Leiomiossarcoma paratesticular: relato de caso e revisão de literatura / Paratesticular leiomysarcoma: a case of report and review of the literature

Introdução: O leiomiossarcoma é um tumor maligno de células mesenquimais. Este estudo tem como objetivo apresentar um caso clínico de sarcoma paratesticular subtipo leiomiossarcoma, tendo em vista sua escassez na literatura. Relato de caso: Paciente, 40 anos, sexo masculino, negro, hígido, iniciou quadro de dor em região de bolsa escrotal. Foi submetido à ultrassonografia que evidenciou tumor testicular à esquerda. Foi realizada abordagem cirúrgica. Considerações finais: O leiomiossarcoma é um tumor maligno com envolvimento de músculo liso. Devido à raridade do leiomiossarcoma paratesticular, não existe protocolo estabelecido na literatura. A importância da equipe multidisciplinar e especializada com acompanhamento longitudinal tem o intuito de instituir a terapia padrão-ouro e evitar recorrência.

Introduction: Leiomyosarcoma is a malignant tumor of mesenchymal cells. This study aims to present a clinical case of paratesticular sarcoma subtype leiomyosarcoma given its scarcity in the literature. Case report: The patient, 40 years old, male, black, healthy, started with pain in the scrotal region. He was submitted to ultrasonography which showed a testicular tumor on the left. A surgical approach was performed. Final consideration: Leiomyosarcoma is a malignant tumor with smooth muscle involvement. Due to the rarity of paratesticular leiomyosarcoma, there is no established protocol in the literature. The importance of a multidisciplinary and specialized team with longitudinal follow-up to establish the gold standard therapy and avoid recurrence.

Escala del modelo de creencias de salud en español para el cáncer y la autoexploración testicular / Spanish-language version of the health belief model scale for testicular cancer and testicular self-examination / Escala em espanhol do modelo de crenças em saúde para câncer e autoexame testicular

RESUMEN El objetivo de este estudio fue adaptar y validar la escala del modelo de creencias de salud para el cáncer y autoexploración testicular (AT) en estudiantes universitarios en México y determinar las variables sociodemográficas, clínicas y del modelo de creencias que influyen en efectuar la AT. Se realizó el proceso de traducción y retraducción de la cual se obtuvieron 72 ítems, que fueron revisados por expertos y se eligieron 39 ítems, los cuales fueron aplicados en un grupo de 30 estudiantes para revisar la comprensión y el tiempo de aplicación; por último, esta versión se aplicó en 803 estudiantes de una universidad pública. Se obtuvo una escala de 38 ítems divididos en 6 factores congruentes con el modelo de creencias de salud: susceptibilidad (α = 0,77), seriedad (α = 0,82), beneficios (α = 0,80), barreras (α = 0,83), autoeficacia (α = 0,88) y motivación para la salud (α = 0,71) que explican el 44% de la varianza y presentan una consistencia interna de adecuada a buena. La variable que más influye en la realización de la autoexploración testicular fue la autoeficacia. La versión en español de la escala del modelo de creencias de salud para el cáncer y la autoexploración testicular obtuvo evidencias de validez y confiabilidad en esta muestra de estudiantes universitarios.

ABSTRACT The objective of this study was to adapt and validate the health belief model scale for testicular cancer and testicular self-examination (TSE) in university students in Mexico and to determine the sociodemographic, clinical, and health belief model variables that influence TSE performance. Translation and back translation were conducted, and 72 items were obtained and reviewed by experts, following which 39 items were selected and applied to a group of 30 students to assess comprehension and application time. Finally, this version was applied to 803 students at a public university. A scale consisting of 38 items was obtained, and the items were divided across six factors consistent with the health belief model: susceptibility (α = 0.77), seriousness (α = 0.82), benefits (α = 0.80), barriers (α = 0.83), self-efficacy (α = 0.88), and health motivation (α = 0.71). These factors explain 44% of the variance and show an internal consistency ranging from acceptable to good. The variable that most strongly influenced the performance of testicular self-examination was self-efficacy. The Spanish-language version of the health belief model scale for testicular cancer and testicular self-examination yielded evidence of validity and reliability in this sample of university students.

