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PubMed2000

[Retroperitoneal lymphadenectomy for testicular cancer and genito-sexual conditions: retrospective study].

OBJECTIVES: The aim of this study was to evaluate retrospectively the preservation of fertility in a number of patients with testis or funicle tumour treated with retroperitoneal lymph node dissection (RPLND). MATERIAL AND METHODS: Between 1983 and 1998, 41 patients with testis or funicle cancer (mean age 29 years, range 18-58) underwent RPLND at our institution. Clinical staging included abdominal CT scan, chest X-rays and serum tumour markers (alpha FP, beta HCG, LDH). RPLND was performed bilaterally in 14 patients and unilaterally in 13 patients (6 right and 7 left). The nerve sparing technique was used in 14 cases. Ejaculation was evaluated in 39 patients (2 patients died of metastases before the study). Mean follow up was 64 months (range 5-182). Semen was available for 21 patients before RPLND and for 19 patients after RPLND. The "t Student" test was used to compare the semen parameters before and after surgery. RESULTS: Bilateral RPLND caused loss of ejaculation in 67% of the patients (8/12). Unilateral right and left RPLND allowed to maintain ejaculation in 100% (6/6) and 57% (4/7) of cases respectively. Nerve sparing procedure preserved ejaculation in 100% of the patients (14/14). After RPLND, both mean total sperm count and mean motility rate were not significantly changed (143 +/- 124 x 10(6) vs 128.2 +/- 72 x 10(6) p > 0.05; 40.7 +/- 17.6 vs 48 +/- 15.5%, p > 0.05). The survival rate of the patients treated with RPLND was 95%. None of the patients treated with unilateral (en bloc or nerve sparing) RPLND had relapse. CONCLUSION: The evolution of surgical technique has notably reduced the andrological complications of the RPLND without affecting the oncological results.

Adolescent↗
PubMed2000

Successful treatment of retrograde ejaculation with sperm recovered from bladder washings. A report of two cases.

BACKGROUND: Retrograde ejaculation causes < 2% of male infertility but is the leading cause of aspermia. The incidence of retrograde ejaculation is increasing due to the aggressiveness of modern urologic cancer surgery and an increase in diabetes mellitus. Generally, the only adverse effect is on fertility. Various approaches have been proposed for treatment, ranging from insemination with sperm-rich urine obtained after masturbation to intracytoplasmic sperm injection (ICSI). We used a protocol involving bladder washing. CASES: Case 1 involved a man with retrograde ejaculation secondary to a successful right orchiectomy and retroperitoneal lymph node dissection for stage B1 embryonal cell carcinoma. He was treated with bladder washing and intrauterine insemination. He fathered three children from six insemination cycles. Case 2 involved a man with idiopathic retrograde ejaculation and a wife with ovulatory dysfunction. He received treatment similar to that in case 1 and fathered one child from two insemination cycles. CONCLUSION: Larger studies need to be done specifically comparing treatments. Our method resulted in four normal infants in two couples over eight total insemination cycles and, taken together with other results from the literature, seems a good choice for clinicians who are treating retrograde ejaculation for the first time. We agree with others who have recommended that in vitro fertilization/ICSI not be the first step for treating the usual couples with retrograde ejaculation.

Adult↗
PubMed2000

Adenocarcinoma of the rete testis. Report of two cases.

Adenocarcinoma of the rete testis is extremely rare and has been the subject of only sporadic case reports. Its natural history appears highly malignant even in localized forms; because of a poor response to adjuvant therapy radical orchiectomy with retroperitoneal lymph node dissection is recommended in stage A. We report our experience with two examples which arose in men of 26 and 57 years of age between 1988 and 1999. Both of them presented with a scrotal mass, and one of them had hydrocele. Neither had a history of maldescendent, infections or trauma. Microscopically the tumors were adenocarcinomas, and the one in the 26 years old patient presented with tubulopapillary formations. Immunohistochemical staining demonstrated positivity for CK and NSE in the 26 year old patient and only a weak positivity for CEA and vimentin in the 57 year old one. EMA and calretinin were always negative. Both were stage A but the young man who underwent radical orchiectomy with no lymph node dissection, developed a lymph node metastasis within one year.

Adenocarcinoma↗
PubMed2001

Surveillance can be the standard of care for stage I nonseminomatous testicular tumors and even high risk patients.

