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PubMed1990

Clinical and biological significance of carcinoma in situ of the testis.

Carcinoma in situ (CIS) of the testis is a preinvasive lesion that with time progresses into invasive germ cell tumour. CIS precedes all types of germ cell tumours except spermatocytic seminoma. An increased risk of harbouring CIS has been reported in men with a history of cryptorchidism, in contralateral testes of men previously treated for unilateral germ cell tumour, in intersex patients, in men with assumed extragonadal germ cell tumour and possibly in infertile men. CIS develops into invasive germ cell cancer in 50% of untreated patients within five years of diagnosis, and it is believed that with time CIS will progress into germ cell cancer in almost all patients. A testicular biopsy is necessary to diagnose CIS. Cells with the characteristics of CIS cells have been detected in seminal fluid, and it may be possible to develop methods for diagnosing the condition by analysis of the semen. We recommend orchidectomy as the treatment of choice in cases of unilateral CIS, if the other testis has a potential for fertility. In other cases, such as patients with testicular tumour and CIS of the contralateral testis, we recommend localized irradiation of the testis with CIS. Leydig cell function seems to be slightly impaired, but sufficient for sexual function, after irradiation. CIS cells show morphological and immunohistochemical similarities with primordial germ cells (gonocytes), whereas they share only few features with spermatogonia. Therefore, we suggest that CIS cells are malignant cells derived from gonocytes during embryonic development.

Carcinoma in Situ↗
PubMedDate not supplied

Does ethane 1,2-dimethanesulphonate (EDS) have a direct cytotoxic effect on the seminiferous epithelium of the rat testis?

The authors examined the possibility that ethane 1,2-dimethanesulphonate (EDS) has a cytotoxic effect on spermatogenesis that is not secondary to androgen withdrawal resulting from the well known cytotoxic effect of EDS on Leydig cells. Adult male rats were implanted with polydimethylsiloxane (PDS) capsules containing testosterone (T) and estradiol (E), and were simultaneously injected with EDS. The PDS-TE implants, by inhibiting luteinizing hormone (LH) production, prevented Leydig cells from repopulating the testis and clamped testosterone within the seminiferous tubules at increasing concentrations relative to implant size. In rats that received EDS alone, the number of advanced spermatids per testis was significantly reduced by 2 weeks, but within 8 weeks returned to the numbers maintained in vehicle-injected control rats or in vehicle-injected rats that received testosterone- and estradiol-filled capsules of 24 cm and 0.1 cm, respectively (PDS-24TE). Surprisingly, in rats that received an EDS injection plus PDS-24TE implants, the number of advanced spermatids per testis was significantly reduced at 8 weeks and severe seminiferous tubule atrophy occurred despite the fact that the testosterone concentration was sufficient to quantitatively maintain spermatogenesis in vehicle-injected rats. In rats injected with EDS and implanted with 24 cm testosterone but not estradiol-filled capsules (PDS-24T), the advanced spermatid number per testis was significantly higher than that in the EDS plus PDS-24TE rats, but significantly lower than that in control rats. These results suggest that EDS may have a cytotoxic effect on the seminiferous epithelium that is independent of the elimination of Leydig cells, and the EDS and estradiol act synergistically to exert a profound toxic effect on spermatogenesis.

Animals↗
PubMed1987

[The non-scrotal testis].

In this article the classification of the nonscrotal testis is elucidated with a description of all forms of incomplete testicular descent. A great deal of attention is paid to the process of reaching the proper diagnosis, outlining the procedure for physical examination. The risk of infertility, the rather rare occurrence of testicular tumor, and a disturbance of the psychosexual development, are reasons why the undescended testis should be treated. How the undescended testis should be treated, hormonal or surgical, depends entirely on the position of the testis. LHRH nasal spray may induce descent in testes that have emerged from the inguinal canal and can be manipulated to at least the scrotal entrance. Surgical treatment is indicated for all undescended testes that have not emerged from the inguinal canal as well as all ectopic testes, and for those testes that failed to descend with hormonal therapy. The treatment protocol for all types of nonscrotal testes is discussed and schematically presented.

Child↗
PubMed1986

Pro-opiomelanocortin-derived peptides in the testis: evidence for a possible role in Leydig and Sertoli cell function.

