Biomedical subjects
Publications and source records attributed to V Loy.
The case of testicular dermoid cyst in a 10-year-old boy who presented for evaluation of a presumed testicular neoplasm is reported. The dermoid cyst was confirmed histologically on frozen section and local excision was performed. Only 5 cases of testicular dermoid cysts in children have been reported so far. We discuss the etiopathogenesis, diagnosis, and treatment.
The question is addressed whether cisplatin-based chemotherapy for germ cell cancer has the same efficacy in intratesticular and in extragonadal sites. For this purpose, 7 patients with germ cell cancer, aged 16-35 years were analysed. Four of the patients had palpable testicular tumors, 3 had occult testicular tumors. All presented with advanced disease and therefore received chemotherapy as the first step of treatment. Orchiectomy was done in the later course. A significant clinical response to chemotherapy was observed at the intratesticular tumor site as well as at extragonadal sites in all patients. Orchiectomy specimens contained viable cancerous cells in 2 patients after two courses of chemotherapy while in 5 patients no invasive germ cell cancer was found. Severe depression of germ cells was observed in all specimens. Testicular intraepithelial neoplasia (TIN; carcinoma in situ) persisted in 4 patients, 1 of whom also had viable cancerous cells in the specimen. Cisplatin-based chemotherapy is also active in intratesticular tumors but there seems to be a slightly different response of metastatic germ cell cancer and intratesticular tumor. Tumor heterogeneity appears to be the most important reason for this different response. The lower response of TIN to chemotherapy as compared to invasive testicular cancer is probably due to a genetically determined lower sensitivity. The blood-testis barrier might contribute a minor part to this phenomenon by modulating the intratubular concentrations of cytostatic compounds. The efficacy of cisplatin-based chemotherapy on invasive intratesticular tumors is not compromised by the blood-testis barrier.(ABSTRACT TRUNCATED AT 250 WORDS)
The expression, serological detection, and possible functional role of the CD30 antigen in Hodgkin's disease and anaplastic large cell lymphoma is well documented. In embryonal carcinoma (EC), the expression of this cytokine receptor has been demonstrated only by immunohistology. Because the CD30 monoclonal antibody Ki-1 was found to cross-react with an unrelated molecule, we examined by in situ hybridization testicular germ cell neoplasms for the presence of CD30-specific transcripts. CD30 mRNA was detectable in the tumor cells of 9 of 9 cases of EC or mixed germ cell tumors with an EC component but in no other nonlymphoid tumors. Thus, the CD30 transcript expression pattern proved to be identical to the immunostaining pattern seen with the CD30-specific monoclonal antibody Ber-H2. By Northern blot analysis, CD30 transcripts could be demonstrated in the EC cell line Tera-2. Employing a highly sensitive second generation sandwich enzyme-linked immunosorbent assay, we could detect the soluble CD30 molecule in 8 of 8 sera from patients with a diagnosis of EC but not in 8 of 10 sera from patients with other testicular germ cell tumors. In fetal tissue, no CD30-expressing germ cells or epithelial cells could be observed. Thus, the cellularly expressed CD30 marker for testicular neoplasms of EC type. Moreover, the serum levels of soluble CD30 antigen seem to be a promising parameter for monitoring patients with EC.
Contralateral biopsies from 1810 consecutive patients with testicular germ-cell tumor were examined immunohistologically by staining for placental alkaline phosphatase. Contralateral testicular intraepithelial neoplasia (TIN; carcinoma in situ) was found in 89 patients (4.9%; 95% confidence interval, 3.9%-5.9%). Testicular atrophy was present in 45.9% of patients with TIN and in 13.1% of those without TIN (P < 0.01). There was a history of cryptorchidism in 16.2% of patients with TIN versus only 8.5% of those without TIN (P < 0.05). Patients with contralateral TIN presented at an earlier age (30.8 versus 33.3 years). In all, 23 patients with contralateral TIN had no specific risk marker. In 14 patients with contralateral TIN who had received local radiotherapy of 18-20 Gy to the testis, rebiopsy revealed the disappearance of TIN in all cases. Serum testosterone levels were within or above the normal range in 7 of 13 patients examined after local radiotherapy. Of 9 patients with contralateral TIN who had received chemotherapy, 2 were shown to have persistent TIN at rebiopsy. We conclude that all patients with testicular germ-cell tumor should be offered a contralateral biopsy. Local radiotherapy of the testis is the treatment of choice in patients with contralateral TIN.
