer in Ontario by histologic subgroup, 1964–1996. CMAJ1999; 160: 201. Google Scholar 6 : Cancer of the male genital tract in Circumpolar Inuit. Acta Oncol1996; 35: 589. Google Scholar 7 : Rising risk of testicular cancer by birth cohort in the United States from 1973 to 1995. J Urol1999; 162: 361. Link, Google Scholar 8 : Trends in cancer incidence in Connecticut, 1935–1991. Cancer1994; 74: 2863. Google Scholar 9 : Continuing increase in incidence of germ-cell testis cancer in young adults: experience from Connecticut, USA, 1935–1992. Int J Cancer1996; 65: 723. Google Scholar 10 : Is testicular cancer incidence in blacks increasing?. Am J Public Health1989; 79: 1553. Google Scholar 11 : An explanation for the increasing incidence of testis cancer: decreasing age at first full-term pregnancy. J Natl Cancer Inst1997; 89: 818. Google Scholar 12 : Incidence of testicular cancer in the United States: has the epidemic begun to abate?. Am J Epidemiol1999; 150: 45. Google Scholar 13 : Testicular cancer in nine northern European countries. Int J Cancer1994; 59: 33. Google Scholar 14 : Trends in incidence of testicular cancer in boys and adolescent men. Int J Cancer1995; 61: 761. Google Scholar 15 : Increase in testicular cancer incidence in six European countries: a birth cohort phenomenon. J Natl Cancer Inst1996; 88: 727. Google Scholar 16 : Trends in incidence of testicular cancer in Norway 1955–1992. Eur J Cancer1995; 31A: 2044. Google Scholar 17 : Testicular-cancer incidence and mortality in Slovakia, 1968–90. Lancet1996; 347: 900. Google Scholar 18 : Testicular cancer in Poland. Lancet1990; 336: 183. Google Scholar 19 : The incidence of cancer in the Czech Republic from 1973 to 1989: cancers with non-parallel trends in age groups. Cent Eur J Public Health1996; 4: 157. Google Scholar 20 : Cancer registration in Germany: current status, perspectives and trends in cancer incidence 1973–93. J Epidemiol Biostat2000; 5: 99. Google Scholar 21 : The epidemiology of testicular cancer. Br J Urol1987; 60: 285. Google Scholar 22 : Epidemiology of testicular tumours. J R Soc Med1985; 78: 3. Google Scholar 23 : The increasing incidence of testicular cancer in East Anglia. Br J Cancer1984; 50: 377. Google Scholar 24 : Incidence of testicular germ-cell malignancies in England and Wales: trends in children compared with adults. Int J Cancer1999; 83: 630. Google Scholar 25 : Trends in testicular carcinoma in England and Wales, 1971–99. BJU Int2001; 87: 361. Google Scholar 26 : The epidemiology of non-seminomatous germ cell tumours in the west of Scotland 1975–89. Br J Cancer1995; 72: 1559. Google Scholar 27 : Trends in cancer incidence and mortality in Scotland: description and possible explanations. Br J Cancer1998; 77: 1. Google Scholar 28 : Testicular cancer trends in the Canton of Vaud, Switzerland, 1974–1987. Br J Cancer1990; 62: 871. Google Scholar 29 : Is the incidence of testicular cancer on the increase in France?. Presse Med1995; 24: 1133. Google Scholar 30 : Trends in testis cancer in France, 1975–1999. Andrologie2002; 12: 269. Google Scholar 31 : Changes in cancer incidence and mortality in New South Wales. Med J Aust1995; 163: 520. Google Scholar 32 : Cancer incidence in migrants to New South Wales (Australia) from the Middle East, 1972–91. Cancer Causes Control1994; 5: 414. Google Scholar 33 : Cancer incidence in New Zealand born residents of New South Wales. N Z Med J1990; 103: 61. Google Scholar 34 : Increased incidence of germ cell testicular cancer in New Zealand Maoris. Br J Cancer1992; 65: 769. Google Scholar 35 : Incidence of urogenital cancers in Gunma Prefecture, Japan: a 10-year summary. Int J Urol1998; 5: 364. Google Scholar 36 : Male genital tract tumors in Punjab, India. J Environ Pathol Toxicol Oncol1992; 11: 331. Google Scholar 37 : Testicular cancer in Nigerians. East Afr Med J1995; 72: 554. Google Scholar 38 : Testes tumors in a Sub-Saharan African city (Yaounde). Incident cases and histopathology. Eur Urol1996; 30: 345. Google Scholar 39 : Frequency and management of germ-cell tumors in a third-world country. Oncol Rep1998; 5: 1241. Google Scholar 40 Parkin D.M., Whelan S.L., Ferlay J., Raymond L., Young J.: Cancer Incidence in Five Continents. Lyon, France: IARC Scientific Publications, 1997 Google Scholar 41 Coleman M.P., Esteve J., Damiecki P., Arslan A., Renard H.: Trends in Cancer Incidence and Mortality. World Health Organization, International Agency for Research on Cancer, International Union Against Cancer and International Association of Cancer Registries. Lyon, France: IARC Scientific Publications, 1993 Google Scholar 42 : Are oestrogens involved in falling sperm counts and disorders of the male reproductive tract?. Lancet1993; 341: 1392. Google Scholar 43 : Risk of testicular cancer in subfertile men: case-control study. BMJ1999; 318: 559. Google Scholar 44 : Geographic clustering of testicular cancer incidence in the northern part of The Netherlands. Br J Cancer1999; 81: 1262. Google Scholar 45 : Familial testicular cancer: a report of the UK family register, estimation of risk and an HLA class 1 sib-pair analysis. Br J Cancer1992; 65: 255. Google Scholar 46 : Cytogenetic analysis of 124 prospectively ascertained male germ cell tumors. Cancer Res1992; 52: 2285. Google Scholar From the Human Fertility Research Group, Urology and Andrology Unit, La Grave Hospital, Toulouse, France© 2003 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited ByGurney J, Sarfati D, Stanley J and Studd R (2018) Do Ethnic Patterns in Cryptorchidism Reflect Those Found in Testicular Cancer?Journal of Urology, VOL. 190, NO. 5, (1852-1857), Online publication date: 1-Nov-2013.Ellinger J, Wittkamp V, Albers P, Perabo F, Mueller S, von Ruecker A and Bastian P (2018) Cell-Free Circulating DNA: Diagnostic Value in Patients With Testicular Germ Cell CancerJournal of Urology, VOL. 181, NO. 1, (363-371), Online publication date: 1-Jan-2009.Wood H and Elder J (2018) Cryptorchidism and Testicular Cancer: Separating Fact From FictionJournal of Urology, VOL. 181, NO. 2, (452-461), Online publication date: 1-Feb-2009.Ellinger J, Albers P, Perabo F, Müller S, von Ruecker A and Bastian P (2018) CpG Island Hypermethylation of Cell-Free Circulating Serum DNA in Patients With Testicular CancerJournal of Urology, VOL. 182, NO. 1, (324-329), Online publication date: 1-Jul-2009.Bergholz R and Wenke K (2018) Polyorchidism: A Meta-AnalysisJournal of Urology, VOL. 182, NO. 5, (2422-2427), Online publication date: 1-Nov-2009.Carrière P, Baade P and Fritschi L (2018) Population Based Incidence and Age Distribution of Spermatocytic SeminomaJournal of Urology, VOL. 178, NO. 1, (125-128), Online publication date: 1-Jul-2007.Bulent A, Taner D, Tolga T, Sertac Y, Celik T, Ferruh Z and Haluk O (2018) Bilateral Testicular Germ Cell Tumors in Turkey: Increase in Incidence in Last Decade and Evaluation of Risk Factors in 30 PatientsJournal of Urology, VOL. 178, NO. 1, (129-133), Online publication date: 1-Jul-2007.HUYGHE E, SOULIE M, ESCOURROU G, MIEUSSET R, PLANTE P and THONNEAU P (2018) CONSERVATIVE MANAGEMENT OF SMALL TESTICULAR TUMORS RELATIVE TO CARCINOMA IN SITU PREVALENCEJournal of Urology, VOL. 173, NO. 3, (820-823), Online publication date: 1-Mar-2005.CARMIGNANI L, GADDA F, MANCINI M, GAZZANO G, NERVA F, ROCCO F and COLPI G (2018) DETECTION OF TESTICULAR ULTRASONOGRAPHIC LESIONS IN SEVERE MALE INFERTILITYJournal of Urology, VOL. 172, NO. 3, (1045-1047), Online publication date: 1-Sep-2004. Volume 170Issue 1July 2003Page: 5-11 Advertisement Copyright & Permissions© 2003 by American Urological Association, Inc.Keywordspublic healthtesticular neoplasmsincidencetestisMetricsAuthor Information ERIC HUYGHE More articles by this author TOMOHIRO MATSUDA More articles by this author PATRICK THONNEAU Requests for reprints: Fertility Research Group, Urology and Andrology Unit, La Grave Hospital, Toulouse 31052, France. More articles by this author Expand All Advertisement PDF DownloadLoading ...

Human embryonic stem cell genes <i>OCT4, NANOG, STELLAR</i>, and <i>GDF3</i> are expressed in both seminoma and breast carcinoma

2005-10-14

Uche Ezeh , Paul J. Turek , Renee A. Reijo Pera +1 more

The seminoma class of testicular germ cell tumor (TGCT) are characterized by a morphological resemblance to primordial germ cells (PGCs) or gonocytes, and chromosome duplications at 12p. Recently, it was … The seminoma class of testicular germ cell tumor (TGCT) are characterized by a morphological resemblance to primordial germ cells (PGCs) or gonocytes, and chromosome duplications at 12p. Recently, it was determined that human embryonic stem cells (hESCs) express genes in common with PGCs, and that three of these genes, GDF3, STELLAR, and NANOG, are located on 12p. The current study was designed to identify whether expression of these 12p genes were elevated in seminoma relative to normal testis, and to determine whether elevated expression was unique to seminoma.Real-time polymerase chain reaction (PCR) and immunohistochemistry were used to assess gene expression in seminoma samples relative to normal testis and endpoint PCR was used to identify the presence or absence of these genes in breast carcinoma.GDF3 expression was increased in eight of nine seminomas compared with normal testis, whereas NANOG, OCT4, or both were expressed at the highest levels in seminoma compared with all other markers analyzed. In addition, the NANOG protein was expressed in the majority of seminoma cells. The adult meiotic germ cell markers BOULE and TEKT1 were undetectable in seminoma, whereas the embryonic and adult germ cell markers DAZL and VASA were significantly reduced. Analysis of these markers in breast carcinoma and the MCF7 breast carcinoma cell line revealed that a core hESC-transcriptional profile could be identified consisting of OCT4, NANOG, STELLAR, and GDF3 and that NANOG protein could be detected in breast carcinoma.These observations suggest that seminoma and breast carcinoma express a common stem cell profile and that the expression of DAZL and VASA in seminoma mark the germ cell origin of seminoma that is absent in breast carcinoma. Our findings suggest that stem cell genes may either play a direct role in different types of carcinoma progression or serve as valuable markers of tumorigenesis.

