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Journal of Clinical Pathology Aug 2007Most neoplastic scrotal masses ultimately prove to be germ cell tumours and are recognisable with routine haematoxylin and eosin-stained sections. The differential... (Review)
Review
Most neoplastic scrotal masses ultimately prove to be germ cell tumours and are recognisable with routine haematoxylin and eosin-stained sections. The differential diagnosis may be focused, even before reviewing histological sections, by knowledge of patient age, medical history, tumour site (testicular vs paratesticular) and gross findings. Some cases may prove to be diagnostically challenging, including rare tumours, a common tumour with an unusual pattern, a metastatic tumour, or a neoplasm with features that mimic another tumour. Several morphological patterns are seen with some frequency and these generate recurring sets of differential diagnostic considerations. These common patterns include testicular tumours with a predominant diffuse arrangement of cells with pale to clear cytoplasm, tumours with a glandular/tubular pattern, tumours with a microcystic pattern and tumours composed of oxyphilic cells. Intratubular proliferations of atypical cells, paratesticular glandular and/or papillary tumours, or tumours with spindle cell morphology can also be challenging to diagnose correctly. In some problematic cases, immunohistochemical staining may be useful to resolve these differential diagnoses.
Topics: Algorithms; Child; Cytoplasm; Diagnosis, Differential; Humans; Immunohistochemistry; Male; Neoplasms, Germ Cell and Embryonal; Seminoma; Sertoli-Leydig Cell Tumor; Testicular Neoplasms; Testis
PubMed: 17307866
DOI: 10.1136/jcp.2005.036475 -
The Pan African Medical Journal 2017We report the dramatic case of a 18-year old patient with immediately metastatic round cells paratesticular liposarcoma. It is a rare tumor that develops in the fatty...
We report the dramatic case of a 18-year old patient with immediately metastatic round cells paratesticular liposarcoma. It is a rare tumor that develops in the fatty tissue surrounding the testicle and the spermatic cord. Clinical and radiological signs are nonspecific and diagnosis is usually based on surgical specimen examination. The treatment involves radical inguinal orchiectomy, sometimes extended to adjacent structures. Adjuvant radiation therapy could be used in the case of locally advanced mass or incomplete resection. Despite its slow progression, prolonged monitoring is required due to the high risk of late recurrence.
Topics: Adolescent; Disease Progression; Humans; Liposarcoma; Male; Neoplasm Metastasis; Orchiectomy; Testicular Neoplasms
PubMed: 28819522
DOI: 10.11604/pamj.2017.27.101.12687 -
Histopathology Nov 2018Testicular seminomas require accurate staging for effective management. Twenty per cent are metastatic at presentation, while 80% are clinical stage I, requiring only...
AIMS
Testicular seminomas require accurate staging for effective management. Twenty per cent are metastatic at presentation, while 80% are clinical stage I, requiring only orchiectomy and surveillance. Tumour size, rete testis invasion, hilar soft tissue invasion and lymphovascular invasion have been shown to incur a higher risk of metastasis and recurrence in clinical stage I seminomas, with little congruence between studies.
METHODS AND RESULTS
We reviewed 211 cases of testicular seminomas and recorded patient age, tumour size, lymphovascular invasion and rete testis, hilar soft tissue, epididymis, spermatic cord, tunica albuginea and tunica vaginalis involvement. A univariate and multivariate analysis was performed comparing clinical stage I to advanced clinical stage patients (stages II and III) in reference to these factors. We found that tumour size (P = 0.02), vascular invasion (P = 0.02) and invasion of rete testis stroma (P = 0.01), epididymis (P = 0.02), spermatic cord (P = 0.047) and hilar soft tissue (P = 0.04) were predictors of higher clinical stage at the univariate level. However, multivariate analysis showed that only tumour size and vascular invasion remained significant (P = 0.008 and 0.032, respectively). A tumour size of 4 cm was the cut-off size found to be significant.
CONCLUSIONS
Tumour size and vascular invasion are the strongest predictors of higher clinical stage in testicular seminomas. Our univariate data suggest that rete testis and hilar soft tissue invasion relate to higher clinical stage. However, neither of these factors were found to be independent risk factors at multivariate analysis. Therefore, this study supports tumour upstaging based only upon size and vascular invasion.
