Review

Authors: Ruiqian Zhang, Michelle K Y Siu, Hextan Y S Ngan...

Ovarian cancer is the deadliest gynecological cancer, leading to over 152,000 deaths each year. A late diagnosis is the primary factor causing a poor prognosis of ovarian cancer and often occurs due to a lack of specific symptoms and effective biomarkers for an early detection. Currently, cancer antigen 125 (CA125) is the most widely used biomarker for ovarian cancer detection, but this approach is limited by a low specificity. In recent years, multimarker panels have been developed by combining molecular biomarkers such as human epididymis secretory protein 4 (HE4), ultrasound results, or menopausal status to improve the diagnostic efficacy. The risk of ovarian malignancy algorithm (ROMA), the risk of malignancy index (RMI), and OVA1 assays have also been clinically used with improved sensitivity and specificity. Ongoing investigations into novel biomarkers such as autoantibodies, ctDNAs, miRNAs, and DNA methylation signatures continue to aim to provide earlier detection methods for ovarian cancer. This paper reviews recent advancements in molecular biomarkers for the early detection of ovarian cancer.

Topics: Algorithms; Autoantibodies; Biomarkers, Tumor; CA-125 Antigen; Carcinoma, Ovarian Epithelial; Female; Humans; MicroRNAs; Ovarian Neoplasms; Proteins

PubMed: 36233339
DOI: 10.3390/ijms231912041

Authors: Robert C Langan, Manuel E E Puente

Scrotal and testicular masses can be broadly categorized into painful conditions, which include testicular torsion, torsion of the testicular appendage, and epididymitis, and painless conditions, which include hydrocele, varicocele, and testicular cancer. Testicular torsion is a urologic emergency requiring prompt surgical intervention to save the testicle, ideally within six hours of presentation when the salvage rate is about 90%. The Testicular Workup for Ischemia and Suspected Torsion score can be used to help physicians identify patients at high risk of torsion and those at lower risk who would benefit from imaging first. Torsion of the testicular appendage presents with gradual onset of superior unilateral pain, is diagnosed using ultrasonography, and is treated supportively with analgesics. Epididymitis is usually caused by infection with Chlamydia trachomatis, Neisseria gonorrhoeae, or enteric bacteria and is treated with antibiotics, analgesics, and scrotal support. Hydroceles are generally asymptomatic and are managed supportively. Varicoceles are also generally asymptomatic but may be associated with reduced fertility. It is uncertain if surgical or radiologic treatment of varicoceles in subfertile men improves the rate of live births. Testicular cancer often presents as a unilateral, painless mass discovered incidentally. Ultrasonography is used to evaluate any suspicious masses, and surgical treatment is recommended for suspected cancerous masses.

Topics: Epididymitis; Humans; Male; Neoplasms, Germ Cell and Embryonal; Scrotum; Spermatic Cord Torsion; Testicular Hydrocele; Testicular Neoplasms; Varicocele

PubMed: 35977130
DOI: No ID Found

Review

Authors: Zi-Jun Zou, Ying-Ming Xiao, Zhi-Hong Liu...

Primary epididymal adenocarcinoma (PEA) is exceedingly rare. Only 22 cases had been published worldwide by 2008; nearly 80% of these cases were reported before 2007. In order to investigate the current clinical status of PEA, we search for relevant literatures with "epididymis and adenocarcinoma" and "epididymal and adenocarcinoma" as keywords published between January 1997 and November 2017 in PubMed. As a result, 17 cases are identified. We review these cases and summarize new and important perspectives about the clinicopathological characteristics, diagnosis, treatment, and prognosis of PEA in the present review.

Topics: Adenocarcinoma; Epididymis; Humans; Male; Prognosis; Testicular Neoplasms

PubMed: 29423406
DOI: 10.1155/2017/4126740

Review

Authors: Vasileios Rafailidis, Dean Y Huang, Paul S Sidhu...

BACKGROUND

Ultrasound (US) is the primary modality for the investigation of scrotal pathology, including both intra- and paratesticular abnormalities.

OBJECTIVE

To describe the abnormalities of the paratesticular space.