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High-Dose Chemotherapy and Stem-Cell Rescue for Metastatic Germ-Cell Tumors

2007-07-25

Lawrence H. Einhorn , Stephen D. Williams , Amy R. Chamness +3 more

Metastatic testicular tumors that have not been successfully treated by means of initial chemotherapy are potentially curable with salvage chemotherapy.We conducted a retrospective review of 184 consecutive patients with metastatic … Metastatic testicular tumors that have not been successfully treated by means of initial chemotherapy are potentially curable with salvage chemotherapy.We conducted a retrospective review of 184 consecutive patients with metastatic testicular cancer that had progressed after they received cisplatin-containing combination chemotherapy. We gave 173 patients two consecutive courses of high-dose chemotherapy consisting of 700 mg of carboplatin per square meter of body-surface area and 750 mg of etoposide per square meter, each for 3 consecutive days, and each followed by an infusion of autologous peripheral-blood hematopoietic stem cells; the other 11 patients received a single course of this treatment. In 110 patients, cytoreduction with one or two courses of vinblastine plus ifosfamide plus cisplatin preceded the high-dose chemotherapy.Of the 184 patients, 116 had complete remission of disease without relapse during a median follow-up of 48 months (range, 14 to 118). Of the 135 patients who received the treatment as second-line therapy, 94 were disease-free during follow-up; 22 of 49 patients who received treatment as third-line or later therapy were disease-free. Of 40 patients with cancer that was refractory to standard-dose platinum, 18 were disease-free. A total of 98 of 144 patients who had platinum-sensitive disease were disease-free, and 26 of 35 patients with seminoma and 90 of 149 patients with nonseminomatous germ-cell tumors were disease-free. Among the 184 patients, there were three drug-related deaths during therapy. Acute leukemia developed in three additional patients after therapy.Testicular tumors are potentially curable by means of high-dose chemotherapy plus hematopoietic stem-cell rescue, even when this regimen is used as third-line or later therapy or in patients with platinum-refractory disease.

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Primary intracranial germ cell tumors: a clinical analysis of 153 histologically verified cases

1997-03-01

Masao Matsutani , Keiji Sano , Kintomo Takakura +4 more

✓ The authors analyzed 153 cases of histologically verified intracranial germ cell tumors. The histological diagnosis was germinoma in 63 patients (41.2%), teratoma in 30 (19.6%), and other types of … ✓ The authors analyzed 153 cases of histologically verified intracranial germ cell tumors. The histological diagnosis was germinoma in 63 patients (41.2%), teratoma in 30 (19.6%), and other types of tumors in 60 patients (39.2%). The patients were treated by a consistent policy of surgical removal with histological verification followed by radiation therapy with or without chemotherapy. The 10- and 20-year survival rates of patients with pure germinoma were 92.7% and 80.6%, respectively. The 10-year survival rates of patients with mature teratoma and malignant teratoma were 92.9% and 70.7%, respectively. Patients with pure malignant germ cell tumors (embryonal carcinoma, yolk sac tumor, or choriocarcinoma) had a 3-year survival rate of 27.3%. The mixed tumors were divided into three subgroups: 1) mixed germinoma and teratoma; 2) mixed tumors whose predominant characteristics were germinoma or teratoma combined with some elements of pure malignant tumors; and 3) mixed tumors with predominantly pure malignant elements. The 3-year survival rates were 94.1% for the first group, 70% for the second group, and 9.3% for the third group, and the differences were statistically significant. Twenty-six patients with malignant tumors received chemotherapy that consisted of cisplatin and carboplatin combinations with or without radiation therapy. However, chemotherapy was not significantly more effective than radiation therapy alone. From these treatment results, the authors classified tumors into three groups with different prognoses and proposed a treatment guideline appropriate for the subgroups.

Cis-Diamminedichloroplatinum, Vinblastine, and Bleomycin Combination Chemotherapy in Disseminated Testicular Cancer

1977-09-01

Lawrence H. Einhorn , John P. Donohue

Fifty patients with disseminated testicular cancer were treated with a three-drug combination consisting of cis-diamminedichloroplatinum, vinblastine, and bleomycin. Three patients were considered inevaluable due to early death. This chemotherapy regimen … Fifty patients with disseminated testicular cancer were treated with a three-drug combination consisting of cis-diamminedichloroplatinum, vinblastine, and bleomycin. Three patients were considered inevaluable due to early death. This chemotherapy regimen produced 74% complete and 26% partial remissions. Furthermore, five patients with partial remission became disease-free after surgical removal of residual disease, producing an overall 85% disease-free status. Toxicity, although significant during remission induction with cis-platinum, vinblastine, and bleomycin, was usually manageable, although there were two drug-related deaths during this period. Thirty-eight of these patients remain alive and 32 remain alive and disease-free at 6 + to 30 + months. We believe this regimen represents a major advance in the management of patients with disseminated testicular cancer.

Computerized Quantitation of Synergism and Antagonism of Taxol, Topotecan, and Cisplatin Against Human Teratocarcinoma Cell Growth: a Rational Approach to Clinical Protocol Design

1994-10-19

Ting‐Chao Chou , Robert J. Motzer , Yanli Tong +1 more

Journal Article Computerized Quantitation of Synergism and Antagonism of Taxol, Topotecan, and Cisplatin Against Human Teratocarcinoma Cell Growth: a Rational Approach to Clinical Protocol Design Get access Ting-Chao Chou, Ting-Chao … Journal Article Computerized Quantitation of Synergism and Antagonism of Taxol, Topotecan, and Cisplatin Against Human Teratocarcinoma Cell Growth: a Rational Approach to Clinical Protocol Design Get access Ting-Chao Chou, Ting-Chao Chou Correspondence to: Ting-Chao Chou, Ph.D., Laboratory of Biochemical Pharmacology, Molecular Pharmacology and Therapeutics Program. Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021 Search for other works by this author on: Oxford Academic PubMed Google Scholar Robert J. Motzer, Robert J. Motzer Genitourinary Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Department of Medicine, Cornell University Medical College Search for other works by this author on: Oxford Academic PubMed Google Scholar Youzhi Tong, Youzhi Tong Search for other works by this author on: Oxford Academic PubMed Google Scholar George J. Bosl George J. Bosl Genitourinary Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Department of Medicine, Cornell University Medical CollegeMolecular Pharmacology and Therapeutics Program, Memorial Sloan-Kettering Cancer Center, Cornell Graduate School of Medical SciencesNew York, N.Y. Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 86, Issue 20, 19 October 1994, Pages 1517–1524, https://doi.org/10.1093/jnci/86.20.1517 Published: 19 October 1994 Article history Received: 26 January 1994 Revision received: 20 July 1994 Accepted: 03 August 1994 Published: 19 October 1994

Effects of Combined Drug Therapy on Metastatic Cancer of the Testis

1960-11-05

Min C. Li

Advanced cancer of the testis was treated in 36 patients with different combinations of an alkylating agent, an antimetabolite, and the antitumor antibiotic actinomycin D. Of 23 patients treated with … Advanced cancer of the testis was treated in 36 patients with different combinations of an alkylating agent, an antimetabolite, and the antitumor antibiotic actinomycin D. Of 23 patients treated with the three classes of drug in combination, 12 gave evidence of tumor regression. Of 9 patients treated with an alkylating agent and actinomycin D, 2 showed resolution of pulmonary metastases. Of 8 patients treated with 6-mercaptopurine (6-MP) and 6-diazo-5-oxo-L-norleucine (DON), one responded. Of the 15 respondents, 10 had choriocarcinoma with or without embryonal carcinoma and teratocarcinoma or both. Tumor regression was associated with a fall of urinary chorionic gonadotropin titer. Side-effects occurred but proved reversible, and they were accepted as hazards of the treatment because of the striking improvement obtained in some cases.

Spermatic cord torsion, reactive oxygen and nitrogen species and ischemia–reperfusion injury

2004-02-01

Danilo Wilhelm Filho , M. A. Torres , André L.B. Bordin +2 more

The growing teratoma syndrome

1982-10-15

Christopher J. Logothetis , Melvin L. Samuels , Antonio Trindade +1 more

Six patients with metastatic mixed germ-cell tumors who had been treated successfully with chemotherapy had recurring solitary enlarging masses. Four had enlarging pulmonary masses and two patients had enlarging abdominal … Six patients with metastatic mixed germ-cell tumors who had been treated successfully with chemotherapy had recurring solitary enlarging masses. Four had enlarging pulmonary masses and two patients had enlarging abdominal masses. Each had the presumed chemotherapy refractory mass surgically resected and was found to have mature teratoma with absence of malignant histologies. The growth in two patients can be attributed to tense and expansile cysts; the remaining four had firm masses. All patients remain free of disease without further therapy at 5, 13, 14, 25, 66, and 108 months. Early recognition of this previously unreported and unusual clinical circumstance of a benign teratoma to grow after chemotherapy will allow for surgical salvage.

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Gonadoblastoma.A review of 74 cases

1970-06-01

Robert E. Scully

A clinicopathologic analysis revealed the gonadoblastoma to be composed of germ cells and immature cells of Sertoli or granulosa type; cells resembling Leydig and lutein cells were usually present as … A clinicopathologic analysis revealed the gonadoblastoma to be composed of germ cells and immature cells of Sertoli or granulosa type; cells resembling Leydig and lutein cells were usually present as well. Calcification was common, occasionally appearing on roentgenograms of the pelvis. All the patients were sexually abnormal. The gonad bearing the tumor was generally of indeterminate nature but was sometimes identifiable as a streak or a dysgenetic cryptorchid. Four fifths of the patients were phenotypic females, who were commonly virilized, while the remainder were phenotypic males, who almost always had cryptorchidism, hypospadias, and female internal secondary sex organs. Eighty-nine percent of the patients were chromatin-negative, and the most common karyotypes were 46,XY and 45,X/46,XY. There was strong evidence of androgen production by some tumors. The gonadoblastoma may be regarded as an in-situ cancer from which germinomas and occasionally other types of invasive germ-cell tumor can develop.