RESUMO O objetivo deste estudo foi adaptar e validar a escala do modelo de crenças em saúde para o câncer e o autoexame testicular (AT) em estudantes universitários no México e determinar as variáveis sociodemográficas, clínicas e do modelo de crenças que influenciam a realização do AT. Realizou-se o processo de tradução e retrotradução, do qual foram obtidos 72 itens que foram revisados por especialistas. Posteriormente, foram escolhidos 39 itens que foram aplicados em um grupo de 30 estudantes para verificação da compreensão e do tempo de aplicação. Por último, esta versão foi aplicada a 803 alunos de uma universidade pública. Obteve-se uma escala de 38 itens, divididos em 6 fatores consistentes com o modelo de crenças em saúde: suscetibilidade (α = 0,77), seriedade (α = 0,82), benefícios (α = 0,80), barreiras (α = 0,83), autoeficácia (α = 0,88) e motivação para a saúde (α = 0,71), que explicam 44% da variância e apresentam consistência interna de adequada a boa. A variável que mais influenciou a realização do autoexame testicular foi a autoeficácia. A versão em espanhol da escala do modelo de crenças em saúde para câncer e autoexame testicular obteve evidências de validade e confiabilidade nesta amostra de estudantes universitários.

Seminoma mixto testicular / Mixed Testicular Seminoma

Introducción: El cáncer de testículo es una neoplasia rara a pesar de ser el tumor sólido más frecuente en hombres de 15 a 35 años de edad. Objetivo: Describir la presentación de un caso atendido en el Hospital General de Cienfuegos. Caso clínico: Se trata de un varón de 21 años sin factores de riesgo, que acude con masa escrotal, ginecomastia y adenopatías, los exámenes complementarios demostraron un seminoma clásico con áreas de anaplásico y una diseminación notable que lo clasifica como estadio III. Conclusiones: La mortalidad por cáncer de testículo es en gran medida prevenible, el examen físico constituye la piedra angular del diagnóstico precoz, es imprescindible tener presente su posibilidad diagnóstica sobre todo en adultos jóvenes. A pesar de la disminución de la letalidad por esta enfermedad, el diagnóstico tardío y en etapas avanzadas, como en este caso, ensombrecen el pronóstico(AU)

Introduction: Testicular cancer is a rare neoplasm, despite being the most frequent solid tumor in men aged 15-35 years. Objective: To describe the case of a patient who received attention at the General Hospital of Cienfuegos. Clinical case: This is the case of a 21-year-old man without risk factors who presents with a scrotal mass, gynecomastia and adenopathies. The complementary texts showed a classic seminoma with anaplastic areas and notable spread, which allowed to classify it as a stage-III neoplasm. Conclusions: Mortality from testicular cancer is largely preventable. The physical examination is the cornerstone of early diagnosis. It is essential to bear in mind its diagnostic possibility, particularly in young adults. Despite the decrease in mortality from this disease, late diagnosis or in advanced stages, as in this case, hides prognosis(AU)

Lipogranuloma Esclerosante Escrotal Primario. Reporte de caso y revisión de la literatura / Primary Scrotal Sclerosing Lipogranuloma. Case report and literature review

RESUMEN El lipogranuloma esclerosante es una condición extraña y benigna que puede afectar cualquier órgano, especialmente los genitales externos masculinos. Se suele presentar como masas subcutáneas en escroto, periné y pene. Aunque la mayoría de los casos son secundarios a aplicación de cuerpos extraños como parafina, vaselina o silicona con propósitos estéticos para aumentar el tamaño del pene, también puede deberse a degeneración lipídica endógena, secundaria a trauma, infecciones o reacciones alérgicas. No existe consenso en cuanto a su manejo ni datos sobre su prevalencia al ser una entidad poco reportada; se ha descrito el manejo con ciclos cortos de corticoides sistémicos, y cirugía en los casos recidivantes. El objetivo de este trabajo es reportar el caso de un paciente que acudió con induración y eritema en pene y escroto, quien negaba la aplicación de sustancias exógenas y que fue llevado a biopsia de la lesión, con diagnóstico de lipogranuloma esclerosante. MÉD.UIS.2021;34(2): 97-102.

ABSTRACT Sclerosing lipogranuloma is a noncommon and benign disease that could affect any system in the body, especially the male external genitalia. It is usually presented as a subcutaneous mass in scrotum, perineum and penis. Although, most cases are secondary to the injection of foreign bodies such as paraffin, petrolatum or silicone for cosmetic purposes to increase penis size, it could also be due to endogenous lipid degeneration, secondary to trauma, infections or allergic reactions. There is no unanimity regarding its management or data on its prevalence as it is a poorly reported entity. Management with short cycles of systemic corticosteroids and surgery in relapsing cases have been described. The purpose of this article is to present a case of a patient with induration and erythema in penis and scrotum, who denied the application of exogenous substances and has a reported biopsy of the lesion with diagnosis of sclerosing lipogranuloma. MÉD.UIS.2021;34(2): 97-102.

