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Cytogenetic investigation of testicular carcinoma in situ and early seminoma by high-resolution comparative genomic hybridization analysis of subpopulations flow sorted according to DNA content.

Interpretation of data from comparative genomic hybridization (CGH) analysis of testicular neoplasms located within normal parenchyma is complicated, because the results may be influenced by a heterogeneity of subpopulations with different chromosomal aberrations and ploidy. In this study, therefore, early stages of testicular germ cell neoplasia were cytogenetically analyzed after flow sorting of nuclei according to their DNA ploidy. DNA from subpopulations with different ploidy was globally amplified by means of degenerate oligonucleotide primed polymerase chain reaction, labeled with FITC-dCTP and -dUTP by nick translation, and analyzed with high resolution CGH. A characteristic pattern of chromosomal abnormalities associated with testicular germ cell cancer (gains in 1q, 7, 8, 12, 14, 21, X; losses from 4, 5, 9, 11, 13, 18, Y) was observed in the tri- to hexaploid but not in the hyperdiploid or in pure tetraploid subpopulations. Our data suggest that subpopulations with a triploid to hexaploid DNA content purified from testes with germ cell neoplasia harbor a mixture of overt tumor and carcinoma-in-situ cells (CIS) and DNA content of CIS cells being in the triploid to hypotetraploid range, supporting the current theory of polyploidization as one of the first events of malignant transformation.

Carcinoma↗

Aggressive diagnostic approach indicated in testicular sarcoidosis.

A twenty-nine-year-old black male presented with a testicular mass and hilar adenopathy. Histologic sections of the testis showed the 3 by 2 by 2-cm mass was an inflammatory granuloma due to sarcoidosis. The epididymides were involved bilaterally. The initial differential diagnosis included: sarcoidosis, testicular neoplasm, an infectious process, or a combination of the three. Biopsy of the testicle is recommended to confirm the diagnosis of sarcoidosis. We believe there are only 6 reported cases of clinically detected testicular sarcoidosis.

Adult↗

Ultrasonographic examination of scrotal masses.

Diagnostic ultrasounds is a simple, rapid, harmless and painless method to visualize intrascrotal contents. It may provide information that is difficult to obtain on clinical examination. Abnormalities such as testicular neoplasms, inflammation and hydroceles are discussed herein.

Abscess↗

Differentiation of seminomatous from nonseminomatous testicular tumors with MR imaging.

Distinguishing seminomatous from nonseminomatous testicular neoplasms preoperatively is useful because treatment of these two tumors types is different. We evaluated whether the distinction could be made with MR imaging in six patients with seminomatous and nine patients with nonseminomatous testicular tumors (including teratoma, teratocarcinoma, embryonal cell, and choriocarcinoma). The MR diagnoses, which were obtained from the formal reports of the MR studies done and interpreted before orchiectomy, were compared with the pathologic diagnosis. The distinction between the two tumor types on MR images was based on the signal intensity and heterogeneity of the lesion. We also retrospectively compared the MR findings with tissue histology. MR scans in nonseminomatous tumors showed a marked heterogeneous mix of signals, with some regions less intense and others more intense than normal testicular tissue on both proton-density and T2-weighted images. The typical background signal was nearly equal to normal testicular tissue. The tumors also had a dark band at their periphery that correlated with a fibrous tumor capsule on histologic examination. In contradistinction, seminomatous tumors were isointense with testis on proton-density images and consistently hypointense and relatively homogeneous on T2-weighted images. These tumors typically lacked a capsule on MR images. One lesion, only 3 mm in diameter, could not be characterized on MR images because of limitations in spatial and contrast resolution. In 13 of the 14 lesions that could be characterized, the histologic type was predicted correctly on the basis of the MR appearance. The one error occurred in a patient with pure seminoma. Although the MR appearance of the lesion was otherwise similar to the other seminomas, the lesion had a single focus of bright signal that was due to hemorrhage. This focus was interpreted incorrectly as a nonseminomatous element. Our findings in this small series of patients suggest that MR imaging can be used to distinguish seminomatous from nonseminomatous testicular tumors.

Adult↗

The incidence of testicular cancer in Royal Air Force personnel.

OBJECTIVES: To review the incidence of testicular cancer within the Royal Air Force (RAF) compared with the national incidence. METHODS: The medical statistics for RAF personnel (supplied by the Central Statistics Office, categorized by occupation) were reviewed for the incidence of testicular cancer and compared to the national rate. RESULTS: A significantly elevated incidence of testicular neoplasm was detected in RAF personnel, which was well above the national rate. The increased incidence appeared most marked in those personnel working directly with aircraft. CONCLUSION: The only cause of the significantly higher incidence of testicular cancer in RAF personnel is probably related to working with aircraft. This concurs with a finding that aircraft technicians in the US Navy had an increased incidence of testicular cancer, and the exposure to hydrocarbon carcinogens in the workplace was implicated.

Adult↗

PCPH expression is an early event in the development of testicular germ cell tumors.