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Difference in prevalence of congenital cryptorchidism in infants between two Nordic countries

2004-04-01

Kirsten A. Boisen , Marko Kaleva , Katharina M. Main +7 more

Campbell's Urology, 7th ed.WalshP.C.: Philadelphia: Lippincott Williams & Wilkins. Philadelphia: W. B. Saunders Co.1998. 210 pages.RetikA.B.: Philadelphia: Lippincott Williams & Wilkins. Philadelphia: W. B. Saunders Co.1998. 210 pages.VaughanE.D.: Philadelphia: Lippincott Williams & Wilkins. Philadelphia: W. B. Saunders Co.1998. 3,426 pages.WeinA.J.: Philadelphia: Lippincott Williams & Wilkins. Philadelphia: Isis Medical Media Ltd.1998. 3,426 pages.

1998-09-01

Mitchell S. Steiner

No AccessJournal of UrologyUrological Survey: Book Review1 Sep 1998Campbell's Urology, 7th ed. Mitchell SteinerMD Mitchell SteinerMitchell Steiner View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)62878-7AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Campbell's … No AccessJournal of UrologyUrological Survey: Book Review1 Sep 1998Campbell's Urology, 7th ed. Mitchell SteinerMD Mitchell SteinerMitchell Steiner View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)62878-7AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Campbell's Urology, 7th ed.." The Journal of Urology, 160(3 Part 1), pp. 967–968 University of Tennessee Medical Group; Memphis, Tennessee© 1998 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited by Ovechkin R, Kanner I, Ganshina I and Maximov M (2021) Physiology of cholinergic and adrenergic synapses. Role in pharmacology and practical significanceVestnik nevrologii, psihiatrii i nejrohirurgii (Bulletin of Neurology, Psychiatry and Neurosurgery), 10.33920/med-01-2108-06, NO. 8, (639-650), Online publication date: 11-Jul-2021. Rappaport J Some Doubts About 'Democratizing' Criminal JusticeSSRN Electronic Journal, 10.2139/ssrn.3418059 Volume 160Issue 3 Part 1September 1998Page: 967-968 Advertisement Copyright & Permissions© 1998 by American Urological Association, Inc.Metrics Author Information Mitchell Steiner More articles by this author Expand All Advertisement PDF downloadLoading ...

Risk of Second Malignant Neoplasms Among Long-term Survivors of Testicular Cancer

1997-10-01

L. B. Travis , Rochelle E. Curtis , Joseph F. Fraumeni +7 more

We have quantified the site-specific risk of second malignant neoplasms among nearly 29,000 survivors (> or = 1 year) of testicular cancer, taking into account the histologic type of initial … We have quantified the site-specific risk of second malignant neoplasms among nearly 29,000 survivors (> or = 1 year) of testicular cancer, taking into account the histologic type of initial cancer and the primary therapy used to treat it.The study cohort consisted of 28,843 men identified within 16 population-based tumor registries in North America and Europe; over 3300 men had survived more than 20 years. New invasive cancers were identified through a search of registry files.Second cancers were reported in 1406 men (observed-to-expected ratio [O/E] = 1.43; 95% confidence interval = 1.36-1.51), with statistically significant excesses noted for acute lymphoblastic leukemia (O/E = 5.20), acute nonlymphocytic leukemia (O/E = 3.07), melanoma (O/E = 1.69), non-Hodgkin's lymphoma (O/E = 1.88), and cancers of the stomach (O/E = 1.95), colon (O/E = 1.27), rectum (O/E = 1.41), pancreas (O/E = 2.21), prostate (O/E = 1.26), kidney (O/E = 1.50), bladder (O/E = 2.02), thyroid (O/E = 2.92), and connective tissue (O/E = 3.16). Overall risk was similar after seminomas (O/E = 1.42) or nonseminomatous tumors (O/E = 1.50). Risk of solid tumors increased with time since the diagnosis of testicular cancer, yielding an O/E = 1.54 (O = 369) among 20-year survivors (two-sided P for trend = .00002). Secondary leukemia was associated with both radiotherapy and chemotherapy, whereas excess cancers of the stomach, bladder, and, possibly, pancreas were associated mainly with radiotherapy.Men with testicular cancer continue to be at significantly elevated risk of second malignant neoplasms for more than two decades following initial diagnosis. Patterns of excess second cancers suggest that many factors may be involved, although the precise roles of treatment, natural history, diagnostic surveillance, and other influences are yet to be clarified.

Histological and Histopathological Evaluation of the Testis

1993-02-01

Lonnie D. Russell , Robert A. Ettlin , Amiya P. Sinha Hikim +1 more

Cell-Cell Interactions in the Testis*

1991-02-01

Michael K. Skinner

THE ability of cells to interact and communicate is a biological phenomenon that developed with the evolution of multicellular organisms. The cell-cell interactions that have evolved are essential for the … THE ability of cells to interact and communicate is a biological phenomenon that developed with the evolution of multicellular organisms. The cell-cell interactions that have evolved are essential for the survival of both simple organisms such as dictyostelium and complex organisms such as mammals. These cellular associations allow an organism to develop capacities that are greater than the simple sum of their individual parts. As early as 1878, Claude Bernard proposed that the "milieu interieur" (i.e. internally produced fluid environment) and a cybernetic-like control system (i.e. cell-cell interactions and communication) in multicellular organisms are needed to adaptively regulate the growth, development, and maintenance of normal tissue function (1, 2). The experimental analysis of cellular interactions was initiated with the investigation of cell aggregation in simple organisms such as sponges (3, 4) and progressed into the areas of embryology (5) and cell biology (6, 7). Analysis of cell biology on a molecular level has revealed the importance of cell-cell interactions during embryo-genesis, organogenesis, and determination of cell lineage (reviews in Refs. 8–12).

Increase in Testicular Cancer Incidence in Six European Countries: a Birth Cohort Phenomenon

1996-06-05

Reinhold Bergström , Hans‐Olov Adami , Matthias Möhner +7 more

Background:For unknown reasons, the age-standardized incidence of testicular cancer has shown a rapid increase in virtually all countries (mostly Western) studied. For populations with a sufficiently long period of cancer … Background:For unknown reasons, the age-standardized incidence of testicular cancer has shown a rapid increase in virtually all countries (mostly Western) studied. For populations with a sufficiently long period of cancer registration, this development can be traced back to the first half of this century.

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Treatment-Specific Risks of Second Malignancies and Cardiovascular Disease in 5-Year Survivors of Testicular Cancer

2007-09-28

Alexandra W. van den Belt‐Dusebout , Ronald de Wit , Jourik A. Gietema +7 more

Purpose To compare radiotherapy and chemotherapy effects on long-term risks of second malignant neoplasms (SMNs) and cardiovascular diseases (CVDs) in testicular cancer (TC) survivors. Patients and Methods In our nationwide … Purpose To compare radiotherapy and chemotherapy effects on long-term risks of second malignant neoplasms (SMNs) and cardiovascular diseases (CVDs) in testicular cancer (TC) survivors. Patients and Methods In our nationwide cohort comprising 2,707 5-year TC survivors, incidences of SMNs and CVDs were compared with general-population rates by calculating standardized incidence ratios (SIRs) and absolute excess risks (AERs). Treatment effects on risks of SMN and CVD were quantified in multivariable Cox regression and competing risks analyses. Results After a median follow-up time of 17.6 years, 270 TC survivors developed SMNs. The SIR of SMN overall was 1.7 (95% CI, 1.5 to 1.9), with an AER of 32.3 excess occurrences per 10,000 person-years. SMN risk was 2.6-fold (95% CI, 1.7- to 4.0-fold) increased after subdiaphragmatic radiotherapy and 2.1-fold (95% CI, 1.4- to 3.1-fold) increased after chemotherapy, compared with surgery only. Subdiaphragmatic radiotherapy increased the risk of a major late complication (SMN or CVD) 1.8-fold (95% CI, 1.3- to 2.4-fold), chemotherapy increased the risk of a major late complication 1.9-fold (95% CI, 1.4- to 2.5-fold), and smoking increased the risk of a major late complication 1.7-fold (95% CI, 1.4- to 2.1-fold), compared with surgery only. The median survival time was 1.4 years after SMN and 4.7 years after CVD. Conclusion Radiotherapy and chemotherapy increased the risk of developing SMN or CVD to a similar extent as smoking. Subdiaphragmatic radiotherapy strongly increases the risk of SMNs but not of CVD, whereas chemotherapy increases the risks of both SMNs and CVDs. Prolonged follow-up after chemotherapy is needed to reliably compare the late complications of radiotherapy and chemotherapy after 20 years.

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Pediatric Central Nervous System Germ Cell Tumors: A Review

2008-06-01

María E. Echevarría , Jason Fangusaro , Stewart Goldman

Abstract Learning Objectives After completing this course, the reader will be able to: Discuss the basic epidemiology of pediatric CNS GCTs.Perform the diagnostic workup and full evaluation that is necessary … Abstract Learning Objectives After completing this course, the reader will be able to: Discuss the basic epidemiology of pediatric CNS GCTs.Perform the diagnostic workup and full evaluation that is necessary when evaluating a patient with a suspected CNS GCT.Select among the different therapeutic alternatives employed in treating children with a CNS GCT. CME This article is available for continuing medical education credit at CME.TheOncologist.com Central nervous system (CNS) germ cell tumors (GCTs) represent approximately 3% of primary pediatric brain tumors and encompass a wide pathologic spectrum. CNS GCTs are most commonly located in the pineal and suprasellar regions of the brain and can be divided into major groups including germinomas and nongerminomatous GCTs (NGGCTs), with teratomas often considered a separate category. The clinical presentation varies by location and size, and it frequently includes endocrine abnormalities, visual changes, and signs of increased intracranial pressure. Neuroimaging studies cannot differentiate GCTs from other tumors, and therefore, the diagnosis usually requires histologic confirmation. The rare exceptions are the cases where characteristic elevations of tumor markers, including alpha-fetoprotein and/or β-human chorionic gonadotropin are documented in the serum and/or cerebrospinal fluid. In these cases, the imaging findings along with the tumor marker elevation may be diagnostic in themselves without the need for tissue confirmation. Treatment and prognosis differ greatly between groups. Germinomas have a superior prognosis than NGGCTs. Five-year overall survival rates &gt;90% were reported initially with the use of craniospinal irradiation. More recently, the use of chemotherapy in addition to radiation therapy has afforded the ability to decrease the dose and volume of radiation therapy without affecting survival rates. NGGCTs are less radiosensitive than germinomas, but the use of adjuvant chemotherapy has improved survival rates in this group as well. The standard management for CNS GCTs remains controversial. Treatment regimens aimed to improve progression-free and overall survival times are ongoing.