Pro-opiomelanocortin (POMC)-derived peptides such as beta-endorphin, ACTH, and MSHs were identified in the testis where they were exclusively localized in Leydig cells. Examination of testicular extracts by a variety of physicochemical and immunological techniques indicates that the processing of the POMC in the testis is very similar to that in the brain. By using a cDNA probe, the POMC-like mRNA present in total testis and cultured Leydig cells was 150-200 bases shorter than that in the hypothalamus and pituitary. In addition, POMC mRNA was localized to Leydig cells using in situ hybridization. The expression of the POMC-like gene and the accumulation of POMC-derived peptides in Leydig cell were shown to be under the control of gonadotropin. As the testis contains low concentrations of POMC-derived peptides, we suggested that they may be implicated in local regulatory events within this organ. This postulate was supported by results from in vivo and in vitro experiments suggesting that different portions of the POMC-molecule may have opposite effects on Sertoli cell functions. For example, MSHs increased cAMP accumulation and aromatase activity in these cells, while opioids inhibited Sertoli cell proliferation and androgen binding protein (ABP) secretion. Furthermore, following intratesticular administration of opiate antagonists, testosterone production was reduced, suggesting that Leydig cell function may be also modulated by beta-endorphin and/or other related peptides. Taken together, these studies support the hypothesis of a possible role of POMC-derived peptides in testicular function.

Animals↗
PubMed1987

Radionuclide imaging of sequential torsions of the appendix testis.

Radionuclide imaging is the diagnostic procedure of choice for evaluation of acute disorders of the scrotum, permitting rapid differentiation of torsion of the spermatic cord from inflammatory processes. The method is less successful in diagnosing torsion of the testicular appendages. In the majority of reported cases of torsion of the appendix testis the scan appears normal. In a very limited number of cases increased perfusion to the affected side has been noted. We report a case of metachronous torsion of both the appendices testis. In each instance, there was decreased tracer uptake on the affected side, suggestive of early torsion of the testicle. The sequential involvement of each testis with a nine month interval between respective torsions provides a unique example where each testis serves, sequentially, as a normal control for the torsed contralateral appendage.

Child↗
PubMed1986

[Epidermoid cyst of the testis: a case report].

A 28-year-old man was admitted to our department with the chief complaint of a painless nodule in the left scrotal content. Physical examination revealed that a small, thumb-finger sized, hard mass with a smooth surface was palpable at the upper part of the left scrotal content. With the preoperative diagnosis of testicular tumor, the left testis was explored under ischemia. Appearance of the testis was normal and the mass was felt in the upper portion of the testis. Since the mass was suspected to be malignant, left radical orchiectomy was performed. The histological diagnosis was epidermoid cyst of the testis. Sixty-five cases of testicular epidermoid cyst including this case have been reported in the Japanese literature, and are reviewed briefly here.

Adult↗
PubMed1986

[A case of pure choriocarcinoma of the testis in an elderly man].

A case of pure choriocarcinoma of the testis in a 62-year-old male is reported. The patient consulted his family physician with an enlarged but painless right scrotal containment in November, 1980. Initial diagnosis was right hydrocele testis and chronic epididymitis, and he was treated with antibiotics. However, the tumor continued to enlarge. Right high orchiectomy was performed on March, 15, 1981 under the diagnosis of suspected right testicular tumor. The resected specimen was 10 X 7 X 6 cm and elastic hard. The cut surface was dark reddish with hemorrhagic foci. Serial sections of the entire testis were made and their histopathological examinations revealed the tumor to be a classical pure choriocarcinoma of the testis. The plasma beta-HCG level was remarkably elevated, but the alpha-fetoprotein level was normal. Anticancer chemotherapy (CDDP 125 mg, MTX 20 mg, ADM 50 mg, and EDX 500 mg) was performed in eight courses after the operation. Multiple metastatic foci were present in both lungs during the treatment, and his condition gradually deteriorated. Therefore, he was transferred to our hospital. Aggressive anticancer treatment could not be given because of his poor general condition, and he died on May, 16, 1982 of carcinomatosis. The autopsy revealed multiple nodular metastasis of the tumor to bilateral lungs, bilateral adrenal glands and right kidney. There was no metastasis to the lymph nodes. The metastatic lesions, macrospically dark reddish with hemorrhagic foci, were histopathologically pure choriocarcinoma.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1981

Undescended testis: a study of 212 cases treated surgically.