Testicular germ cell tumors (TGCTs) include various malignancies with distinct pathologies that share a common precursor lesion (intratubular germ cell neoplasia, unclassified, ITGCNU, or carcinoma in situ, CIS). TGCTs, as a whole, represent a highly curable tumor paradigm, with high sensitivity to radiotherapy and, especially, to cisplatin-based chemotherapy. However, a percentage of cases display therapeutic resistance, and the molecular mechanisms underlying such resistant phenotype remain to be elucidated. We put forward the notion that expression of oncogenic forms of the PCPH gene, which are known to confer resistance to radiation and chemotherapeutic drugs, including cisplatin, may be expressed in TGCTs, and thus contribute to the development of therapeutic resistance. To begin testing this concept, we studied PCPH expression in human TGCT cell lines and in 54 solid tumors by RT-PCR, western immunoblot and immunohistochemistry. The results demonstrated that: i) PCPH is expressed in TGCT cell lines and tumors, including CIS; ii) its expression levels vary among different TGCT pathologies, being generally higher in well differentiated regions and lower in areas of predominant proliferation; iii) PCPH expression is substantially increased in tumors relative to matched normal testicular tissue; iv) tumor samples express PCPH polypeptides of low molecular mass, consistent with the known size of the PCPH oncoprotein, that are either absent from, or markedly reduced in, matched normal tissue. Collectively, these results positively identify PCPH as a good early molecular marker for testicular neoplasms, and strongly indicate that immunodetection of truncated PCPH polypeptides may be a useful diagnostic tool for TGCT.

Adolescent↗

Non-germ cell tumors of testis.

Testicular tumors of non-germ cell origin represent from 5 percent to 10 percent of all testicular neoplasms. Included in this group are sex cord/gonadal stromal tumors, most originating from Leydig or Sertoli cells, mixed tumors, and tumors of mesenchymal or hematopoietic origin. In addition, various miscellaneous lesions, tumor-like conditions, and secondary testicular tumors may be classified as non-germ cell tumors. This review covers the presentation, diagnosis, and treatment of these rare lesions.

Humans↗

Leydig cell tumor of the testis in Klinefelter syndrome: MR detection.

Klinefelter syndrome is associated with the development of breast and extragonadal germ cell tumors in some patients. Leydig cell tumor in association with Klinefelter syndrome is a rare entity. We report such a case to illustrate the usefulness of MR imaging in detecting a testicular neoplasm when clinical examination and ultrasonography are equivocal.

Humans↗

Epidermoid cyst (monodermal teratoma) of the testis.

We report 14 patients with epidermoid cyst of the testis (monodermal teratoma). In 7 patients (5 treated within the last 5 years) the mass was excised and adjacent testicular tissue was biopsied. Seven patients underwent radical inguinal orchiectomy. Carcinoma in situ was not detected in any testicular tissue examined. There was no evidence of tumour recurrence in any patient after a mean follow-up of 10 years. Ultrasonographic appearance was not specific for a diagnosis of epidermoid cyst and exploratory surgery was required in all cases. Excision of the tumour and biopsy of adjacent testicular tissue to determine the presence or absence of carcinoma in situ is adequate treatment for this rare testicular neoplasm.

Adult↗

Paraneoplastic limbic encephalitis, a complication of the testicular cancer.

We report a case of paraneoplastic limbic encephalitis related to a testicular neoplasm. The syndrome is characterized by progressive amnesia and psychiatric disturbances resulting from an inflammatory reaction probably related to an immune response to the neuronal proteins expressed by tumors. It is usually associated with small cell lung cancer. In other cases, testicular cancer occurs more frequently than expected. Cranial magnetic resonance imaging may show increased signal intensity in the limbic cortex. Genitourinary examinations are sometimes inadequate. Testicular ultrasonography is recommended if no tumor is detected on the chest and abdominal computed tomography scan. The outcome of the treatment of the testicular cancer on the paraneoplastic syndrome is variable.

Antineoplastic Combined Chemotherapy Protocols↗

Testicular germ cell neoplasms.

Rapid progress in the management and treatment of testicular germ cell neoplasms has been made during the last 20 years. The development of sensitive radioimmunoassays for the serum tumor markers alpha-fetoprotein and the beta subunit of human chorionic gonadotropin has greatly aided in the diagnosis, staging, and treatment of nonseminomatous neoplasms. The development of effective combination chemotherapy for nonseminomatous germ cell tumors represents the major advance, and has changed a disease that formerly had a 75 percent two-year mortality to one with a 75 percent cure rate. Cis-platinum, vinblastine, and bleomycin have formed the basis of the most effective regimens. All patients should be treated with curative intent, preferably at an academic center by experienced medical oncologists. Toxicity, particularly myelosuppression, with effective regimens has been significant, but is manageable in most cases. If feasible, surgical removal of residual disease should be considered in patients failing to achieve complete remission with induction chemotherapy. Prognosis is poor for patients with remaining disease after chemotherapy and surgery, but some have been saved with VP-16-containing regimens. Most seminomas are curable with radiotherapy alone, but patients presenting with advanced disease (stages III and IV) should be treated initially with chemotherapy.

Antineoplastic Combined Chemotherapy Protocols↗

Familial testicular teratoma in 2 children: familial report and review of the literature.

Familial occurrence of a testicular tumor is rare. We report mature teratomas in 2 first cousins in a consanguineous family. The cases were unique because both tumors were pathologically similar and their onsets were close. Of 34 families with testicular neoplasms reviewed this is the first family composed of 2 affected children with mature teratomas. The analysis of the familial cases showed segregation of twins and a slightly higher incidence of bilateral tumors. The genetic roles are discussed in the etiology of testicular tumor.

Humans↗