A 34-year-old man underwent left hemicastration for malignant unclassified sex cord gonadal stromal tumor. At 6 months pulmonary metastases developed and the patient received 3 courses of chemotherapy consisting of cisplatin, bleomycin and etoposide. A residual focus in the right lung was excised and proved to be viable tumor. He then received 2 adjuvant courses of cisplatin, etoposide and ifosfamide. Six months later he was without evidence of disease. A review of the literature revealed 21 previous cases of malignant unclassified sex cord gonadal stromal tumor. Although chemotherapy usually fails in treating Leydig cell tumors our case corroborates 6 previous reports of favorable response to cisplatin-based chemotherapy. This finding suggests that different subtypes of sex cord gonadal stromal tumor respond differently to chemotherapy.
OBJECTIVE: To review the records of patients with epidermoid cysts and those with germ cell tumours to determine the most appropriate method of treatment. PATIENTS AND METHODS: The records of the patients treated for epidermoid cysts and testicular germ-cell tumours in a period covering 22 years were analysed retrospectively. Nine specimens with an epidermoid cyst were examined by immunohistology for the presence of testicular intraepithelial neoplasia (TIN) (or carcinoma in situ of the testis). RESULTS: Ten patients with a simple epidermoid cyst and 481 patients with testicular germ-cell tumour were treated during the observation period. The relative incidence of epidermoid cysts in relation to the number of patients with testicular germ-cell tumours was 2.1% (95% confidence interval 0.8-3.35%). The mean age of the 10 patients with an epidermoid cyst was 24.1 years. The right testis was affected in seven patients and the left in three. Six of these patients received conservative surgery with excellent cosmetic results. No relapse had occurred after a median observation period of 30 months. Immunohistological staining for placental alkaline phosphatase disclosed the absence of TIN in the parenchyma surrounding the cysts. CONCLUSION: The absence of TIN calls into question the common assumption that an epidermoid cyst constitutes a monodermal teratoma. Two distinct entities of epidermoid cyst are proposed--one occurring in conjunction with a teratoma or a germ cell tumour (a 'complex' or 'mixed' epidermoid cyst) and the other a 'simple' epidermoid cyst without TIN in the adjacent tissue and thus representing a benign neoplasm that is not a teratoma. The absence of TIN near a simple epidermoid cyst justifies testis-sparing surgery.
Granulomatous orchitis is an inflammatory change of the testis, rarely bilaterally, which cannot be distinguished from testis cancer with clinical modalities and therefore the diagnosis is usually made after orchiectomy. We reviewed our experience with 5 cases of granulomatous orchitis all treated with orchiectomy for suspected testicular cancer. Patients' age ranged from 52 to 69 years; three times the right side was affected, histologically intratubular and interstitial type were identified as well as complete testicular destruction. Testicular intraepithelial neoplasia was not detected in any of the specimens.
A 69 year old patient with relapsing idiopathic scrotal calcinosis (ICS) is presented. Histological evaluation of the excised material showed the typical morphological features of calcified material within the corium. A review of the literature revealed 12 of 75 patients who had evidence of epithelial lining of the corial calcifications. Generally the calcified masses were surrounded by granulation tissue with mononuclear and foreign body giant cells. There is accumulating evidence for dystrophic calcification of cyst rather than an idiopathic genesis.