Extragonadal Germ Cell Tumors of the Mediastinum and Retroperitoneum: Results From an International Analysis

2002-04-01

Carsten Bokemeyer , Craig R. Nichols , J P Droz +7 more

To characterize the clinical and biologic features of extragonadal germ cell tumor (EGCT) and to determine the overall outcome with currently available treatment strategies.Of an unselected population of 635 consecutive … To characterize the clinical and biologic features of extragonadal germ cell tumor (EGCT) and to determine the overall outcome with currently available treatment strategies.Of an unselected population of 635 consecutive patients treated from 1975 through 1996 at 11 cancer centers, 341 patients (54%) had primary mediastinal EGCT, and 283 patients (45%) had retroperitoneal EGCT. Five hundred twenty-four patients (83%) had a nonseminomatous germ cell tumor (GCT), and 104 patients (16%) had a seminomatous histology.After platinum-based induction chemotherapy with or without secondary surgery, 141 patients (49%) with mediastinal nonseminomas (median follow-up, 19 months; range, 1 to 178 months) and 144 patients (63%) with retroperitoneal nonseminoma (median follow-up, 29 months; range, 1 to 203 months) are alive (P =.0006). In contrast, the overall survival rate for patients with a seminomatous EGCT is 88%, with no difference between patients with mediastinal or retroperitoneal tumor location (median follow-up, 49 months; range, 4 to 193 months; respective 70 months; range, 1 to 211 months). A significantly lower progression-free survival rate was found in seminoma patients treated with initial radiotherapy alone compared with chemotherapy. Nonseminomatous histology, presence of nonpulmonary visceral metastases, primary mediastinal GCT location, and elevated beta-human chorionic gonadotropin were independent prognostic factors for shorter survival. Hematologic malignancies (n = 17) occurred without exception in patients with primary mediastinal nonseminoma. Sixteen patients developed a metachronous testicular cancer despite the use of platinum-based chemotherapy.Whereas patients with pure seminomatous EGCT histology have a long-term chance of cure of almost 90% irrespective of the primary tumor site, 45% of patients with mediastinal nonseminomas are alive at 5 years. This outcome is clearly inferior compared with patients with nonseminomatous retroperitoneal primary tumors.

EAU Guidelines on Testicular Cancer: 2011 Update

2011-05-27

Peter Albers , Walter Albrecht , Ferrán Algaba +5 more

POSSIBLE CARCINOMA-IN-SITU OF THE TESTIS

1972-09-01

NielsE. Skakkebæk

Developmental model for the pathogenesis of testicular carcinoma in situ: genetic and environmental aspects

2006-03-15

Ewa Rajpert‐De Meyts

Carcinoma in situ testis (CIS), also known as intratubular germ cell neoplasia (ITGCN), is a pre-invasive precursor of testicular germ cell tumours, the commonest cancer type of male adolescents and … Carcinoma in situ testis (CIS), also known as intratubular germ cell neoplasia (ITGCN), is a pre-invasive precursor of testicular germ cell tumours, the commonest cancer type of male adolescents and young adults. In this review, evidence supporting the hypothesis of developmental origin of testicular germ cell cancer is summarized, and the current concepts regarding aetiology and pathogenesis of this disease are critically discussed. Comparative studies of cell surface proteins (e.g. PLAP and KIT), some of the germ cell-specific markers (e.g. MAGEA4, VASA, TSPY and NY-ESO-1), supported by studies of regulatory elements of the cell cycle (e.g. p53, CHK2 and p19-INK4d) demonstrated a close similarity of CIS to primordial germ cells and gonocytes, consistent with the pre-meiotic origin of CIS. Recent gene expression profiling studies showed that CIS cells closely resemble embryonic stem cells (ESCs). The abundance of factors associated with pluripotency (NANOG and OCT-3/4) and undifferentiated state (AP-2γ) may explain the remarkable pluripotency of germ cell neoplasms, which are capable of differentiating to various somatic tissue components of teratomas. Impaired gonadal development resulting in the arrest of gonocyte differentiation and retention of its embryonic features, associated with an increasing genomic instability, is the most probable model for the pathogenesis of CIS. Genomic amplification of certain chromosomal regions, e.g. 12p, may facilitate survival of CIS and further invasive progression. Genetic studies, have so far not identified gene polymorphisms predisposing to the most common non-familial testicular cancer, but this research has only recently begun. Association of CIS with other disorders, such as congenital genital malformations and some forms of impaired spermatogenesis, all rising in incidence in a synchronous manner, led to the hypothesis that CIS might be a manifestation of testicular dysgenesis syndrome (TDS). The aetiology of TDS including testicular cancer remains to be elucidated, but epidemiological trends suggest a primary role for environmental factors, probably combined with genetic susceptibility.

European consensus on diagnosis and treatment of germ cell cancer: a report of the European Germ Cell Cancer Consensus Group (EGCCCG)

2004-08-19

Hans‐Joachim Schmoll , Rainer Souchon , S. Krege +7 more

Radiotherapy versus single-dose carboplatin in adjuvant treatment of stage I seminoma: a randomised trial

2005-07-01

R.T.D. Oliver , MD Mason , GM Mead +7 more

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Carcinoma‐in‐situ of the testis: possible origin from gonocytes and precursor of all types of germ cell tumours except spermatocytoma

1987-02-01

N E Skakkebæk , Jens Berthelsen , Aleksander Giwercman +1 more

Based on evidence from morphological and histochemical studies and from clinical experience, the following hypotheses are proposed: (1) carcinoma‐in‐situ (CIS) germ cells are malignant gonocytes; (2) these CIS gonocytes have … Based on evidence from morphological and histochemical studies and from clinical experience, the following hypotheses are proposed: (1) carcinoma‐in‐situ (CIS) germ cells are malignant gonocytes; (2) these CIS gonocytes have some capacity to regress into more primitive, totipotent embryonic cells which can give rise to all types of nonseminomatous germ cell tumours; (3) the tumour germ cells of classical seminomas are malignant gonocytes derived from CIS gonocytes which have lost their ability to regress into totipotent embryonic cells; (4) the ability of CIS gonocytes to regress into totipotent embryonic cells decreases with age, whereas the capacity to form classical seminoma cells is preserved; (5) the transformation of CIS gonocytes into invasive tumours is dependent on factors such as gonadotrophins and/or testicular steroids; (6) the pathogenesis of classical and spermatocytic seminoma are unrelated. As a consequence of these hypotheses an alternative nomenclature for carcinoma‐in‐situ, seminoma and dysgerminoma is suggested.

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European Consensus Conference on Diagnosis and Treatment of Germ Cell Cancer: A Report of the Second Meeting of the European Germ Cell Cancer Consensus group (EGCCCG): Part I

2008-01-14

S. Krege , J. Beyer , Rainer Souchon +7 more

Age at Surgery for Undescended Testis and Risk of Testicular Cancer

2007-05-03

Andreas Pettersson , Lorenzo Richiardi , Agneta Nordenskjöld +2 more

Undescended testis, which is a risk factor for testicular cancer, is usually treated surgically, but whether the age at treatment has any effect on the risk is unclear. We studied … Undescended testis, which is a risk factor for testicular cancer, is usually treated surgically, but whether the age at treatment has any effect on the risk is unclear. We studied the relation between the age at treatment for undescended testis and the risk of testicular cancer.We identified men who underwent orchiopexy for undescended testis in Sweden between 1964 and 1999. Cohort subjects were identified in the Swedish Hospital Discharge Register and followed for the occurrence of testicular cancer through the Swedish Cancer Registry. Vital statistics and data on migration status were taken from the Register of Population and Population Changes for the years 1965 through 2000. We estimated the relative risk of testicular cancer using Poisson regression of standardized incidence ratios, comparing the risk in the cohort with that in the general population. We also analyzed the data by means of Cox regression, using internal comparison groups.The cohort consisted of 16,983 men who were surgically treated for undescended testis and followed for a total of 209,984 person-years. We identified 56 cases of testicular cancer during follow-up. The relative risk of testicular cancer among those who underwent orchiopexy before reaching 13 years of age was 2.23 (95% confidence interval [CI], 1.58 to 3.06), as compared with the Swedish general population; for those treated at 13 years of age or older, the relative risk was 5.40 (95% CI, 3.20 to 8.53). The effect of age at orchiopexy on the risk of testicular cancer was similar in comparisons within the cohort.Treatment for undescended testis before puberty decreases the risk of testicular cancer.

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Combination of Paclitaxel, Ifosfamide, and Cisplatin Is an Effective Second-Line Therapy for Patients With Relapsed Testicular Germ Cell Tumors

2005-09-17

G. Varuni Kondagunta , Jennifer Bacik , Alessia Donadio +5 more

The efficacy of paclitaxel was evaluated in combination with ifosfamide and cisplatin as second-line chemotherapy for patients with relapsed testicular germ cell tumors (GCTs).Forty-six patients with progressive metastatic GCTs were … The efficacy of paclitaxel was evaluated in combination with ifosfamide and cisplatin as second-line chemotherapy for patients with relapsed testicular germ cell tumors (GCTs).Forty-six patients with progressive metastatic GCTs were treated with paclitaxel and ifosfamide plus cisplatin (TIP) as second-line therapy. Eligibility required that patients have both a testis primary tumor site and a prior complete response (CR) to a first-line chemotherapy program, which had been identified previously as favorable prognostic factors to conventional-dose salvage chemotherapy.Thirty-two (70%) of 46 patients achieved a CR to treatment. Three patients (7%) who achieved a CR relapsed after TIP chemotherapy. Twenty-nine patients are continuously disease free at a median follow-up time of 69 months, resulting in a 63% durable CR rate and a 2-year progression-free survival rate of 65% (95% CI, 51% to 79%).Four cycles of TIP as second-line therapy achieved a durable CR rate in a high proportion of patients with relapsed testicular GCT. The high CR rate emphasizes the importance of patient selection according to prognostic factors to achieve a favorable outcome to conventional-dose salvage therapy.

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Cardiovascular Disease as a Long-Term Complication of Treatment for Testicular Cancer

2003-04-15

Robert Huddart , A. Norman , Maryam Shahidi +4 more

Purpose: To assess the risk of cardiovascular morbidity and cardiac risk factors in long-term survivors of testicular cancer according to treatment received. Patients and Methods: All resident male patients registered … Purpose: To assess the risk of cardiovascular morbidity and cardiac risk factors in long-term survivors of testicular cancer according to treatment received. Patients and Methods: All resident male patients registered in the United Kingdom between 1982 and 1992 attending for follow-up were eligible for recruitment. Patients completed a current health questionnaire and underwent clinical review, along with hematologic, biochemical, and hormonal profiles. For patients not under routine review, follow-up information was sought from their general practitioner and mortality data were sought from the Office of National Statistics. Descriptive analysis was performed on all variables and comparisons were made among patients treated by orchidectomy and follow-up only, chemotherapy alone (C), radiotherapy alone (RT), and radiotherapy and chemotherapy (C/RT). Results: Data on cardiovascular events were available on 992 patients. After a median follow-up of 10.2 years, 68 events had been reported, including 18 deaths. After adjusting for age, increased risk for cardiac events was seen after C (relative risk [RR] = 2.59; 95% confidence interval [CI], 1.15 to 5.84; P = .022), RT (RR = 2.40; 95% CI, 1.04 to 5.45; P = .036), and C/RT (RR = 2.78; 95% CI, 1.09 to 7.07; P = .032). There were no significant differences in cardiac risk factors. On multivariate analysis, age, treatment group, free thyroxine, protein, and magnesium levels were associated with cardiovascular disease. Conclusion: In long-term survivors of testicular cancer, we observed a two-fold or greater risk of developing cardiovascular disease. This was not due to increases in cardiac risk factors, which suggests a direct or indirect treatment effect. These data support the continued research into the minimization of treatment in good-prognosis testicular cancer.