PURPOSE: We investigate the results of a surveillance program for stage I nonseminomatous germ cell tumors to validate a surveillance policy, and furthermore improve it by analyzing diagnostic instruments and identifying prognostic factors for relapse. MATERIALS AND METHODS: From 1982 to 1994, 90 patients with stage I nonseminomatous germ cell tumors entered a surveillance protocol after orchiectomy. Patients with relapse were treated with cisplatin based chemotherapy. A statistical analysis of possible prognostic factors for relapse was performed. RESULTS: Relapse occurred in 23 (26%) patients. Disease specific survival was 98.9%, and 1 patient died of tumor. Most relapses were located in retroperitoneal lymph nodes only (78%). Tumor markers were the most important indicators of relapse. However, in 22% of patients with relapse abdominal x-ray of lymphangiographic contrast showed the first sign of relapse. Computerized tomography located all but 1 relapse. Vascular invasion (p = 0.0001), tumor size (p = 0.0341) and presence of immature teratoma (p = 0.0154) were significantly predictive of relapse with the multivariate analysis, percentage embryonal carcinoma only by univariate analysis (p = 0.032). The relapse rate was highest (52%) when vascular invasion was present. CONCLUSIONS: With surveillance for stage I nonseminomatous germ cell tumors, excellent treatment results can be achieved that are comparable to primary retroperitoneal lymph node dissection. Tumor markers and computerized tomography are highly reliable for detecting relapse. Lymphangiography is still of staging value. Pathological factors may influence the choice of adjuvant treatment. However, relapse risks of 50% to 60% are maximally achieved with presently available prognostic factors, and so sparing morbidity of adjuvant treatment by a surveillance protocol remains a feasible option even in these patients.

Adolescent↗
PubMed2001

[Histopathologic risk factors in patients with non-seminomatous germ tumors of the testis in clinical stage 1. Retrospective study of 75 patients].

OBJECTIVES: This retrospective study was performed to evaluate histopathologic prognostic risk factors in 75 patients on clinical stage 1 nonseminomatous germ cell cancer of the testis (NSGCTT). METHODS: From September 1976 to February 2000 we operated on 75 patients for NSGCTT on clinical stage 1 disease. Average age was 29.5 years (range 16-71). After orchiectomy, therapeutic options included retroperitoneal lymph node dissection (RLND) for 44 patients (58.6%), surveillance for 26 (34.6%) and neoadjuvant chemotherapy for 5 (6.6%). Testis primary tumor samples were assessed for studying prognostic risk factors that included vascular and/or lymphatic invasion (IV/IL+), percentage of embryonal carcinoma (%EC) and absence of yolk sac tumor (YS-). RESULTS: All patients were alive and disease-free. The average age follow-up was 84.5 months (range 1-254). Relapses occurred in 11 (14.6%) patients after an average follow-up of 9.09 months (range 3-24). Prognostic risk factors were detected as follows: IV/IL+ in 17 cases (22.7%), (50-80%) EC in 23 (30.6%), CE% > 80 in 23 (30.6%), YS- in 55 (72%). In 8 (10.6%) patients there was not any prognostic risk factor. Disease relapse related to prognostic risk factors was detected as follows: 18.1% for VI/LI, 90.9% for EC% > 50 (27.2% for 50-80% EC and 63.6% for CE% > 80) and 90.9% for YS-. Relapsing rates between patients with EC% > 80 and 50-80% EC resulted statistically significant (p = 0.02, odds ratio = 12.25). Relapsing rates between patients on surveillance and those who underwent RLND was next to be significant (p = 0.05, odds ratio 3.68). CONCLUSIONS: EC% > 80 is a prognostic risk factor for disease relapse in patients with clinical stage 1 NSGCT who are selected in a high risk group requiring RPLND or neoadjuvant chemotherapy as therapeutical option.

Adolescent↗
PubMed2002

[A case report of testicular leiomyosarcoma].

