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Testicular neoplasms in children.

Six cases of testicular tumors in children are presented: 3 patients had teratoma, 1 embryonal carcinoma, 1 orchioblastoma, and 1 paratesticular rhabdomyosarcoma. Three of the 6 patients presented with hydroceles. The treatment consisted of orchiectomy alone. All patients were alive and free of disease one and one-half to eight and one-half years after orchiectomy. It is suggested that orchiectomy alone is curative in most children with testicular tumors under the age of two years.

Age Factors↗

Testicular vasculitis mimicking a testicular neoplasm.

Vasculitis of the testis generally presents as a manifestation of systemic vasculitis which is well documented. In isolation, it has only been described on few occasions previously, and hitherto it has been in the young. It often mimics a neoplasm of the testis resulting in radical orchidectomy, only for it to be diagnosed when the specimen is examined under the microscope. In our case, an elderly man presented to us with a presumed testicular neoplasm, however, despite strong clinical and radiological suspicion a testicular vasculitis in isolation was revealed. Following our experience, we performed a literature review and examined all of the cases of testicular vasculitis reported so far and present our findings. We report the general clinical presentation, methods of investigation and subsequent management. This is the first time it has been described in the elderly population.

Aged↗

Acute myeloid leukemia mimicking primary testicular neoplasm. Presentation of a case with review of literature.

We describe a new unique case of acute myeloid leukemia (AML) in a 21-yr-old male presenting with abdominal pain, bilateral testicular masses and gynecomastia. Further work-up with computed tomography of the chest, abdomen and pelvis revealed massive retroperitoneal, peripancreatic and mediastinal lymphadenopathy, suggesting primary testicular neoplasm. The patient was subjected to right orchiectomy that showed infiltration of testicular tissue with malignant cells, originally misinterpreted as undifferentiated carcinoma. Immunohistochemistry studies, however, showed these cells to be strongly positive for myeloperoxidase and CD45, indicating a myeloid cell origin. Bone marrow (BM) aspirate and biopsy demonstrated replacement of marrow with immature myeloid cells. Both the morphology and immunophenotype of the blast cells were consistent with AML type M4 (acute myelo-monocytic leukemia), using French-American-British (FAB) classification. The patient received standard induction chemotherapy with cytosine arabinoside (ARA-C) and daunorubicin followed with two cycles of consolidation therapy with high dose ARA-C, which resulted in remission of BM disease and resolution of lymphadenopathy and left testicular masses. After the second cycle of consolidation therapy, the patient developed sepsis that was complicated by refractory disseminated intravascular coagulopathy. He expired with a clinical picture of multiple organ failure. The unique features of this case are presented and the related literature is reviewed.

Abdominal Pain↗

Testicular neoplasm diagnosed by ultrasound.

The diagnosis of testicular cancer is usually made by the findings of a testicular mass on physical examination. In rare cases a young man will present with retroperitoneal nodes and a normal testicular examination. In such cases a testicular ultrasound may localize the testis which harbors a subclinical neoplasm. In addition serum markers of B-HCG and AFP are essential. As a screening procedure a urine pregnancy test is helpful, since it can be obtained quickly while quantitative B-HCG and APF results are delayed.

Adult↗

Transforming growth factor-beta expression in human testicular neoplasms.

OBJECTIVE: To investigate the localization of transforming growth factors (TGF-beta 1, -beta 2 and -beta 3) and their receptors (TGF-beta RI and RII). STUDY DESIGN: The study included 26 paraffin-embedded tissues from human testicular neoplasms: 15 seminomas, 2 embryonal carcinomas, 1 immature teratoma, 4 immature teratomas with embryonal carcinoma, 1 immature teratoma with seminoma, 1 seminoma with embryonal carcinoma and 2 gonadal stromal tumors (Leydig cell tumors). RESULTS: TGF-beta 1 immunoreactivity was cytoplasmic and was expressed in 22 (84.6%), TGF-beta 2 in 20 (77%), TGF-beta 3 in 11 (42.3%), TGF-beta-RI in 21 (80.8%) and TGF-beta-RII in 18 (69.2%) of the 26 neoplasms. The percentage of positive immunostained cells and the intensity of staining were significantly higher in tumor than in peritumor nonneoplastic testis. In the peritumor nonneoplastic testis, Leydig, Sertoli and germ cells coexpressed both the three TGF-beta isoforms and TGF-beta-RI and RII. The myoepithelial cells of the seminiferous tubules showed immunoreactivity for TGF-beta RI and RII but not for TGF-beta s. In tumor testis areas the pattern of TGF-beta and TGF-beta receptor expression and distribution varied according to the histologic type of testicular tumor. Seminomas showed a diffuse pattern of TGF-beta immunoreactivity, whereas immature teratomas had focal and patchy distribution. In teratomas, differentiated structures contained more TGF-beta s than undifferentiated structures.

Activin Receptors, Type I↗

[Case report of a non-seminomatous testicular neoplasm indicating marked efficacy of a combination chemotherapy of VBL, ACTD, BLM, CDDP and EX (VAB-4 combination therapy)].

The patient was a 29 years old male. He was attended to our hospital with a chief complaint of a right scrotal mass on August 20, 1983. Based on the diagnosis of testicular neoplasm, orchiectomy was performed on September 7, 1983. After surgery, the patients, HCG and alpha-fetoprotein (AFP) values of still remained high. Pathological diagnosis was mixed tumor (choriocarcinoma, Embryonal carcinoma, and malignant cystic teratoma). From September 22, VAB-4 combination therapy was performed and complete remission was obtained without severe side effects. The patient was in good health with normal HCG and AFP values on January 20, 1984.

Adult↗

[Diagnosis and therapy of malignant testicular neoplasms].

For successful treatment of even advanced testicular tumors an accurate histological classification and clinical staging is necessary. The pathohistomorphological classification can be completed by the so-called tumor markers such as alpha-fetoprotein and beta-humanchoriongonadotropin (beta-HCG). These markers are especially valuable in the follow-up of the patient and in the control of the therapeutical effectivity. By optimal diagnosis and therapy seminomas in stage I and II are in 70% to 100%, teratomas in 40% to 80% curable; in the more advanced stages in 30 to 40% a two years relapse-free time can be obtained.

Antineoplastic Agents↗

[The immune status of patients with irradiated testicular neoplasms].

The authors present the results of investigations of the immune reactivity of 72 patients irradiated for testicle tumors. The responses to tuberculin and DNCB (2.4-dinitrochlorobenzol) were examined before the treatment, within twelve months after radiotherapy and three years after radiotherapy and when metastases appeared. After radiotherapy, the number of positive responses was slightly decreased in both examination methods, but the difference was in no case significant. Patients with metastases showed a significantly decreased response to DNCB compared to the results obtained before radiotherapy. 5.6% of the patients had suffered from herpes zoster. The incidence of other infective diseases was not increased. The conclusion is drawn that the moderate immunosuppression caused by radiotherapy does not exert any influence on the further way of living of patients with testicle tumors.

Adult↗