MATERIALS/METHODS

The paratesticular space contains the epididymis, spermatic cord and the tunica vaginalis cavity and is affected by a variety of inflammatory or tumoral entities. Differential diagnosis based on US criteria is frequently problematic, as the findings are non-specific.

RESULTS

Some general rules apply: (i) unlike testicular lesions, extra-testicular entities are usually benign in the adult, (ii) the first steps to accurate diagnosis include careful localization of the lesion and assessment of its consistency (solid or cystic) and (iii) magnetic resonance imaging can be useful for further tissue characterization of lesions suspected to contain fat, but surgical biopsy will often provide the definite diagnosis. Contrast-enhanced ultrasound (CEUS) has been applied with limited experience indicating a narrow role, primarily for the differential diagnosis of echogenic cystic entities and the delineation of a necrotic abscess from a solid neoplasm.

DISCUSSION

The various abnormalities are discussed and illustrated.

CONCLUSION

This manuscript summarizes the literature on paratesticular lesions and the value of US in diagnosis.

Topics: Adult; Contrast Media; Diagnosis, Differential; Epididymis; Genital Diseases, Male; Humans; Male; Scrotum; Spermatic Cord; Testicular Diseases; Testis; Ultrasonography

PubMed: 33864338
DOI: 10.1111/andr.13021

Review

Authors: Allison Voisin, Fabrice Saez, Joël R Drevet...

Up to 15% of male infertility has an immunological origin, either due to repetitive infections or to autoimmune responses mainly affecting the epididymis, prostate, and testis. Clinical observations and epidemiological data clearly contradict the idea that the testis confers immune protection to the whole male genital tract. As a consequence, the epididymis, in which posttesticular spermatozoa mature and are stored, has raised some interest in recent years when it comes to its immune mechanisms. Indeed, sperm cells are produced at puberty, long after the establishment of self-tolerance, and they possess unique surface proteins that cannot be recognized as self. These are potential targets of the immune system, with the risk of inducing autoantibodies and consequently male infertility. Epididymal immunity is based on a finely tuned equilibrium between efficient immune responses to pathogens and strong tolerance to sperm cells. These processes rely on incompletely described molecules and cell types. This review compiles recent studies focusing on the immune cell types populating the epididymis, and proposes hypothetical models of the organization of epididymal immunity with a special emphasis on the immune response, while also discussing important aspects of the epididymal immune regulation such as tolerance and tumour control.

Topics: Adaptive Immunity; Animals; Epididymis; Fertility; Genital Neoplasms, Male; Humans; Immunity, Innate; Infertility, Male; Male; Spermatozoa

PubMed: 30924450
DOI: 10.4103/aja.aja_11_19

Review

Authors: Cédric Desbène, Ramatou Yéya Maiga, Olivier Gaillard...

Besides structural and physiological data of HE4 protein, this paper points out the optimal conditions for sampling, assays and interpretation of results for the management of ovarian cancer.

Topics: Biomarkers, Tumor; Blood Chemical Analysis; Blood Specimen Collection; Female; Humans; Immunoassay; Ovarian Neoplasms; Proteins; WAP Four-Disulfide Core Domain Protein 2

PubMed: 29623893
DOI: 10.1684/abc.2018.1330

Review

Authors: Dean Y Huang, Filippo Pesapane, Vasileios Rafailidis...

Multiparametric ultrasound (MPUS), combining conventional techniques (greyscale and colour Doppler ultrasound), ultrasound strain elastography, and contrast-enhanced ultrasound (CEUS), has been successfully used in the assessment of adult scrotal pathology. Contrast-enhanced ultrasound can confidently establish testicular tissue vascularity even in the small-volume paediatric testis. Elastography provides further assessment of tissue stiffness, potentially adding useful diagnostic information. In children, ultrasonography is particularly advantageous, being safe, radiation-free and negating the need for sedation or general anaesthesia during the imaging evaluation. In this review article, we aim to familiarise readers with the MPUS scanning protocol used for paediatric scrotal examination and provide an overview of scrotal MPUS features, with particular focus to clinical indications where MPUS may be advantageous over conventional ultrasonography.