Medical Research Council prospective study of surveillance for stage I testicular teratoma. Medical Research Council Testicular Tumors Working Party.

1992-11-01

G. Read , Sally Stenning , M.H. Cullen +4 more

PURPOSE A prospective study of surveillance after orchidectomy alone in patients with stage I nonseminomatous germ cell testicular tumor (NSGCT) was performed to determine the relapse-free rate and to identify … PURPOSE A prospective study of surveillance after orchidectomy alone in patients with stage I nonseminomatous germ cell testicular tumor (NSGCT) was performed to determine the relapse-free rate and to identify the histologic criteria that predict for relapse. PATIENTS AND METHODS Three hundred ninety-six patients from 16 United Kingdom and one Norwegian centers were entered onto the study between January 1, 1984 and October 1, 1987 of whom 373 were eligible for analysis. In a previous retrospective study, we defined a prognostic index based on histologic criteria that identified a group of patients with a high risk of relapse. This index was based on the presence of venous and lymphatic invasion, undifferentiated cells, and the absence of yolk sac elements in the primary tumor. RESULTS The 2-year actuarial relapse-free rate after orchidectomy was 75% (95% confidence interval, 71% to 79%), and the rate at 5 years was 73%. Five patients died of tumor or treatment-related complications, which resulted in a 5-year survival of 98%. The relapse-free rate in patients with three or four risk factors was 54%. CONCLUSIONS This study confirms the safety of surveillance as a method of management and identifies a group of patients with a high risk of relapse. A prospective phase II study has been initiated to determine whether two courses of platinum-based adjuvant chemotherapy will prevent relapse in these high-risk patients.

Testicular size: assessment and clinical importance.

1966-01-01

A Prader

Treatment of Disseminated Germ-Cell Tumors with Cisplatin, Bleomycin, and either Vinblastine or Etoposide

1987-06-04

Stephen D. Williams , Robert Birch , Lawrence H. Einhorn +3 more

Standard chemotherapy for disseminated germ-cell tumors includes a combination of cisplatin, vinblastine, and bleomycin, but this regimen produces substantial neuromuscular toxicity. In a randomized clinical trial in 261 men with … Standard chemotherapy for disseminated germ-cell tumors includes a combination of cisplatin, vinblastine, and bleomycin, but this regimen produces substantial neuromuscular toxicity. In a randomized clinical trial in 261 men with disseminated germ-cell tumors, we substituted etoposide for the vinblastine in this regimen in half the patients to compare the efficacy and toxicity of the two treatments. Among 244 patients who could be evaluated for a response, 74 percent of those receiving the regimen including vinblastine and 83 percent of those receiving the regimen including etoposide became disease-free with or without subsequent surgery (P not significant). Among the 157 patients with high tumor volume, 61 percent became disease-free on the regimen that included vinblastine, as compared with 77 percent on the regimen that included etoposide (P less than 0.05). Survival among the patients who received etoposide was higher (P = 0.048). The regimens were similar in terms of myelosuppressive effects and pulmonary toxicity. However, the etoposide regimen caused substantially fewer paresthesias (P = 0.02), abdominal cramps (P = 0.0008), and myalgias (P = 0.00002). We conclude that etoposide with cisplatin and bleomycin is superior to vinblastine with cisplatin and bleomycin in the treatment of disseminated germ-cell tumors because of diminished neuromuscular toxicity and, among patients with advanced disease, better efficacy.

Testicular Germ-Cell Cancer

1997-07-24

George J. Bosl , Robert J. Motzer

Approximately 95 percent of malignant tumors arising in the testis are germ-cell tumors, a term that indicates their origin in primordial germ cells. Germ-cell tumors also occasionally arise in extragonadal … Approximately 95 percent of malignant tumors arising in the testis are germ-cell tumors, a term that indicates their origin in primordial germ cells. Germ-cell tumors also occasionally arise in extragonadal primary sites, and their management follows that of testicular germ-cell tumors. More than 90 percent of patients with newly diagnosed germ-cell tumors are cured, and delay in diagnosis correlates with a higher stage at presentation for treatment.1,2 Management has changed substantially in the past 20 years, largely because of the ability of cisplatin-containing combination chemotherapy to cure advanced disease.3 In this review, we discuss recent developments in our understanding . . .

International germ cell consensus classification: A prognostic factor-erased staging system for metastatic germ cell cancers

1997-02-01

GM Mead , SP Stenning , Penny A. Cook +7 more

Purpose: Cisplatin-containing chemotherapy has dramatically improved the outlook for patients with metastatic germ cell tumors (GCT), and overall cure rates now exceed 80%. To make appropriate risk-based decisions about therapy … Purpose: Cisplatin-containing chemotherapy has dramatically improved the outlook for patients with metastatic germ cell tumors (GCT), and overall cure rates now exceed 80%. To make appropriate risk-based decisions about therapy and to facilitate collaborative trials, a simple prognostic factor-based staging classification is required. Materials: Collaborative groups from 10 countries provided clinical data on patients with metastatic GCT treated with cisplatin-containing chemotherapy. Multivariate analyses of prognostic factors for progression and survival were performed and models were validated on on independent data set. Results: Data were available on 5,202 patients with nonseminomatous GCT (NSGCT) and 660 patients with seminoma. Median follow-up time was 5 years, For NSGCT the following independent adverse factors were identified: mediastinal primary site; degree of elevation of alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), and lactic dehydrogenase (LDH); and presence of nonpulmonary visceral metastases (NPVM), such as liver, bone, and brain. For seminoma, the predominant adverse feature was the presence of NPVM. integration of these factors produced the following groupings: good prognosis, comprising 60% of GCT with a 91% (89% to 93%) 5-year survival rate; intermediate prognosis, comprising 26% of GCT with a 79% (75% to 83%) 5-year survival rate; and poor prognosis, comprising 14% of GCT (all with NSGCT) with a 48% (42% to 54%) 5-year survival rate. Conclusion: An easily applicable, clinically based, prognostic classification for GCT has been agreed on between all the major clinical trial groups who are presently active worldwide. This should be used in clinical practice and in the design and reporting of clinical trials to aid international collaboration and understanding. (C) 1997 by American Society of Clinical Oncology.

Testicular Cancer, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology

2019-12-01

Timothy D. Gilligan , Daniel W. Lin , Rahul Aggarwal +7 more

Testicular cancer is relatively uncommon and accounts for <1% of all male tumors. However, it is the most common solid tumor in men between the ages of 20 and 34 … Testicular cancer is relatively uncommon and accounts for <1% of all male tumors. However, it is the most common solid tumor in men between the ages of 20 and 34 years, and the global incidence has been steadily rising over the past several decades. Several risk factors for testicular cancer have been identified, including personal or family history of testicular cancer and cryptorchidism. Testicular germ cell tumors (GCTs) comprise 95% of malignant tumors arising in the testes and are categorized into 2 main histologic subtypes: seminoma and nonseminoma. Although nonseminoma is the more clinically aggressive tumor subtype, 5-year survival rates exceed 70% with current treatment options, even in patients with advanced or metastatic disease. Radical inguinal orchiectomy is the primary treatment for most patients with testicular GCTs. Postorchiectomy management is dictated by stage, histology, and risk classification; treatment options for nonseminoma include surveillance, systemic therapy, and nerve-sparing retroperitoneal lymph node dissection. Although rarely occurring, prognosis for patients with brain metastases remains poor, with >50% of patients dying within 1 year of diagnosis. This selection from the NCCN Guidelines for Testicular Cancer focuses on recommendations for the management of adult patients with nonseminomatous GCTs.

Prevalence and Natural History of Cryptorchidism

1993-07-01

Gertrud S. Berkowitz , Robert H. Lapinski , Jacqueline G. Gazella +3 more

Objective. A prospective hospital-based cohort study was conducted to determine the prevalence rates of cryptorchidism at birth, 3 months, and 1 year of age. Design. A total of 6935 consecutive … Objective. A prospective hospital-based cohort study was conducted to determine the prevalence rates of cryptorchidism at birth, 3 months, and 1 year of age. Design. A total of 6935 consecutive male neonates delivered at Mount Sinai Hospital in New York City between October 1987 and October 1990 were examined at birth for cryptorchidism. Standardized examination and classification criteria were used. Infants classified as cryptorchid at birth were reexamined at 3 months and 1 year after the expected date of delivery. Results. Of 6935 neonates assessed at birth, 255(3.7%) were found to be cryptorchid at birth. The rates were significantly elevated for low birth weight, preterm, small-for-gestational age, and twin neonates. The overall rate had declined to 1.0% by the 3-month assessment and 1.1% at the 1-year assessment. Although the rates at the 1-year assessment tended to be higher for low birth weight and preterm infants, no significant group differences were observed. Conclusions. Since the prevalence rates in this study are similar to those reported several decades ago, these data provide no evidence that the rate of cryptorchidism has increased either at birth or by 1 year of age. Furthermore, most testes that descend spontaneously do so within the first 3 months after the expected date of delivery.

International Germ Cell Consensus Classification: a prognostic factor-based staging system for metastatic germ cell cancers. International Germ Cell Cancer Collaborative Group.

1997-02-01

P M Wilkinson , G. Read

PURPOSE Cisplatin-containing chemotherapy has dramatically improved the outlook for patients with metastatic germ cell tumors (GCT), and overall cure rates now exceed 80%. To make appropriate risk-based decisions about therapy … PURPOSE Cisplatin-containing chemotherapy has dramatically improved the outlook for patients with metastatic germ cell tumors (GCT), and overall cure rates now exceed 80%. To make appropriate risk-based decisions about therapy and to facilitate collaborative trials, a simple prognostic factor-based staging classification is required. MATERIALS Collaborative groups from 10 countries provided clinical data on patients with metastatic GCT treated with cisplatin-containing chemotherapy. Multivariate analyses of prognostic factors for progression and survival were performed and models were validated on an independent data set. RESULTS Data were available on 5,202 patients with nonseminomatous GCT (NSGCT) and 660 patients with seminoma. Median follow-up time was 5 years. For NSGCT the following independent adverse factors were identified: mediastinal primary site; degree of elevation of alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), and lactic dehydrogenase (LDH); and presence of nonpulmonary visceral metastases (NPVM), such as liver, bone, and brain. For seminoma, the predominant adverse feature was the presence of NPVM. Integration of these factors produced the following groupings: good prognosis, comprising 60% of GCT with a 91% (89% to 93%) 5-year survival rate; intermediate prognosis, comprising 26% of GCT with a 79% (75% to 83%) 5-year survival rate; and poor prognosis, comprising 14% of GCT (all with NSGCT) with a 48% (42% to 54%) 5-year survival rate. CONCLUSION An easily applicable, clinically based, prognostic classification for GCT has been agreed on between all the major clinical trial groups who are presently active worldwide. This should be used in clinical practice and in the design and reporting of clinical trials to aid international collaboration and understanding.