BACKGROUND: Testicular germ cell neoplasms occur bilaterally in approximately 2-5% of patients. Bilateral testicular tumors of different histogenesis are extremely rare, and the study of such cases may offer clues to the pathogenesis of both tumor entities. METHODS: A report of a case and review of the literature are presented. RESULTS: A 33-year-old man had a right-sided testicular neoplasm consisting of teratoma, embryonal carcinoma, and yolk sac tumor. Retroperitoneal lymph node metastases were excised, and, subsequently, adjuvant abdominal radiation therapy was administered. The patient later received six cycles of cisplatin-based chemotherapy for pulmonary relapse. When he was 40 years of age, a contralateral Leydig cell tumor (LCT) was treated by testis-sparing excision. This is the first observation of testicular germ cell tumor (GCT) and contralateral LCT. Three cases of germ cell neoplasm and concurrent ipsilateral LCT have been reported previously. CONCLUSIONS: The association of GCT and LCT in one patient is quite unusual because both entities are rare. Sharing of common etiologic factors by both entities is a possible explanation.
METHOD: By a telephone poll conducted among 143 selected representative urologists in private practice throughout the west German Länder. BASIC REMARKS: Via a search for carcinoma in situ of the testicles (CIS, or testicular intra-epithelial neoplasia, TIN), active early detection of testicular germ cell tumors is now possible. RESULTS: Among 143 urologists questioned, 62 claimed to be familiar with testicular CIS. However, only 52% were able correctly to answer one question as to its significance, and only 33% could correctly answer a question on the diagnosis of CIS. Only 28% of all those questioned were able to answer correctly 2 questions about CIS. Knowledge about CIS proved to be inversely correlated with the interval in years since obtaining a licence to practice as a specialist. CONCLUSION: The poll reveals that, at the present time, too few urologists are familiar with carcinoma in situ of the testicles, and the possibilities of active early detection of testicular tumors.
Four patients with unilateral testicular germ-cell tumor and biopsy-proven contralateral testicular intraepithelial neoplasia (TIN; so-called carcinoma in situ) received localized low-dose radiation therapy (18-20 Gy) of the testis with TIN. Repeated biopsies disclosed the disappearance of TIN and germ cells. No recurrence of TIN or germ cells was observed after a follow-up of 18-42 months. All patients reported a normal sex life without need of androgen supplementation. Serum follicle-stimulating hormone increased significantly immediately after radiation treatment and started to decline after 24 months. Serum luteinizing hormone increased slightly but not significantly. A decline after 24 months was observed in only one of three patients. Serum testosterone decreased significantly in all patients after 1 year but never became subnormal. Low-dose radiation treatment is efficacious in eradicating testicular intraepithelial neoplasia without destroying Leydig cells or stromal cells of the testis. Thus, a patient otherwise destined to develop a second testicular tumor can be spared orchiectomy and life-long hormonal replacement.
A 32-year-old patient with unilateral beta hCG-positive seminoma and contralateral testicular intraepithelial neoplasia (TIN; so-called carcinoma-in-situ) with no metastases (clinical stage I) received one course of adjuvant carboplatin therapy. He refused further treatment of TIN in his remaining testis. His wife became pregnant by him 4 months later and delivered a healthy child at term. This case shows that patients with TIN in their remaining solitary testis are not necessarily infertile, and testes afflicted with TIN must also contain tubules that retain normal spermatogenic potential. Surveillance may be an treatment option for patients with TIN in their remaining testis in cases where there is a strong desire for paternity.
The prevalence of bilateral tumours was found to be 4% in a retrospective analysis of 531 consecutive patients with testicular germ cell tumours. Patients with bilateral tumours were younger when their first tumour was diagnosed than those who had only 1 testicular tumour. Bilateral undescended testis was more frequent in 21 patients with bilateral tumours than in the total population of patients examined (2 of 21 versus 10 of 452, i.e. 9.5% versus 2.2%). Histology and unilateral undescended testis were not helpful in identifying patients at risk of developing a second tumour. In a separate study, 76 consecutive patients with unilateral testicular cancer underwent contralateral testicular biopsy at the time of orchiectomy. Five patients had testicular intra-epithelial neoplasia (TIN, so-called carcinoma in situ) in the contralateral testis; 1 of these patients had a history of bilateral undescended testis and 4 had an increased level of serum follicle stimulating hormone post-operatively. None of the other 71 patients had developed a second tumour after a median observation time of 30 months. Testicular biopsy and a search for TIN appear to be a safe method for the early identification of the patients at risk of developing a contralateral testicular tumour.