Topics: Adult; Humans; Male; Middle Aged; Neoplasm Staging; Retrospective Studies; Risk Factors; Seminoma; Testicular Neoplasms
PubMed: 29858564
DOI: 10.1111/his.13667 -
Urologic Oncology Mar 2019Retroperitoneal lymph node dissection (RPLND) is an important component of the multimodal treatment which cures most patients diagnosed with testicular germ cell tumors.... (Review)
Review
Retroperitoneal lymph node dissection (RPLND) is an important component of the multimodal treatment which cures most patients diagnosed with testicular germ cell tumors. Considering the high cure rates achieved, research focus in recent years has been directed toward improving quality of life and decreasing long-term treatment related sequelae. Consequently, the role of RPLND has evolved over the past 3 decades in both low-stage and advanced testicular cancer. The use of RPLND in clinically stage I and low volume stage II disease may offer the advantages of treating retroperitoneal teratoma which is present in 15% to 20% of patients, avoiding chemotherapy and reducing the need for frequent imaging during follow-up. Similarly, ongoing studies are evaluating the safety and effectiveness of RPLND for the treatment of early stage seminoma to avoid the long-term effects of chemotherapy and radiotherapy. RPLND is traditionally used for the treatment of residual masses >1 cm after completion of chemotherapy. Its role in subcentimeter residual masses remains somewhat controversial given the fact that 25% to 30% of these patients are found to harbor either teratoma or viable nonteratomatous germ cell tumors. The presence of teratoma increases the probability of teratoma in metastatic sites. Modified unilateral templates were developed based on early mapping studies with the aim of preserving antegrade ejaculation. Recent data suggests initial mapping studies underestimated the risk of contralateral retroperitoneal metastases which may reach 32%. Furthermore, antegrade ejaculation may be preserved in >95% of patients undergoing bilateral nerve sparing primary RPLND and >80% undergoing nerve-sparing PC-RPLND, which, in our view is the more prudent oncologic approach. Recently, multiple series have demonstrated the safety and short-term efficacy of minimally invasive RPLND; however, larger studies with prolonged follow-up are required to validate the long-term oncologic efficacy of newer techniques.
Topics: Biomarkers, Tumor; Chemotherapy, Adjuvant; Disease Progression; Humans; Laparoscopy; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Male; Neoplasm Staging; Orchiectomy; Postoperative Complications; Quality of Life; Radiotherapy, Adjuvant; Retroperitoneal Space; Robotic Surgical Procedures; Seminoma; Testicular Neoplasms; Testis
PubMed: 30446455
DOI: 10.1016/j.urolonc.2018.09.009 -
Journal of the American Veterinary... Nov 2016
Topics: Animals; Biopsy; Dog Diseases; Dogs; Male; Sertoli Cell Tumor; Skin Neoplasms; Testicular Neoplasms
PubMed: 27767436
DOI: 10.2460/javma.249.9.1023 -
Andrology Jan 2015
Topics: Animals; Biomedical Research; Cooperative Behavior; Humans; International Cooperation; Male; Neoplasms, Germ Cell and Embryonal; Prognosis; Risk Factors; Testicular Neoplasms
PubMed: 25711179
DOI: 10.1111/andr.12010 -
Andrology Jan 2015Recent years have led to a better understanding of the mechanisms underlying cisplatin response and resistance in germ cell tumours (GCT), and several promising targets... (Review)
Review
Recent years have led to a better understanding of the mechanisms underlying cisplatin response and resistance in germ cell tumours (GCT), and several promising targets have been identified. Two main mechanisms of the responsiveness to DNA damaging agents have been postulated. Firstly, GCT readily activate a DNA damage response, but show deficits in several damage repair pathways. In particular, they have been found to have defects in interstrand crosslink repair and in homologous recombination (HR). Secondly, GCT, especially embryonal carcinoma (EC) cells, show a hypersensitive apoptotic response to DNA damage, which activates p53, and leads to up-regulation of the pro-apoptotic factors Noxa, Puma and Fas in non-resistant EC. These cells fail to activate p21 which induces a G1/S arrest, but accumulate in G2/M phase. In the absence of functional p53, family members like p73 and GTAp63 might be important in initiating this response. Mechanisms involved in cisplatin resistance are as follows: down-regulation of Oct4 (e.g. as a result of hypoxia, treatment with retinoic acid or exposure to cisplatin) and failure to induce Puma and Noxa; changes in the expression levels of micro-RNAs such as miR-17/-106b, miR-302a, or miR-371 to -373; elevated levels of MDM2 and cytoplasmic translocation of p21 by phosphorylation; and activation of the PDGFRβ/PI3K/pAKT pathway. Several approaches to overcome resistance have been successfully examined in vitro and in vivo, including PARP inhibitors, especially in cells showing deficient HR-repair; stabilization of p53 using nutlin-3; inhibition of several components of the PI3K/pAKT pathway using small molecules; and DNA demethylation by 5-azacytidine or 5-aza-deoxy-cytidine, among others. Many of these substances deserve further exploration, alone or in combination with DNA damaging agents, and the most promising approaches should be taken forward to clinical testing. Targeted therapy based on mechanistic insights holds the promise to turn cisplatin-resistant GCT into a curable disease.