The Testis in Normal and Infertile Men.

1977-12-01

Philip Troen , Howard R. Nankin

Scrotal Pain in Testicular Cancer: Analysis of Its Association with Clinicopathological Features

2025-06-25

Berk Yasin Ekenci , Metin Yığman , Emre Hepşen +3 more | Bulletin of Urooncology

Pulmonary toxicity in children, adolescents, and young adults with testicular germ cell tumors: A population‐based retrospective matched cohort study

2025-06-24

Rand Ajaj , Andrea S. Gershon , Cindy Lau +6 more | International Journal of Cancer

Abstract While testicular germ cell tumors (TGCT) are highly curable, survivors experience toxicities. Pulmonary outcomes post‐TGCT are not well understood, particularly among children, adolescents, and young adults (CAYA). Using provincial … Abstract While testicular germ cell tumors (TGCT) are highly curable, survivors experience toxicities. Pulmonary outcomes post‐TGCT are not well understood, particularly among children, adolescents, and young adults (CAYA). Using provincial cancer registries, we identified all CAYA (aged 11–21 years) diagnosed with a TGCT from 1992 to 2021 in Ontario, Canada, and matched them (1:5) to general population males (controls). We linked CAYA to health administrative databases to identify pulmonary disease and pulmonary disease healthcare visits (PDV) and classified PDV severity as low (outpatient family physician/pediatrician), medium (outpatient respirologist/internist), or high (hospitalization/emergency department). We assessed acute (<5 years from diagnosis) and late (≥5 years after diagnosis) toxicities using the cumulative incidence function and cause‐specific hazard models. We identified 748 patients (404 chemotherapy‐treated) and 3740 controls. Patients' median age at diagnosis was 19.0 years [interquartile range (IQR):18.0–21.0] and 29.7 years (IQR:25.0–37.6) at end of follow‐up. Non‐chemotherapy‐treated patients had higher risk of acute toxicities (obstructive lung disease, medium severity PDV, hospitalizations) but similar risk of late toxicities to controls. Chemotherapy‐treated patients had higher risk than controls of most acute pulmonary toxicities (except asthma and low severity PDV) and several late toxicities: asthma [hazard ratio (HR) = 2.0, 95%CI:1.1–3.8], pulmonary embolism/infarction (HR = 7.3, 95%CI:1.2–44.3), medium severity PDV (HR = 3.9, 95%CI:2.1–7.3), and high severity PDV (HR = 1.7, 95%CI:1.0–2.8), particularly hospitalizations (HR = 4.1, 95%CI:1.7–9.5). CAYA TGCT survivors treated with chemotherapy are at risk for late asthma, pulmonary embolism, pulmonary fibrosis, and specialist and hospital‐based pulmonary care. Further follow‐up is needed to characterize late pulmonary outcomes as survivors age.

Azoospermie et antécédents de cryptorchidie à propos de 6 cas à Conakry

2025-06-23

FD Sewadouno , AB Aweh , Issa Hamadou +3 more | Journal of African clinical cases and reviews.

Introduction : La cryptorchidie, testicule non descendu dans sa position normale intrascrotale, est l’une des anomalies congénitales les plus fréquentes du système génital masculin. Elle est considérée comme une pathologie … Introduction : La cryptorchidie, testicule non descendu dans sa position normale intrascrotale, est l’une des anomalies congénitales les plus fréquentes du système génital masculin. Elle est considérée comme une pathologie complexe car probablement multifactorielle. Des facteurs hormonaux, génétiques et environnementaux sont impliqués dans sa genèse. Cette pathologie représente un facteur de risque majeur d’infertilité et de cancer testiculaire. Ce travail a pour objectif d’étudier le profil spermiologique de 6 patients adultes infertiles, ayant une azoospermie et un antécédent de Cryptorchidie. Méthodologie : Il s’est agi d’une étude prospective portant sur 6 patients adultes cryptorchides entre le 1er Janvier au 31 Décembre 2024. Ces patients étaient adressés au laboratoire d’Histologie-Embryologie, Biologie de la Reproduction et Cytogénétique de la Faculté des Sciences et Techniques de la Santé de l’Université Gamal Abdel Nasser de Conakry après avoir consulté initialement un médecin urologue afin de bénéficier d’un bilan biologique devant la découverte d’une cryptorchidie. L’azoospermie était confirmée quand on ne retrouvait aucun spermatozoïde après examen du culot de centrifugation, sur au moins deux spermogrammes réalisés à au moins 3 mois d’intervalle, selon les normes de l’OMS de 2021. Résultats : L’âge moyen des patients était de 24,66 ans. Tous nos patients (n=6) étaient mariés. Les paramètres spermatiques comprenaient : la couleur, le volume, le pH, la viscosité et la concentration. La couleur du sperme et le volume étaient anormaux chez 1 de nos patients. La concentration était nulle chez tous nos patients. La FSH, LH, prolactine et testostérone totale étaient élevées chez 2 de nos patients. L’azoospermie était excrétoire chez 4 et sécrétoire chez 1 de nos patients. Mots-clés : Cryptorchidie, Azoospermie, infertilité masculine, Adulte, Testicule.

Orbital Yolk Sac Tumor in an Infant

2025-06-23

Dong Hoon Lee , J.Y.M. Koo , Bo Ram Kim +1 more | Journal of Craniofacial Surgery

Yolk sac tumors most commonly arise in the gonads, such as the testes or ovaries. Extragonadal yolk sac tumors occur primarily in midline sites, such as the mediastinum, sacrococcygeal area, … Yolk sac tumors most commonly arise in the gonads, such as the testes or ovaries. Extragonadal yolk sac tumors occur primarily in midline sites, such as the mediastinum, sacrococcygeal area, and retroperitoneum. Orbital yolk sac tumor is an extremely rare disease. Herein, the authors report an unusual case of an orbital yolk sac tumor in an infant. The patient responded very well to chemotherapy. Imaging tests performed after the completion of chemotherapy showed no evidence of disease, and the serum AFP level was normal. In conclusion, distinguishing orbital yolk sac tumors from other orbital lesions, including those of congenital, benign, or malignant origin, is critical for its prompt treatment.

CACA guidelines for holistic integrative management of central nervous system germ cell tumor

2025-06-23

Chao Zhang , Xiang Huang , Yijin Gao +7 more | Holistic Integrative Oncology

Abstract Central nervous system germ cell tumors (CNS GCTs) are common malignancies of the central nervous system of children and adolescents. The management of CNS GCTs is complex because of … Abstract Central nervous system germ cell tumors (CNS GCTs) are common malignancies of the central nervous system of children and adolescents. The management of CNS GCTs is complex because of varied tumor sites, clinical presentations, treatments and outcomes. Multidisciplinary integrated treatment involving radiotherapy, chemotherapy and surgery is the most commonly used approach for CNS GCTs worldwide and is essential for achieving favorable clinical outcomes. The Pediatric Oncology Committee of the Chinese Anti-Cancer Association (CACA) has formulated the guidelines for the management of CNS GCTs based on domestic and foreign clinical studies and experiences. The guidelines cover the diagnosis and treatment of primary CNS GCT in the pineal region, the sellar region, and the thalamus and basal ganglia region, recurrent, disseminated, and bifocal/multifocal CNS GCT, as well as traditional Chinese medicine. In these guidelines, different treatment regimens are proposed for secretory or non-secretory GCTs. The therapeutic concepts of primary treatment and second-look surgery are also introduced. The hope is to help standardize the diagnosis and treatment, and further improve the outcomes of CNS GCTs patients.

12 years of experience in intrauterine testicular torsion management

2025-06-23

Olga Devrim Ayvaz , Sabri Cansaran , Ayşenur Cerrah Celayir +1 more | Pediatric Surgery International

Intrauterine testicular torsion is a rare pathology and there is no consensus on how to treat and follow-up these patients. This study aims to evaluate the surgical indications, findings, testicular … Intrauterine testicular torsion is a rare pathology and there is no consensus on how to treat and follow-up these patients. This study aims to evaluate the surgical indications, findings, testicular viability rate, and management approaches of intrauterine testicular torsion cases in our center over a 12-year period. 17 patients diagnosed with intrauterine testicular torsion and operated on between January 2010 and 2023 were included in the study. The patients' age at birth, mode of birth, weight, maternal age, genetic diagnosis, presence of other anomalies, complaints upon presentation, physical examination findings, laboratory results, preoperative ultrasound and Doppler imaging findings, surgery date, surgery weight, torsion side, surgery method and findings, torsion type (intravaginal, extravaginal), degree of torsion, length of hospital stay, complications, pathology results, testicular status in postoperative follow-up and ultrasonography and Doppler findings were examined. The median age of the cases was one day. Orchiectomy was performed in fourteen cases (82.4%), while three cases (17.6%) were managed with detorsion and orchiopexy. Prophylactic contralateral orchiopexy was performed in four (23.5%) cases, and undescended testicle surgery was performed in one (5.9%) case. None of the testes managed with detorsion and orchiopexy remained viable during follow-up. The etiology, risk factors, and optimal management approach of intrauterine testicular torsion are not fully elucidated. Based on the current literature, the salvage rates are close to zero in our study as well as many others despite the efforts to promptly diagnose and operate intrauterine torsion cases. Creating management algorithms based on the data gathered from multiple centers over the years can yield better outcomes for this devastating pathology.

Scrotal pain as the presenting symptom of metastatic sigmoid cancer

2025-06-23

Trygve Ulvund Solstad , Claudia Schröder , Michael Festersen Nielsen +1 more | Ugeskrift for Læger

Colorectal cancer is one of the most common malignancies globally, and typical sites of metastasis include the liver and lungs; however, metastasis to the testes is exceedingly rare. We report … Colorectal cancer is one of the most common malignancies globally, and typical sites of metastasis include the liver and lungs; however, metastasis to the testes is exceedingly rare. We report a case where a 54-year-old male presented with acute scrotal pain and swelling. Scrotal ultrasound revealed a solid mass, and further investigations identified metastatic adenocarcinoma originating from the sigmoid colon. This case highlights the importance of considering malignancy in older patients with scrotal symptoms, especially when common causes have been ruled out.