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Contralateral biopsies taken from 1,188 patients with testicular germ-cell tumour were examined immunohistologically by staining for placental alkaline phosphatase. Testicular intraepithelial neoplasia (TIN; carcinoma in situ) was detected in 53 patients (4.5%; 95% confidence interval 3.3-5.7%). Testicular atrophy was found in 45.7% of cases with TIN and in 14.1% of cases without TIN (p < 0.01). History of undescended testis was present in 21.3% of cases with TIN and in only 9.3% in cases without (p < 0.05). Patients with contralateral TIN presented at an earlier age (31.0 vs. 33.7 years). Twenty cases with contralateral TIN had no specific risk marker. It is concluded that all patients with testicular germ cell tumour should be offered a contralateral biopsy.
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A routine biopsy of the contralateral testis obtained during orchiectomy for embryonal carcinoma in a 26-year-old patient was negative for testicular intraepithelial neoplasia (TIN; carcinoma in situ of the testis). However, a rebiopsy that was taken because of unexplained elevation of alpha-fetoprotein 15 months later proved to be positive for TIN. Six previously reported cases of false-negative testicular biopsies obtained during a search for TIN are reviewed. In the light of several thousands of biopsies performed world-wide to date, the number of false-negative biopsies is probably very low. Although TIN is obviously not randomly dispersed throughout the testis in all patients, a routine biopsy of the contralateral testicle in patients with testis cancer remains a valuable tool for early detection of bilateral testicular tumors.-cal distribution of TIN in testes removed for this lesion. Their results suggested that after puberty TIN is usually randomly dispersed throughout the testicle. Support for this concept was recently given by Mumperow et al. (1992). These authors examined tumor-bearing testes and they did not find differences in the presence of TIN in biopsies taken from a location close to the tumor and taken from a location distant from the tumor. Thus, one single biopsy is regard to be representative for the entire testis and one biopsy taken after puberty is also assumed to be reliable for predicting whether the testis will ever develop cancer (Berthelsen and Skakkebaek 1981 a). Conversely, if the biopsy is negative for TIN, a future tumor manifestation in the testicle examined is not expected according to this theory (Skakkebaek et al. 1987). Taken together, the concept of TIN would constitute an ideal avenue for the early detection of testis cancer in high-risk populations with the biopsy being a safe means of discriminating between individuals who will or who will not develop testis cancer.
Random systematic ultrasonographically guided transrectal core biopsies of the prostate were performed in 73 patients with pulmonary malignancies to exclude prostate cancer as a primary malignant neoplasm. Of the patients 41 had normal prostates as judged by digital rectal examination, 27 had firm prostates and 5 had clinical stage B nodules. Hypoechoic areas were seen on transrectal ultrasonography in 14 of the 41 patients (34%) with normal prostates. Biopsy of the hypoechoic areas in this subgroup detected only 1 grade II prostate cancer. In another patient with normal transrectal ultrasound grade I cancer was detected by mapping of the prostate with 6 systematic ultrasonographically guided transrectal core biopsies. Of the remaining 39 patients with normal prostates transrectal ultrasound detected no hypoechoic defect in 26, a specificity for the detection of prostate cancer of 67%. Multiple core biopsies revealed prostate cancer in 15 of the 32 cases of palpably abnormal prostates, including 12 that were hypoechoic. Prostate cancer is a rare histopathological finding in men with normal prostates on rectal examination. Transrectal ultrasound detected only 1 of 2 low volume prostate cancers in our study group. Thus, ultrasound seems to have little use in patients with prostates that appear normal on digital examination, and its specificity is low.