Topics: Abscess; Adolescent; Age Factors; Child; Contraindications, Drug; Contrast Media; Cysts; Echocardiography, Doppler, Color; Elasticity Imaging Techniques; Epididymitis; Genital Diseases, Male; Humans; Infant, Newborn; Infarction; Lipoma; Male; Phospholipids; Scrotum; Spermatic Cord Torsion; Sulfur Hexafluoride; Testicular Neoplasms; Testis; Ultrasonography

PubMed: 32271626
DOI: 10.1259/bjr.20200063

Review

Authors: J Junnila, P Lassen

Family physicians often must evaluate patients with testicular pain or masses. The incidental finding of a scrotal mass may also require evaluation. Patients may seek evaluation of a scrotal mass as an incidental finding. An accurate history combined with a complete examination of the male external genitalia will help indicate a preliminary diagnosis and proper treatment. Family physicians must keep in mind the emergency or "must not miss" diagnoses associated with testicular masses, including testicular torsion, epididymitis, acute orchitis, strangulated hernia and testicular cancer. Referral to a urologist should be made immediately if one of these diagnoses is suspected. Benign causes of scrotal masses, including hydrocele, varicocele and spermatocele, may be diagnosed and managed easily in the primary care office.

Topics: Diagnosis, Differential; Epididymitis; Genital Diseases, Male; Hernia, Inguinal; Humans; Male; Orchitis; Spermatic Cord Torsion; Spermatocele; Testicular Diseases; Testicular Hydrocele; Testicular Neoplasms; Varicocele

PubMed: 9490992
DOI: No ID Found

Review

Authors: P J Schwingl, H A Guess

OBJECTIVE

To recommend further research on vasectomy based on a systematic review of the effectiveness and safety of vasectomy.

DESIGN

A systematic MEDLINE review of the literature on the safety and effectiveness of vasectomy between 1964 and 1998.

MAIN OUTCOME MEASURE(S)

Early failure rates are <1%; however, effectiveness and complications vary with experience of surgeons and surgical technique. Early complications, including hematoma, infection, sperm granulomas, epididymitis-orchitis, and congestive epididymitis, occur in 1%-6% of men undergoing vasectomy. Incidence of epididymal pain is poorly documented. Animal and human data indicate that vasectomy does not increase atherosclerosis and that increases in circulating immune complexes after vasectomy are transient in men with vasectomies. The weight of the evidence regarding prostate and testicular cancer suggests that men with vasectomy are not at increased risk of these cancers.

CONCLUSION(S)

Publications to date continue to support the conclusion that vasectomy is a highly effective form of contraception. Future studies should include evaluations of the long-term effectiveness of vasectomy, evaluating criteria for postvasectomy discontinuation of alternative contraception for use in settings where semen analysis is not practical, and characterizing complications including chronic epididymal pain syndrome.

Topics: Adolescent; Adult; Contraindications; Counseling; Humans; MEDLINE; Male; Prostatic Neoplasms; Testicular Neoplasms; United States; Vasectomy; Vasovasostomy

PubMed: 10785217
DOI: 10.1016/s0015-0282(00)00482-9

Authors: Olga Lopez, Hisham F Bahmad, Ruben Delgado...

BACKGROUND

Papillary cystadenoma is a rare benign neoplasm of the epididymis. It may occur sporadically or in association with von Hippel-Lindau disease (VHLD). Papillary cystadenoma of the epididymis (PCE) is a benign mimic of metastatic clear cell renal cell carcinoma (CCRCC) given their histologic similarities.

CASE PRESENTATION

Herein, we present the case of a 40-year-old man with a four-year history of microhematuria and a recently detected right paratesticular mass. A testicular sonogram revealed a hypoechoic, hypervascular solid mass in the right epididymal head treated by surgical excision. Histopathological examination demonstrated a 1.1 cm papillary cystadenoma of the epididymis. Genetic testing performed later showed no signs of VHLD. However, heterozygous mutations in three genes - , , and - were found which have never been reported in PCE before.

CONCLUSIONS

Papillary cystadenoma of the epididymis should always be considered in the differential diagnosis of epididymal lesions, especially those that are cystic. The mainstay of treatment remains surgical excision, which provides an excellent prognosis.

PubMed: 35496736
DOI: 10.4322/acr.2021.374