Criptorquidismo abdominal unilateral em gato

2025-06-21

Anderson Coutinho , Marco Aurélio Araújo Correia | PubVet

Abdominal cryptorchidism in domestic cats is characterized by a malformation of the genitourinary system. It is a reproductive disorder resulting from the failure of the testicle, developed in the abdominal … Abdominal cryptorchidism in domestic cats is characterized by a malformation of the genitourinary system. It is a reproductive disorder resulting from the failure of the testicle, developed in the abdominal cavity, to migrate to the scrotum. This anomaly has a low prevalence in felines but can lead to hormonal imbalances, resulting in behavioral changes. This type of testicular dystopia may go unnoticed by owners and, over time, can have consequences for the animal, such as difficulty gaining weight due to compulsive behavior, as well as an increased risk of neoplasia. This report describes a case of unilateral abdominal cryptorchidism in a semi-domesticated male cat, approximately 2 years and 11 months old. Over time, the condition manifested as poor weight gain, compulsive behavior (exacerbated libido), restlessness, and excessive vocalization, which prompted the owners to seek veterinary consultation and evaluation. Following clinical examination, hematological tests, and imaging studies, abdominal cryptorchidism was recommended. The procedure was carried out without any complications during the intraoperative and immediate postoperative periods. Shortly after discharge, the cat showed significant improvement in symptoms, along with satisfactory weight gain.

From Incidence to Inequality: Charting the Global Burden of Testicular Cancer in Adolescents and Young Adults for the Global Burden of Disease Study 2021

2025-06-21

Hongting Xie , Quan Sun , Peng Xue +7 more | medRxiv (Cold Spring Harbor Laboratory)

Background: The incidence of testicular cancer (TC) among adolescents and young adults (AYAs: aged 15-39 years) population presents unique biological and epidemiologic characteristics, and there is currently a wide variation … Background: The incidence of testicular cancer (TC) among adolescents and young adults (AYAs: aged 15-39 years) population presents unique biological and epidemiologic characteristics, and there is currently a wide variation in incidence and survival across regions. Methods: The data on incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) owing to TC were obtained from the Global Burden of Disease 2021. We quantified differences in the burden of TC among AYA at the socio-demographic index (SDI), regional, and national levels. Decomposition analysis was used to identify the main drivers of variation in the burden. Frontier analysis demonstrated the potential for countries to reduce the burden. Results: Globally, there were 28499 new cases, 61596 prevalent cases, 5699 mortality cases, and 376564 DALYs due to TC among AYA in 2021. Between 1990 and 2021, the age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) increased while the age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR) decreased. Regionally, Southern Latin America exhibited the highest ASRs. Nationally, Monaco ranked highest in ASIR and ASPR, while Mexico had the highest ASMR and ASDR. Population growth and epidemiological changes were major drivers for the burden of DALYs in middle SDI regions, which had the greatest potential for improvement. Conclusions: The global burden of TC among AYA has risen, which is most pronounced in middle SDI regions. Among the AYA population, TC survivors have increased significantly due to the decreased ASMR and ASDR, who badly need more attention for TC treatment.

Voluminous bilateral malignant ovarian germ cell tumors with carcinomatosis in a child

2025-06-21

N. Boujida , Khadija Elaitari , Soukayna Jabour +6 more | Radiology Case Reports

Right-sided cryptorchidism and contralateral intrascrotal testicular torsion in a young dog: a rare case report

2025-06-21

Saeed Farzad‐Mohajeri , Ramina Khodadadian , Hamidreza Moosavian +3 more | Veterinary Research Communications

Specialized abdominoscrotal hydrocele: Case report (CARE-compliant)

2025-06-20

T Wang , Ya-Long Ma , Nuan Han +2 more | Medicine

Abdominoscrotal hydrocele (ASH) is a rare condition characterized by fluid-filled masses in the inguinal scrotal and abdominal components, and the understanding of this condition, especially its pathogenesis, remains incompletely transparent. … Abdominoscrotal hydrocele (ASH) is a rare condition characterized by fluid-filled masses in the inguinal scrotal and abdominal components, and the understanding of this condition, especially its pathogenesis, remains incompletely transparent. The child, a 2-year-old boy, 4 days ago, no apparent cause of paroxysmal abdominal pain during the constipation symptoms, self-defecation after abdominal pain relief, occasional mild cough, no nausea and vomiting. "Abdominal cavity occupation." Laparoscopic exploration, the most prominent position of the cyst was opened with tissue scissors to cut the cyst wall extensively, the intra-abdominal purse-string suture was closed to close the internal ring opening on the affected side and tied with a knot. The child had no postoperative discomfort and was discharged from the hospital with no abnormalities on regular follow-ups and had returned to normal. We reported a more unusual case with specific clinical manifestations that helped us to understand abdominoscrotal hydrocele further, and we conducted a systematic review of the relevant literature to provide an overview of the clinical manifestations, pathogenesis, diagnosis and treatment.

Immune profiling of pediatric germ cell tumors identifies key cell populations and novel therapeutic targets

2025-06-20

Lenilson Silva , Ingridy Izabella Vieira Cardoso , Mabel Cruz +7 more | Frontiers in Immunology

Introduction Pediatric germ cell tumors (GCTs) are rare malignancies, comprising only about 3% of childhood cancers. Despite surgery and platinum-based chemotherapy being mainstays of treatment, their effectiveness varies by tumor … Introduction Pediatric germ cell tumors (GCTs) are rare malignancies, comprising only about 3% of childhood cancers. Despite surgery and platinum-based chemotherapy being mainstays of treatment, their effectiveness varies by tumor subtype, and long-term toxicities remain a concern. We therefore explored the immune landscape of pediatric GCTs to uncover subtype-specific immunological features and identify potential immunotherapeutic targets. Methods This retrospective study investigated the immune landscape of pediatric GCTs, utilizing a cohort of 17 patients, including 14 extracranial GCTs (11 ovarian, 3 testicular), three central nervous system (CNS) mixed tumors and four non-neoplastic tissues (controls). Results Immune profiling revealed distinct immune microenvironments across the GCT subtypes. Dysgerminomas exhibited an immune-active profile with elevated levels of T cells, CD8 + T cells, and cytotoxic cells, alongside upregulation of immune checkpoints CTLA4 , TIGIT , and IDO1 , suggesting potential responsiveness to checkpoint inhibitors. In contrast, yolk sac tumors displayed an immunosuppressive environment with high CD24 and PVR expression, indicative of unique immune evasion mechanisms. Embryonal carcinomas also showed high CD24 expression. An in silico analysis of adult GCTs highlighted similarities and differences with pediatric cases; IDO1 and CD24 were consistently upregulated across age groups, while CTLA4 and PVR showed variation. Conclusion Overall, this study provides new insights into pediatric GCT immunology, supporting the potential for tailored immunotherapeutic strategies targeting the distinct immune profiles of pediatric GCT histologies.

Persistent D-dimer Elevation in a Yolk Sac Germ Cell Tumor Without Thrombosis: A Potential Surrogate Marker of Tumor Necrosis

2025-06-19

Kasun Maduranga , C. M. D Selvarajah , Dilip C Madanayake +2 more | Cureus

Man With Scrotal Pain

2025-06-19

Joo Shiang Ang , J M Dew Lim | Annals of Emergency Medicine

Best evidence topic report: in emergency settings, can an absent cremasteric reflex be used to aid diagnosis of testicular torsions?

2025-06-19

Lauren Edwards , Craig Ferguson | Emergency Medicine Journal

A short systematic review was completed to answer the three-part question: in patients presenting with acute unilateral testicular pain, is an absent cremasteric reflex an accurate sign for diagnosis of … A short systematic review was completed to answer the three-part question: in patients presenting with acute unilateral testicular pain, is an absent cremasteric reflex an accurate sign for diagnosis of testicular torsion (TT)? MEDLINE, Embase and Cochrane databases were searched on 05 January 2025 using the outlined search strategy. 67 unique papers were found and screened for relevance. 13 relevant papers were identified. Study information, participant group, relevant outcomes and study weaknesses were extracted from each paper and presented in a table. Results revealed up to 100% of patients with TT had an absent cremasteric reflex; however, due to small sample sizes, there was wide variation in sensitivities (21–100%) between the papers. Small sample sizes and the inclusion of retrospective studies were significant limitations within this paper. The clinical bottom line proposes that although an absent cremasteric reflex is common in TT, the presence of a cremasteric reflex cannot be used to rule out TT.

Assessment and classification of sex cord‐stromal tumours of the testis: recommendations from the testicular sex cord‐stromal tumour (<scp>TESST</scp>) group, an Expert Panel of the Genitourinary Pathology Society (<scp>GUPS</scp>) and International Society of Urological Pathology (<scp>ISUP</scp>)

2025-06-18

Andrés Acosta , Maurizio Colecchia , Éva Compérat +7 more | Histopathology

Aims Testicular sex cord‐stromal tumours (TSCSTs) are relatively rare, accounting for ~5% of all testicular neoplasms. They were historically classified into Leydig cell tumour, Sertoli cell tumour, granulosa cell tumour, … Aims Testicular sex cord‐stromal tumours (TSCSTs) are relatively rare, accounting for ~5% of all testicular neoplasms. They were historically classified into Leydig cell tumour, Sertoli cell tumour, granulosa cell tumour, and unclassified sex cord‐stromal tumour. More recently, classification was expanded to incorporate additional histologic types, including some associated with inherited cancer predisposition syndromes. However, the classification of TSCSTs still relies entirely on morphology, with some tumour types being defined based on their resemblance to ovarian counterparts. In recent years, molecular studies have identified drivers and genomic alterations associated with aggressive behaviour and progression; however, these findings have not yet impacted classification and management. Methods and results Under sponsorship of the International Society of Urological Pathology (ISUP) and the Genitourinary Pathology Society (GUPS), a group of genitourinary pathologists was assembled in 2023 with the aim of assessing how to use these new data to improve the classification and management of TSCSTs. Conclusions This paper summarizes the recommendations derived from the consensus activities and the first meeting of the te sticular s ex cord‐ s tromal t umour (TESST) group (held at Johns Hopkins Hospital, Baltimore, USA, 3/23/2024).