This report describes a case of primary leiomyosarcoma of the testis in a 70-year-old man. Treatment consisted in orchidectomy by the inguinal route with no adjuvant treatment. The patient developed pulmonary metastasis 14 months after surgical treatment. Few reports have been published on primary leiomyosarcoma of the testis. Most reported cases have been in small series in association with germ cell tumors. Surgical treatment is the most effective therapeutic modality. The standard surgical technique is orchidectomy by the inguinal route. Retroperitoneal lymph node dissection is not always performed. The prognosis of isolated testicular sarcoma is better than that of sarcoma associated with germ cell components.

Aged↗
PubMed2003

Testicular cancer: maintaining the high cure rate.

The management of germ cell tumors has advanced dramatically, with cure rates approaching 90% to 95%. Treatment of stage I/A seminomas generally includes orchiectomy and adjuvant radiotherapy. Treatment of stage I/A nonseminomatous germ cell tumors involves orchiectomy followed by retroperitoneal lymph node dissection or active surveillance. One of the major advances has been the introduction of cisplatin-based chemotherapy for metastatic disease and the development of a system of risk attribution. The logical management of any patient with curable disease is to provide curative therapy and then follow the patient in a structured manner, to diagnose and treat any complications in a timely manner.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

Testicular germ cell tumors in childhood: treatment results of 52 patients.

We analysed the treatment results of 52 children with testicular germ cell tumors. Histopathological diagnoses were endodermal sinus tumor (63.4%), embryonal carcinoma (28.8%), teratocarcinoma (5.7%), and mixed tumors (2.1%). Radical inguinal orchiectomy was performed in 42 patients and retroperitoneal lymph node dissection in 10 (3/10 positive). Overall survival rates were: whole group: 71.2%; stage I: 89.7%; II: 68.5%; III: 31.2%; IV: 30% (p =.001). Five-year overall survival rates were 85.8% and 100% for stage I patients who received chemotherapy or not (p =.27); BEP regimen: 85.7%; classical VAC: 67.9%; vinblastine + bleomycin: 63.6%. Chemotherapy is not required in stage I. BEP regimen is effective in testicular germ cell tumors.

Adolescent↗
PubMed1992

Treatment of anejaculation with electroejaculation.

Male infertility caused by anejaculation is common after spinal cord injury (SCI) and following retroperitoneal lymph node dissection (RPLND) for testicular cancer. Other conditions sometimes associated with neurogenic ejaculation loss are diabetes mellitus, multiple sclerosis, extensive pelvic surgery and adult myelodysplasia. Primary absence of ejaculation also has been described. Few treatment options exist for these patients, if they wish to father a child. With electroejaculation (EEJ), or the low-current stimulation of the ejaculatory organs via a rectal probe, emission of semen can be initiated in these men. In non-SCI-patients EEJ requires general anaesthesia. The collected semen is washed and the motile sperm fraction isolated before artificial insemination (AI) of the partner. At the University of Michigan 198 men have been treated between 1986 and December 1991. An ejaculate could be obtained from nearly all patients. A major obstacle to success is the severe asthenozoospermia and the poor functional quality of the obtained sperm samples. This can be caused by the EEJ-technique itself, as well as by the long anejaculatory status. A semen sample with at least 10 million progressively motile sperm cells, useful for AI, was obtained in 75% of the SCI men and in 87% of the men following RPLND. In the couples wishing insemination, 49 pregnancies were induced, accounting for an overall pregnancy rate of 35% per couple. Thirty five healthy babies have been born. Only three complications were encountered. At Hannover Medical School only few patients have been stimulated to date. We could obtain an adequate sperm sample for AI from all of them. No complications were seen. As the first couple has just entered the phase of AI with husband sperm, an analysis of these results would be premature. Electroejaculation combined with artificial insemination is an efficient and safe treatment of male infertility due to neurogenic anejaculation.

Adult↗
PubMed1992

[A clinical study of 115 patients with testicular tumor].