Two hundred and twelve of undescended testes were operated on in the Department of Surgery, Singapore General Hospital between the years 1974 through 1980. There was a 51.9% incidence of right undescended testis, 34.9% left undescended testis and 13.2% were bilateral. The method of treatment was surgical exploration with orchidopexy wherever technically feasible or orchidectomy if the testis was found to be severely hypoplastic. Of the total series, 42% were operated on before the age of 5 years. The oldest patient undergoing orchidopery was aged 40. Failure of orchidopexy to secure the scrotal position for the testis was noted in 14 cases. This was probably due to inadequate mobilisation at the first operation. There was no mortality and no significant morbidity following surgical treatment in this series.

Adolescent↗
PubMed1984

Adenocarcinoma of the rete testis. Case report, ultrastructural observations, and clinicopathologic correlates.

Adenocarcinoma of the rete testis is a rare tumor that tends to occur in men over the age of 60 and is usually associated with a poor prognosis. We report such a tumor occurring in a 63-year-old male 2 years after he underwent a scrotal exploration in the management of a hydrocele, varicocele, and inguinal hernia. The postorchidectomy course was characterized by slowly advancing, painful scrotal and perineal skin recurrences, lymph node metastases, and the absence of response to Adriamycin and electron-beam therapy. We are confident that the lesion is a carcinoma of the rete testis because: 1) the tumor is situated mainly in the testicular mediastinum, 2) primary germinal and nongerminal testicular tumors and spread from distant sources have been excluded, 3) a transition from normal rete testis to atypical and neoplastic rete epithelium is demonstrable, and 4) the transmission electron-microscopic findings support our conclusion. The distinction between carcinoma of the rete testis and malignant mesothelioma may be difficult and requires consideration of the gross, light-microscopic, and ultrastructural tumor characteristics in optimally fixed tissue.

Adenocarcinoma↗
PubMed1981

Primary malignant carcinoid of the testis.

A primary malignant carcinoid in the testis of a 76-year-old man was studied. The clinical indication was the appearance of extensive, papular cutaneous metastases. A markedly enlarged, indurated left testis was discovered during evaluation of the skin lesions. There were no clinical features of carcinoid syndrome. Histochemically, the tumor cells were argyrophilic but nonreactive to an argentaffin stain. Electron microscopy revealed numerous round, neurosecretory-type granules that ranged from 70 to 300 nm. At the time of autopsy, metastases were found in the heart, lungs, and the opposite testis. Review of the laterature failed to uncover any previous reports of a primary malignant carcinoid in the testis.

Aged↗
PubMed1994

[Cysts in the cavum tunica vaginalis testis: a case report].

A case of cysts in the cavum tunica vaginalis testis was reported. A 58-year-old man visited our clinic with the chief complaint of urethral bleeding. Urethro-cystogram revealed stricture of bulbous urethra. We palpated several pea-sized painless masses in the left scrotum. On ultrasonogram of the left scrotal contents several cystic lesions were detected at the cranial side of the left testis. At operation, cysts were found in the cavum tunica vaginalis testis, and were resected along with the tunica vaginalis. Fluid of the cysts was serous without sperm. Histopathologically mesothelial cyst was suspected. The incidence of cysts in the cavum tunica vaginalis testis is rare and only 17 cases have been reported in Japan. We reviewed 9 cases of cysts arising from lamina parietalis of tunica vaginalis.

Cysts↗
PubMed1994

Seminomas of the canine testis. Counterpart of spermatocytic seminoma of men?

BACKGROUND: Dogs develop germ cell tumors of the testis at a relatively high rate. It is not known to what degree these tumors resemble various human testicular neoplasms. EXPERIMENTAL DESIGN: The epidemiology and morphology of a series of spontaneous canine testicular tumors, collected between 1985 and 1991, was analyzed, and compared with human testicular germ cell tumors. DNA content analysis of representative samples was performed using flow cytometry and image cytometry. Eight human spermatocytic seminomas were studied in parallel. RESULTS: All canine tumors had the histopathologic features reported as typical for dog testis seminomas. These tumors could show both an intratubular and an invasive component. Most of them were pure (78%), while they could be combined with a Leydig cell tumor, a Sertoli cell tumor, or both. No somatic, placental or yolk sac cells were identified, and there was no carcinoma in situ (CIS). A bimodal age distribution, with a peak around 1 year of age and between 4 and 16 years of age, was found for all pure and mixed testicular tumors, except for those composed of a Leydig cell and a seminoma component. These tumors were all present in dogs older than 7 years, being significantly more older (p < 0.01) than dogs with a pure tumor of either type. All Sertoli cell and Leydig cell tumors were diploid. No consistent peritriploid DNA content, characteristic of human testicular germ cell tumors, was found for canine seminomas, which most often had a diploid DNA content. Human spermatocytic seminomas always contained diploid tumor cells, and showed a relatively low number of high ploidy cells, comparable to canine seminomas of the testis. CONCLUSIONS: The so-called seminomas of the testis are tumors of old age. Histologically, these tumors are composed of a single cell type with some variation without evidence of differentiation. It is proposed that canine seminoma correspond to human spermatocytic seminomas. It is thought that the Leydig elements in these tumors represent a reactive change rather than biphasic differentiation of a single stem cell capable of germinal and sex-cord cell development.