Contents of the inguinal canal: identification by different imaging methods / Conteúdos do canal inguinal: identificação pelos diferentes métodos de imagem

Abstract Although the correct diagnosis of inguinal hernias can often be made by clinical examination, there are several situations in which imaging methods represent the best option for evaluating such hernias, their content, and the possible complications. In addition, bulging of the inguinal region is not always indicative of a hernia, because other lesions, including tumors, cysts, and hematomas, also affect the region. The objective of this pictorial essay is to demonstrate what can be identified within inguinal hernias. Differentiating the types of herniated structures is of absolute importance for planning the appropriate treatment.

Resumo Embora o diagnóstico correto possa ser muitas vezes realizado pelo exame clínico, há várias situações em que os métodos de imagem representam a melhor opção para avaliar hérnias inguinais, seu conteúdo e eventuais complicações. Além disso, os abaulamentos da região inguinal nem sempre são hérnias, pois outras lesões como tumores, cistos e hematomas também acometem este sítio. O objetivo deste ensaio é demonstrar alguns diferentes conteúdos que podem ser diagnosticados no interior de hérnias inguinais. A diferenciação dos tipos de estruturas herniadas é de suma importância no planejamento do tratamento.

Tumor desmoplásico de célula pequeña y redonda paratesticular/testicular: reporte de caso y revisión de la literatura / Paratesticular/testicular desmoplastic round small cell malignant tumor: case report and literature review

Resumen El tumor desmoplásico de célula redonda y pequeña (TDCRP) es una patología neoplásica maligna agresiva y poco común. Afecta predominantemente a hombres entre la segunda y tercera década de la vida. Los pacientes que la padecen tienen un pronóstico pobre, con una supervivencia global a 5 años de hasta el 30%. Por lo general se presenta como una masa en la cavidad abdominal, frecuentemente multifocal. Para su tratamiento se recomienda un enfoque multimodal con cirugía, quimioterapia y radioterapia. Poco más de 20 casos de TDCRP a nivel testicular/paratesticular se han reportado en la literatura. A continuación, se presenta un caso ilustrativo en esta localización, se discute el caso y se realiza revisión de la literatura.

Abstract Desmoplastic small round cell tumor (DSRCT) is an aggressive and rare malignant neoplasm. It mainly affects young men in their twenties and thirties. Patients with it have a poor prognosis, with a 5-year survival rate of up to 30%. It generally presents as a mass in the abdominal cavity, often multifocal. A multimodal approach is recommended for its treatment, with surgery, chemotherapy, and radiotherapy. Just over 20 cases of testicular/paratesticular DSRCT have been reported in the literature. Below, we present an illustrative case in this location, we discuss the case and review the literature.

Linfoma testicular primario tipo B de célula grande: aspectos clínicos, histopatológicos, diagnóstico terapéutico y pronósticos / Large cell type B primary testicular lymphoma: clinical, histopathological, therapeutic diagnosis and prognostic aspects

RESUMEN Fundamento: el linfoma testicular constituye entre el 1 y el 9 % de los tumores testiculares, es el tumor testicular maligno más frecuente en los varones mayores de 50 años. El pronóstico es reservado debido a una gran tendencia a la propagación sistémica temprana. La presentación clínica más habitual, dolor testicular a la palpación y espontáneo, con aumento del volumen y de la consistencia testicular. Su tratamiento se sustenta en tres pilares fundamentales: orquiectomía, quimioterapia y radioterapia. Objetivo: describir un enfermo con linfoma testicular tipo B de célula grande. Presentación del caso: paciente masculino de 55 años de edad, hipertenso, fumador 10 cigarrillos al día, bebedor ocasional. Acude a consulta por aumento de volumen testicular izquierdo. En la analítica se observa elevación del lactato deshidrogenasa. Ecografía: teste izquierdo con ecogenicidad muy heterogénea, parénquima desestructurado, sin lesiones nodulares. Engrosamiento difuso del epidídimo. Vascularización incrementada. Se realiza orquiectomía radical inguinal, al ser el diagnóstico anatomopatológico linfoma difuso de células grandes tipo B, en la actualidad ha sido tratado con quimioterapia, por presentar además afectación ósea. Pero ha evolucionado favorablemente. Conclusiones: el linfoma testicular es una enfermedad poco frecuente, a pesar de ser considerado el tumor testicular más común en mayores de 60 años. En su mayoría se trata de linfomas no Hodgkin difusos de grado intermedio alto de malignidad e inmunofenotipo B. El pronóstico siempre es reservado debido a su gran tendencia a la propagación sistémica. El tratamiento está basado en la cirugía (orquiectomía radical inguinal), quimioterapia y radioterapia.