One hundred and fifteen cases of testicular tumors treated at our Hospital between 1970 and 1989 were analyzed. The incidence of testicular tumors was 0.44% in the male outpatient department of our urological clinic. The age of these patients ranged from 6 months to 86 years (average: 31.7 years old) with two peaks in distribution; 0 to 5 and 21 to 45 years. Most of their chief complaints (77%) were painless swelling of scrotal contents. Location of the tumors included 56 in the right, 57 in the left and 2 on both sides. Histologically, there were 68 cases of seminoma, 10 cases each of embryonal carcinoma and teratoma, 22 cases of mixed type, 3 cases of malignant lymphoma and 2 cases of others. Stage of tumor was stage I in 69 cases, IIA in 25 cases, IIB in 8 cases and III in 13 cases. High orchiectomy was performed on all the patients. Radiotherapy, chemotherapy and retroperitoneal lymph node dissection were respectively done in 77, 42 and 16 cases. Seventeen patients died, and the 5-year survival rate calculated by the Kaplan-Meier method was 87.9% in seminoma and 68.9% in non-seminoma. The survival rate for the patients treated by chemotherapy including CDDP after 1983 was compared to those treated by other therapy before 1982. Between the two groups there was no significant difference.

Adolescent↗
PubMed2005

[Simultaneous bilateral testicular tumors with different cell types: a case report].

A 22-year-old man presented to our out-patient clinic with the chief complaint of a painless mass in the right scrotum and lymph node swelling around the abdominal aorta in October, 2002. The bilateral testicular tumors were palpated and visualized by ultrasound and magnetic resonance imaging (right phi5 cm, left phi2 cm in diameter). Computed tomography revealed a metastatic lymph node around the abdominal aorta (3 x 3 x 10 cm in size). He underwent bilateral radical orchiectomy after frozen storage. Enucleation of the left testicular tumor was not performed because of its irregular demarcation. Histological examination revealed typical seminoma of the right testis and embryonal carcinoma of the left testis. Retroperitoneal lymph node dissection was performed after 4 courses of systematic chemotherapy (bleomycin, etoposide, platinum). No viable tumor cells were present histologically in the excised lymph nodes. The postoperative course was good and uneventful at 16 months under androgen replacement therapy without disease recurrence.

Adult↗
PubMed2005

[Urological cancer].

We reported laparoscopic adrenalectomy for adrenal cancer, our experience of laparoscopic partial nephrectomy, radical prostatectomy, retroperitoneal lymph node dissection for testicular cancer. Minimally invasive therapy is the direction of progress in current clinical medicine, so laparoscopic procedures have developed and their application has expanded in the urological field.

Adrenal Gland Neoplasms↗
PubMed2005

Surgery for testicular cancer: indication, results and technical aspects.

The standard therapeutique approach to patients with advanced germ cell tumors of the testis is a combination of systemic chemotherapy with surgical removal of the residual disease. The indication of surgery, residual tumor resection (RTR) or retroperitoneal lymph node dissection (RPLND), has changed during the last 10 years. Sugery is not longer recommended after chemotherapy of pure seminoma and surveillance of the residual tumor is the favored option. RPLND is a critical component of the treatment armentarium in low-stage nonseminomatous germ cell. RPLND is an accurate staging tool prviding important information to dtermine the need for chemotherapy. When performed properly, RPLND eliminates the retroperitoneum as a site for relapse, wich in turn provides emotional and psychological relief to the patient, and simplifies the follow-up protocol. In advanced nonseminomatous tumours, surgery after chemotherapy is recommended in most of the cases since large studies have shown that a considerable proportion of patients with complete radiological remission after chemotherapy harbor vital carcinoma or teratoma. Prediction models of necrosis after chemotherapy in order to avoid RTR are generally accepted since the accuracy of most models is too low. RTR is indicated in patients with elevated markers after two different chemotherapy regimens (including salvage chemotherapy) either to resect teratoma or cystic residual disease or to remove chemorefractory disease. Laparoscopic approache is a viable staging tool; however, oncologic control of the retroperitoneum has not been reliably determined.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2005

Round cell liposarcoma of scrotum with indolent course in young adult.