Animals↗
PubMed1996

Scrotal-inguinal ultrasonography: a technique for identifying the nonpalpable inguinal testis without laparoscopy.

PURPOSE: Treatment of the patient with a nonpalpable testis is controversial, since a high percent will have an inguinal testis or testicular remnant at exploration. While laparoscopy is an effective modality for localizing the intra-abdominal testis, diagnostic laparoscopy is of limited value for patients with nonpalpable (normal or atrophic) inguinal testes. In an effort to identify preoperatively impalpable inguinal testes, we performed scrotal-inguinal ultrasound. MATERIALS AND METHODS: We evaluated 64 patients (74 nonpalpable testes) in the last 4 years, representing 20% of all those presenting with cryptorchidism. Average patient age was 4.5 years (range 6 months to 17 years). All patients underwent preoperative scrotal-inguinal ultrasound and surgical exploration. Diagnostic laparoscopy was reserved for patients with negative ultrasound and no palpable tissue in the scrotum or groin on a preoperative examination. RESULTS: Scrotal-inguinal ultrasound correctly identified 40 of the 42 inguinal testes (95% sensitivity), 7 of the 21 atrophic inguinal testes (33% sensitivity) and 1 of the 11 intra-abdominal testes (9% sensitivity). Therefore, scrotal-inguinal ultrasound correctly identified an inguinal testis or remnant for 47 of the 74 nonpalpable testes (64%), eliminating the need for diagnostic laparoscopy in those cases. For 26 of 74 nonpalpable testes with negative ultrasound 13 had an associated palpable inguinal or scrotal nubbin of tissue, and inguinal exploration only was performed, resulting in 9 orchiectomies, 2 inguinal orchiopexies and 2, 2-stage orchiopexies. Of the 13 nonpalpable testes without palpable nubbins and negative scrotal-inguinal ultrasound 8 were intra-abdominal and 5 were atrophic inguinal testes. CONCLUSIONS: Scrotal-inguinal ultrasound identifies patients with nonpalpable testes who will maximally benefit from diagnostic laparoscopy. When diagnostic laparoscopy was limited to nonpalpable testes without palpable nubbins and negative scrotal-inguinal ultrasound, only 13 of 74 (18%) required laparoscopy. Inguinal exploration without further diagnostic studies is appropriate for boys with nonpalpable testes and palpable nubbins.

Adolescent↗
PubMed1996

[Familial occurrence of tumors and developmental anomalies of the testis].

BACKGROUND: Family occurrence ranks belong the factors followed in etiology and pathogenesis of germ-cell tumours of the testis. Its association with abnormal testicular development, respectively with other risk factors is relatively frequent. OBJECTIVES: The aim of this study was to indicate this coherence by means of case histories of author's patients and to propose further procedures. METHODS AND RESULTS: There were 535 patients treated for testicular cancer in the period of 1982-1994. Family occurrence was observed in 6 cases (1.12%), most frequently incombination with maldescensus testis. Individual families were analysed in detail, including HLA typization. Bilaterality of testicular cancer was observed in two brothers who were HLA identical. Other two brothers had the history of bilateral maldescensus testis, one of whom was subdued to bilateral orchiectomy in childhood, the other at the age of 16, a tumour in one testicle following orchidopexy performed in childhood. The history of maldesensus testis was observed in four members of another family, two of whom developed tumours. CONCLUSIONS AND MEANING FOR PRACTICE: Authors recommend supplementation of the initial examination of each patient with suspective testicular cancer with detailed family history aim at the occurrence of urogenital anomalies and tumours. General knowledge of the first-degree relatives about the possibility of family occurrence of tumours, and instructions for testicular self-examination are considered as the most suitable method from the stand point of secondary prevention. (Ref. 21.)

Adolescent↗
PubMedDate not supplied

Expression of apolipoprotein E mRNA in the epithelium and interstitium of the testis and the epididymis.