Topics: Animals; Antineoplastic Agents; Biomarkers, Tumor; Cisplatin; Drug Resistance, Neoplasm; Gene Expression Regulation, Neoplastic; Humans; Male; Signal Transduction; Testicular Neoplasms
PubMed: 25546083
DOI: 10.1111/andr.299 -
BMC Urology Jun 2019Testicular epidermoid cysts (TECs) are rare benign testicular neoplasms. As TECs are rarely associated with germ cell tumours (GCTs), the understanding of biological...
BACKGROUND
Testicular epidermoid cysts (TECs) are rare benign testicular neoplasms. As TECs are rarely associated with germ cell tumours (GCTs), the understanding of biological behaviour and clinical management of TEC is unresolved.
METHODS
We retrospectively searched the files of patients treated for testicular neoplasms and germ cell cancer in the time from 2000 to 2017. Those with TEC were subjected to closer review looking to clinical and histological features, and to results from imaging with ultrasonography (US), contrast enhanced sonography (CEUS) and magnetic resonance imaging (MRI).
RESULTS
Among 589 patients undergoing surgery for testicular tumour, nine simple TECs were identified (1.5, 95% confidence intervals 0.53-2.50%). Median age was 26 years. Imaging revealed sharply demarcated roundish lesions with avascular central areas. Eight patients underwent testis-sparing excision with no recurrence ensuing. One had orchiectomy because of large size of the mass. Histologically, TECs consisted of cornifying squamous cell epithelium and no accompanying germ cell neoplasia in situ. Two additional cases (0.3% of all) required orchiectomy because these TECs were associated with ipsilateral GCT.
CONCLUSIONS
TEC is usually a benign lesion that can safely be diagnosed with US, CEUS and MRI due to its roundish shape and its avascular centre. Histologically, this TEC corresponds to the prepubertal-type teratoma unrelated to germ cell neoplasia in situ of the 2016 WHO classification. The other subtype of TEC that is associated with invasive GCT represents a teratoma of postpubertal-type. From a clinical point of view it could be easier to differentiate between a "simple TEC" which is benign (prepubertal type) and a "complex TEC" which is malignant because of its association with invasive GCT.
Topics: Adolescent; Adult; Child; Epidermal Cyst; Humans; Male; Neoplasms, Germ Cell and Embryonal; Retrospective Studies; Testicular Neoplasms; Testis; Young Adult
PubMed: 31185974
DOI: 10.1186/s12894-019-0477-1 -
American Family Physician Feb 2008Testicular cancer is the most common malignancy in men 20 to 35 years of age and has an annual incidence of four per 100,000. If diagnosed early, the cure rate is nearly... (Review)
Review
Testicular cancer is the most common malignancy in men 20 to 35 years of age and has an annual incidence of four per 100,000. If diagnosed early, the cure rate is nearly 99 percent. Risk factors for testicular cancer include cryptorchidism (i.e., undescended testicles), family history, infertility, tobacco use, and white race. Routine self-examination and physician screening have not been shown to improve outcomes, and the U.S. Preventive Services Task Force and American Cancer Society do not recommend them in asymptomatic men. Patients presenting with a painless testicular mass, scrotal heaviness, a dull ache, or acute pain should receive a thorough examination. Testicular masses should be examined with scrotal ultrasonography. If ultrasonography shows an intratesticular mass, the patient should be referred to a urologist for definitive diagnosis, orchiectomy, and further evaluation with abdominal computed tomography and chest radiography. The family physician's role after diagnosis of testicular cancer includes encouraging the patient to bank sperm because of possible infertility and evaluating for recurrence and future complications, especially cardiovascular disease.
Topics: Age Factors; Cardiovascular Diseases; Humans; Male; Medical History Taking; Neoplasm Recurrence, Local; Neoplasm Staging; Neoplasms, Second Primary; Physical Examination; Prognosis; Risk Factors; Testicular Neoplasms; Treatment Outcome
PubMed: 18326165
DOI: No ID Found -
The Pan African Medical Journal 2019Paratesticular rhabdomyosarcoma is a rare tumor. Treatment is based on multimodal therapy as well as on surgery, chemotherapy and radiotherapy. This study and literature... (Review)
Review
Paratesticular rhabdomyosarcoma is a rare tumor. Treatment is based on multimodal therapy as well as on surgery, chemotherapy and radiotherapy. This study and literature review highlight the diagnostic and therapeutic approaches to treat paratesticular rhabdomyosarcoma.
Topics: Combined Modality Therapy; Humans; Male; Rhabdomyosarcoma; Testicular Neoplasms; Young Adult
PubMed: 31448017
DOI: 10.11604/pamj.2019.33.55.17269