[Testicular neoplasms: some aspects of fluorescence microscopy].
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Testicular malignancies in closely related family members rarely occur. Only 18 cases have been reported in the literature. Our cases concern two families with testicular tumors occurring in cousins. This is the first such incidence reported. The need for a thorough checkup of other family members is reiterated.
Over a 9-year period 40 testicular and paratesticular neoplasms were seen at the Kenyatta National Hospital, Nairobi, Kenya. Their incidence rate was 0.08 per annum per 100,000 Kenyan males. This low incidence was largely accounted for by a decrease in tumors of germ cell origin. The proportional distribution of the testicular neoplasms, however, was not significantly different from findings in the United States. An inheritable factor apparently controls the decreased susceptability to testicular neoplasms.
A nineteen-year retrospective study of the usefulness of liver scanning in the staging evaluation of germinal cell testicular neoplasms was undertaken at the National Naval Medical Center. Of 94 patients, 90 (96 per cent) demonstrated accurate correlation between liver scan and histopathologic diagnosis.
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.
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.
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Twenty-six patients with primary testicular tumor were evaluated by computed tomography. It was highly accurate in differentiating lymph node metastases from testicular tumors. CT scanning may reveal tumor in lymph nodes not normally opacified during bipedal lymphangiography. It can also be used in treatment planning, follow-up, and in localizing sites of recurrence when serum tumor markers become positive. Some pitfalls of CT are also discussed.
Seven patients with advanced testicular tumors, resistant to existing chemotheurapeutic agents, were treated with a new antitumor agent, the Cisplatinum (associated to mannitol induced hyperdiuresis). There were 3 objective remissions (1 complete and 2 partial). Major toxicity was gastrointestinal. There was little renal and hematologic toxicity in our serie. The drug may have use in combination therapy in advanced non seminomatous testicular tumors.
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With 23 years an embryonal teratoma of the testicles and with 29 years a seminoma was treated by semicastration and post-irradiation or applications of cytostatics. In the two cases 10 or 12 years later seminomas of the other side appeared. Problems of the double-side simultaneous and successive affection are discussed, therapeutic consequences derived and the prognosis is entered. Apart from this the clinical and morphological signs of bilateral metastases of the testicles by a bronchial carcinoma are explained and discussed.
It can be established that it is nowadays possible by means of an interdisciplinary therapy to achieve a full remission of more than 2 years in 80% of the malignant teratomas of stages I and II and in up to 40% of the teratomas of stage III, which possibly means a cure of the patient.
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It is very difficult to compare the therapeutic results of malignant testicular tumours because of the different histological classification systems, the uncertainty in the definition of the different stages, the error rate of the lymphography which amounts up to 35%, and the multitude of surgical, radiation, and chemotherapeutic methods. A histological classification and an exact determination of the stage is required as a condition of beginning a radiotherapy. The desirable focal dose for seminomas is between 4000 and 5000 rad, the maximum dose for teratomas is 6000 rad. For the stages T1-3N0 the iliac and the paraaortic lymph nodes are irradiated, for the stages T1-4N1-2 the interpleural space andthe supraclavicular region are included. For a group of 91 patients there was reached a five-year survival rate of 85,5% in case of seminomas and of 64% in case of teratomas.
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