Apolipoprotein E (apo E) is an important constituent of plasma lipoproteins and is believed to be involved in the regulation of lipid transport and distribution between tissues. The production of this apolipoprotein in extra-hepatic tissues such as the testis and epididymis could facilitate specific local functions. Apo E mRNA was detected in testis, epididymis, seminal vesicles, and prostate. In the epididymis, apo E was detected using in situ hybridization in epithelial cells and in some cells in the interstitium throughout the organ (i.e., caput, corpus, and cauda). Northern blot analysis showed that apo E mRNA is present in Sertoli cells and germ cells, but not peritubular myoid cells. Interstitial cells of the testis displayed the most intense signal for apo E message using in situ hybridization. Messenger RNA for apo E was also detected in the interstitium of rat testes at 3 and 6 days after animals were treated with ethylene dimethanesulfonate (EDS) to eliminate Leydig cells. Thus, in addition to Leydig cells, other cell types within the interstitium are capable of producing apo E message. Levels of testicular apo E mRNA increased between 30 and 60 days pc during which the germ cell population is increasing. As determined by northern blot analysis of RNA from stage synchronized testes, the levels of apo E mRNA fluctuate in relation to the cycle of the seminiferous epithelium. The cells responsible for this stage-specific variation in message could not be identified by in situ hybridization. Apolipoprotein Al (apo Al) mRNA was also found to be expressed in the epididymis but not in the testis of adult rats. The role of apolipoproteins in spermatogenesis and sperm maturation has not been elucidated. The results of this study demonstrate the specific tissues and cells types which play a role in the production and possible regulation of apo E mRNA in the male reproductive tract. These data will help in the elucidation of the function of apo E in spermatogenesis and sperm maturation.

Age Factors↗
PubMed1997

[Conservative surgery of epidermoid cyst of the testis].

Epidermoid cyst of the testis is a rare, benign testicular tumor. It is estimated that epidermoid cyst of the testis represent less than 1% of all testicular tumors. Opinion is divided as to the best treatment for this condition. The majority opinion favours excision of the tumour and preservation of the testis, although some recommend radical inguinal orchiectomy. We present a case of a 26 years old man with an epidermoid cyst of the testis and submitted to organ preserving surgery. Organ preserving surgery with the excision or enucleation of the epidermoid cyst suffices, having not been reported relapse or metastasis after such treatment. The longest reported follow up time is 37 years. The conservative management of epidermoid cyst is an alternative with important psycho logical benefits and without jeopardizing life.

Adult↗
PubMed1998

[Pagetoid spread of intratubular germ cell neoplasia into rete testis forming tumor-like mass].

Intratubular germ cell neoplasia (ITGCN) is the preinvasive phase of testicular germ cell tumors. ITGCN can spread into the rete testis in a pagetoid manner, but there are very few published data about this phenomenon. Furthermore, the tumor-like mass formed by ITGCN with pagetoid spread into the rete testis has not been documented to date, and the present case is the first to be reported. A tumor-like mass was found close to the superior pole of the left testis in a 39-year-old male and was unrelated to the epididymis. Three other nodules of seminoma surrounded by fibroconnective tissue existed next to the mass. Histological sections revealed ITGCN which was characterized by the presence of large and polygonal germ cells exhibiting clear cytoplasm with distinct cell borders. The cytoplasm was rich in glycogen and the cell membrane was immunohistochemically positive for placental alkaline phosphatase. The nuclei had less coarse chromatin than that of seminoma. ITGCN cells spread in between the lining epithelium of the rete and the basement membrane. This characteristic spread was consistent with pagetoid spread into the rete testis.

Adult↗
PubMed1998

[Diagnosis of non-palpable testis: value of a new miniaturized laparoscope].

Laparoscopy and magnetic resonance imaging (MRI) are competitive tools in the diagnosis of nonpalpable testis. We investigated 29 boys for this indication with MRI. If MRI failed to locate the testis, laparoscopy was performed with a new, miniaturized set of pediatric instruments (1.9-mm optic). MRI revealed 10 inguinal and 7 abdominal testes. There was no false-positive finding. In 12 boys MRI showed no testis. Four cases were true negative, 8 false negative (32%). In these 8 MRI-negative patients, laparoscopy revealed 7 inguinal and 1 abdominal testis. The optical quality of the mini-telescope was sufficient for a 100% correct diagnosis. Laparoscopy-related complications did not occur. In summary, laparoscopic evaluation is the preferred method in pediatric cases of nonpalpable testes.

Adolescent↗