Myxoid/Round cell liposarcoma accounts for one-half of all liposarcomas and occurs as the second most common subtype. Both myxoid and round cell types share clinical, histological features and are accepted to represent a spectrum of lesions ranging from pure myxoid to near completely round cell liposarcoma. Round cell liposarcoma is highly metastatic and is classified as high grade and poorly differentiated myxoid sarcoma. Typical non-round cell myxoid liposarcoma is less metastatic and has more favorable prognosis. Karyotypic study of myxoid and round cell liposarcomas reveal a characteristic reciprocal translocation t (12;16)(q13;p11) resulting in the fusion of CHOP gene with TLS gene in more than 90% of cases. Most masses within the scrotal sac arise from the testis proper, and less likely from the extratesticular tissue. Liposarcoma represents approximately 20% of malignant extratesticular neoplasms, with the well differentiated subtype being the most common. Myxoid/round cell liposarcoma and round cell liposarcoma are rarely encounter in extratesticular soft tissue. We reported a rare case of round cell liposarcoma (high grade myxoid liposarcoma) of extratesticular tissue. To our knowledge, this is the first case of a large size (> 5cm) round cell liposarcoma arising from soft tissue within the scrotal sac of young adult with indolent course. Simple excision or enucleation are inadequate therapies and wide excision of the hemiscrotum including inguinal soft tissue and nodes is recommended. The role of retroperitoneal lymph node dissection and adjuvant chemotherapy remains controversial.

Adult↗
PubMed2006

[A case report: simultaneous bilateral testicular tumors with different cell types--complete response after combination chemotherapy of cisplatin and irrinotecan hydrochloride--].

A 38-year-old man was admitted to our hospital complaining of bilateral scrotal swelling. On examination, the patient was found to have bilateral testicular tumors with jugular chain lymph node and para-aortic lymph node metastasis. He underwent bilateral inguinal orchiectomy. Histopathological examination of the excised tumors revealed seminoma, embryonal carcinoma, yolk sac tumor and immature teratoma in the right testis and seminoma in the left testis. The patient was treated postoperatively with two courses of BEP (bleomycin, etoposide, cisplatin) therapy and two courses of EP (etoposide, cisplatinum) therapy. The patient had lung metastasis during the follow-up period and we treated him with salvage combination chemotherapy of cisplatin and irinotecan hydrochloride (CPT-11). After the third course of cisplatin and CPT-11 chemotherapy the lung metastasis disappeared and we performed retroperitoneal lymph node dissection. The patient has remained free of disease 11 months after discharge.

Adult↗
PubMed2006

Is bleomycin necessary in adjuvant chemotherapy of clinical stage I non-seminomatous testicular cancer?

The aim of our study was to assess the feasibility of bleomycin omission from two cycles of adjuvant bleomycin, etoposide and cysplatin (BEP) chemotherapy in patients with clinical stage I non-seminomatous germ cell tumors (NSGCT). A total of 41 patients with high risk clinical stage I NSGCT of the testis were treated with adjuvant chemotherapy at our center from October 1994 to June 2005. The criteria for high risk were lymphatic and/or vascular tumor invasion in the primary tumor. 24 patients underwent adjuvant chemotherapy with two standard cycles of BEP (I group) and 17 patients received two alternative cycles of EP (II group). Toxicity was analyzed on a per treatment cycle basis. One patient from group 1 required subsequent retroperitoneal lymph node dissection for recurrent mature teratoma. All the patients were alive and relapse-free at a median follow-up time of 75 and 49 months for groups 1 and 2 respectively. In patients from group 1 more number of treatment cycles was associated with grade 2-3 leukopenia compared to group 2 (p=0,043). The results of this study show that two cycles of EP regimen is as effective as two cycles of BEP chemotherapy in patients with clinical stage I NSGCT and may be suggested as a less toxic alternative approach to standard adjuvant treatment.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

[Surgical interventions and andrological complications].

Several abdomino-Pelvic surgical procedures can cause ejaculatory failure or impotence. Retroperitoneal lymph node dissection for testis cancer is followed by loss of ejaculation if bilateral. In low stage cancers, monolateral procedure is associated with maintenance of ejaculation in most patients. Evaluation of seminal fluid before surgery is essential for cryopreservation and artificial insemination erectile impotence is consequent to section of "nervi erigentes" in pelvic surgery for cancer. Careful anatomic dissection can spare these nerves but oncologic radicality should be always kept in mind.

Abdomen↗
PubMed1991

Haematogenous tumour growth in the inferior vena cava in a patient with a nonseminomatous testicular tumour.

The case history is reported of a patient with an invasion of the inferior vena cava by metastases of a non-seminomatous testicular tumour. He was treated with combination chemotherapy, followed by laparotomy and resection of residual tumour tissue. Fourteen months after this operation he is in good health. For every retroperitoneal lymph node dissection it is necessary to be on the look-out for invasion of the vena cava, because of the risk of a sudden pulmonary embolism.

Adult↗