Survivorship surveillance in testicular cancer: the need for longitudinal and comparative approaches

2025-06-18

Taha Bhatti | Supportive Care in Cancer

Evaluation of semen parameters and histopathological comparison of inguinal and abdominal orchiectomy specimens in late post pubertal men with unilateral undescended testis

2025-06-17

Serkan Yenigürbüz , Caner Ediz , Hasan Hüseyin Tavukçu +2 more | Basic and Clinical Andrology

Abstract Background The embryological development of the testicles and their descent to the scrotum is multifactorial process, and the role of the internal inguinal ring has not yet been clarified. … Abstract Background The embryological development of the testicles and their descent to the scrotum is multifactorial process, and the role of the internal inguinal ring has not yet been clarified. In this study, we aimed to assess the role of the internal inguinal ring in this process by comparing the inguinal and abdominal orchiectomy specimens histopathologically. The patients were classified according to localization of the undescended testicle as group 1 ( n = 11), consisting of abdominal-localized individuals, and group 2 ( n = 40), composed of inguinal-localized individuals. Data regarding age, side of the undescended testicle, testicular volume, spermatic cord length, testosterone level, semen analysis, and histopathological reports of undescended testicles in both groups were analyzed and compared. Results The median age of groups 1 and 2 was twenty-one. The median testicular volume was significantly lower in group 1 than in group 2 ( p = 0.002). In addition, progressive motility and normal sperm morphology rates were substantially higher in group 2 than in group 1 ( p = 0.019 vs p = 0.029). There was no difference between the groups in terms of analyses of histopathological parameters performed in testis tissue. ( p > 0.05). Conclusions Although testicular volume, sperm motility, and normal morphology rates were lower in abdominal testes, no significant differences were found in histopathological parameters between the groups.

V4 Laparoscopic retroperitoneal lymph node dissection for testicular cancer post-chemotherapy

2025-06-16

Manuel Pinto , Helena Sousa , Nuno Vinagre +3 more | European Urology Open Science

P24 A rare cause of acute abdomen: Abdominal testicular torsion

2025-06-16

M. Cavis | European Urology Open Science

Testicular mixed germ cell tumor

2025-06-15

Ammar Ashraf | Radiopaedia.org

A rare case report of 27-year-old young male with synchronous testicular non seminomatous germ cell tumour and acute myeloid leukemia

2025-06-15

Pallavi S. Ladda , Mayur Mundada , Faiq Ahmed +1 more | Indian Journal of Pathology and Oncology

Subinguinal Orchidectomy for Testicular Cancer: Innovation or Unnecessary Advancement

2025-06-15

D. Jacob , Pragnitha Chitteti , Mohamed Mubarak +1 more | Cureus

Introduction

2025-06-14

| TNM Online

Abstract The TNM system for the classification of malignant tumours was developed by Pierre Denoix between the years 1943 and 1952. Cancer staging is essential to patient care, research and … Abstract The TNM system for the classification of malignant tumours was developed by Pierre Denoix between the years 1943 and 1952. Cancer staging is essential to patient care, research and cancer control. Cancer control activities include direct patient‐care‐related activities, the development and implementation of clinical practice guidelines and centralised activities such as recording disease extent in cancer registries for surveillance purposes and planning cancer systems. International agreement on the classification of cancer by the extent of disease provides a method of conveying disease extent to others without ambiguity. Classification by the anatomical extent of disease is the one with which the UICC TNM system primarily deals. The sites in this classification are listed by code number of the International Classification of Diseases for Oncology. cTNM and pTNM describe the anatomical extent of cancer in general without considering treatment.

Optimal Management of Stage II Seminoma: Preventing Harm While Preserving Cure

2025-06-13

Ciara Conduit , Aditya Bagrodia , Robert J. Hamilton +2 more | JCO Oncology Practice

Stage II testicular seminoma is highly curable when treated using standard-of-care cisplatin-based chemotherapy or radiotherapy. However, these treatments can affect long-term quality of life because of the development long-term, or … Stage II testicular seminoma is highly curable when treated using standard-of-care cisplatin-based chemotherapy or radiotherapy. However, these treatments can affect long-term quality of life because of the development long-term, or chronic, toxicities and late effects. In recent years, multiple emerging treatment strategies for stage II seminoma have been explored with the principal aim of minimizing toxicity in this young patient population. These strategies have included cisplatin-sparing chemotherapy, combined modality chemoradiotherapy, and surgery in the form of primary retroperitoneal lymph node dissection; small cohort studies for each approach have reported promising efficacy with minimal toxicity, albeit without long-term follow up. While there is a need to optimize and rationalize treatment to ensure that quality of life is front of mind, it is essential that the excellent outcomes using standard-of-care treatment are not taken for granted and that cure is not compromised for young patients with stage II seminoma. This review assesses the relative merits and deficiencies of each emerging treatment strategy, with one lens focused on preventing harm and the other focused on preserving disease control and cure.

Balloon-Release Pattern on the Chest X-ray of a Young Male Patient With Metastatic Testicular Choriocarcinoma: A Case Report of an Aggressive Pulmonary Presentation

2025-06-13

Idalberto Luis Fernandez Eng , Yoniel Suarez-Guerrero , Ernesto Alfonso Figueredo +2 more | Cureus

Serous Borderline Tumors of the Testis and Paratestis

2025-06-13

Ali Shahabi , Aleksei Konstantinov , Jesse K. McKenney +7 more | The American Journal of Surgical Pathology

Serous borderline tumors of the testis and paratestis are rare, and experience with these neoplasms is limited. We report a series of 19 tumors, emphasizing their morphologic spectrum and clinical … Serous borderline tumors of the testis and paratestis are rare, and experience with these neoplasms is limited. We report a series of 19 tumors, emphasizing their morphologic spectrum and clinical behavior. Eighteen tumors (95%) had conventional serous borderline tumor morphology identical to ovarian serous borderline tumors, and 1 case (5%) had a pattern resembling the epithelial subtype of noninvasive implants of serous borderline tumor. A component of micropapillary serous borderline tumor was present in 6 tumors (31%), including 1 that was exclusively micropapillary. Five tumors (26%) had associated autoimplants. Microinvasion was identified in 4 tumors (21%). One tumor had associated low-grade serous carcinoma, and 1 tumor had associated high-grade serous carcinoma. Immunohistochemical stains demonstrated diffuse expression of PAX8 in 12 of 12 (100%) cases. Estrogen receptor was diffusely positive in 11 of 12 (92%) cases and progesterone receptor was positive in 8 of 9 (89%) cases. D2-40 was negative in 7 of 9 (78%) cases and calretinin was negative in 11 of 11 cases (100%). Clinical follow-up data were available in 9 patients (47%) with pure serous borderline tumors, of which 4 had micropapillary features (44%), 3 had microinvasion (33%), and 2 had autoimplants (22%). None of these 9 patients experienced adverse outcomes related to serous borderline tumor over the follow-up period (mean: 94 mo, median: 85 mo, range: 17 to 204 mo). Serous borderline tumors of the testis and paratestis are identical morphologically to their ovarian counterparts and can be associated with similar histologic phenomena (microinvasion, autoimplants, and micropapillary features). Although they can develop associated serous carcinoma, we conclude that serous borderline tumors of the testis and paratestis (when pure) appear to show indolent behavior.

The Epididymis: An Ultrasound Primer-What the Radiologist Needs to Know

2025-06-12

Michelle Lin , Kamran Ali , Sharon M. Gordon +3 more | Abdominal Radiology

Large Seminoma in a Reproductive-Age Woman with Complete Androgen Insensitivity Syndrome: A Case Report

2025-06-07

Kristian Alda , Achmad Kemal Harzif | International Journal of Social health

Complete Androgen insensitivity Syndrome (CAIS) is a disorder of androgen hormone resistance characterized by female phenotypes in individuals with XY karyotype. The typical clinical feature for CAIS is primary amenorrhea … Complete Androgen insensitivity Syndrome (CAIS) is a disorder of androgen hormone resistance characterized by female phenotypes in individuals with XY karyotype. The typical clinical feature for CAIS is primary amenorrhea in adolescents, or inguinal swelling in infants. Women with this disorder have breast development and puberty growth at an appropriate age, but not menstruation. In this paper reported cases of women aged 38 years came with complaints of an enlarged lump in the left inguinal since 10 years. During his life the patient has never experienced menstruation. The lump in the patient is then removed, histological examination is performed, and a semimoma feature is obtained. The karyotype examination is performed and shows the XY sex chromosome.

Hemorrhagic epididymal cyst mimicking testicular torsion: A case report

2025-06-06

Salim Ouskri , Mohammed Ali Mikou , Idriss Ziani +3 more | International Journal of Surgery Case Reports

Erratum to ‘Controversies in malignant ovarian germ cell tumors’ [International Journal of Gynecological Cancer Volume 35 Issue 3 (2025) 101670]

2025-06-04

Michael J. Seckl , Baljeet Kaur , Ehsan Ghorani +2 more | International Journal of Gynecological Cancer

The perioperative outcomes of retroperitoneal lymph node dissection in Germany for patients with testicular cancer: Results from the <scp>GRAND</scp> study

2025-06-04

Nikolaos Pyrgidis , Maria Apfelbeck , Marc Kidess +7 more | International Journal of Cancer

Abstract We aimed to assess the current trends and outcomes of retroperitoneal lymph node dissection (RPLND) in patients with testicular cancer in Germany, as well as to provide evidence on … Abstract We aimed to assess the current trends and outcomes of retroperitoneal lymph node dissection (RPLND) in patients with testicular cancer in Germany, as well as to provide evidence on the role of the type of surgical approach, prior chemotherapy, and annual hospital caseload. We used the GeRmAn Nationwide inpatient Data, provided by the Research Data Center of the Federal Bureau of Statistics (2005–2022). We assessed trends and perioperative outcomes (mortality, intensive care unit [ICU] admission, transfusion, acute embolism, and length of hospital stay) based on the surgical approach (robotic, laparoscopic, and open), prior chemotherapy, and annual hospital caseload (with cut‐offs of three and 10 cases/year) with a multivariable regression analysis. Overall, 6673 patients underwent RPLND for testicular cancer. Of them, 5570 (83%) received open, 819 (12%) laparoscopic, and 284 (5%) robot‐assisted surgery. Patients had previously received chemotherapy in 1908 (29%) cases. Accordingly, 4431 (66%) patients underwent surgery in centers performing more than 3 cases/year, and 1325 (20%) in centers performing more than 10 cases/year. Over the past 18 years, the number of patients undergoing RPLND has decreased by half. In the multivariate regression analysis, a robotic and a laparoscopic approach was associated with lower odds of ICU admission, transfusion, and shorter hospital stay ( p < .001) compared to an open approach. Patients undergoing surgery after prior chemotherapy presented similar perioperative outcomes compared to those who had not previously received chemotherapy. Similarly, patients undergoing surgery at high‐volume centers presented comparable perioperative outcomes to those in low‐volume centers based on the cut‐off of three and 10 cases/year. Still, our findings were mitigated by selection bias. Overall, the number of annual RPLND cases in Germany has decreased over time.