ABSTRACT Background: testicular lymphoma constitutes between 1 and 9 % of testicular tumors; it is the most frequent malignant testicular tumor in men over 50 years of age. The prognosis is reserved due to a great tendency to early systemic spread. The most common clinical presentation is testicular pain on palpation and spontaneous, with increased volume and testicular consistency. Its treatment is based on three fundamental pillars: orchiectomy, chemotherapy and radiotherapy. Objective: to describe a patient with large cell type B testicular lymphoma. Case report: 55-year-old male patient, hypertensive, smoker 10 cigarettes a day, occasional drinker. He goes to consultation due to left testicular volume increase. In the laboratory tests, the lactate dehydrogenase is elevated. Ultrasound Scand: Left testicle with very heterogeneous echogenicity, unstructured parenchyma, no nodular lesions. Diffuse thickening of the epididymis. Increased vascularization. Inguinal radical orchiectomy is performed, the anatomic-pathological diagnosis being diffuse large B cell type lymphoma, it has now been treated with chemotherapy, because he alsopresented bone involvement. But he has evolved favorably. Conclusions: testicular lymphoma is a very rare entity, despite being considered the most common testicular tumor in people over 60 years of age. The majority are diffuse non-Hodgkin lymphomas of high intermediate degree of malignancy and immune-phenotype B. The prognosis is always reserved due to its great tendency to systemic spread. The treatment is based on surgery (radical inguinal orchiectomy), chemotherapy and radiotherapy.

Metástase de seminoma em região orbital em cão - relato de caso / Metastatic seminoma in the orbital region in a dog - case report

O seminoma é uma neoformação testicular originária de células germinativas de ocorrência comum em cães, com maior prevalência em animais senis. Em geral, o comportamento biológico do seminoma canino é benigno. Relata-se neste trabalho um caso de seminoma com metástase em região orbital em um cão com 14 anos de idade. O animal foi atendido com queixa de aumento de volume em órbita esquerda, com posterior detecção de nódulo testicular. A punção aspirativa por agulha fina da massa orbital sugeriu tratar-se de linfoma de alto grau, contudo o diagnóstico definitivo de seminoma difuso foi estabelecido pela avaliação histopatológica, a qual revelou tratar-se de neoplasia maligna pouco diferenciada, sendo o diagnóstico de seminoma difuso confirmado pelo exame imunoistoquímico. Relatos de seminomas metastáticos em cães são incomuns. Objetivou-se com este trabalho relatar um caso de seminoma anaplásico difuso em cão cujo foco principal de metástase ocorreu em região orbital, além de descrever e discutir as dificuldades diagnósticas encontradas.(AU)

Seminoma is a testicular neoformation originating from germ cells, commonly occurring in dogs. With higher prevalence in senile animals, the biological behavior of canine seminomas generally benign. This case reports seminoma with mestastasis in the orbital region in a 14-year-old dog. The animal was treated with a complaint of increased volume in the left orbit, and later a nodule in the testicle was discovered. Fine-needle aspiration of the orbit mass initially indicated a high-grade lymphoma. The definitive diagnosis of diffused seminoma was established by histopathological examination, resulting in poorly differentiated malignant neoplasia. Finally, the diagnosis was confirmed through immunohistochemistry, being the result compatible with diffused seminoma. Metastatic seminomas reported in dogs are quite uncommon. In this work we report a case of diffused anaplastic seminoma in dogs, where the main focus of metastasis was observed in the orbital region, and we also describe and discuss the difficulties encountered in the diagnostic.(AU)

Factores asociados a la histología de masa residual retroperitoneal post quimioterapia en tumor testicular de células germinales / Factors Associated with the Histology of Retroperitoneal Residual Mass Post Chemotherapy in Testicular Germ Cell Tumo

Objetivo El objetivo de este estudio es describir las características y factores relacionados con la histología de la masa residual postquimioterapia en pacientes con tumor de células germinales de origen testicular sometidos a linfadenectomía retroperitoneal durante 12 años de seguimiento. Métodos Retrospectivamente se recolectaron datos clínicos, quirúrgicos y patológicos de la historia clínica de los pacientes en un centro de referencia de manejo de cáncer durante un periodo de 12 años. Se estimó la asociación entre los datos recolectados con la histología del tumor residual post quimioterapia. Resultados Se incluyeron 64 pacientes, la edad promedio fue 28.1 años, el tamaño promedio de masa residual fue de 6.7 cm. La histología de la masa residual fue teratoma en 60.9%, necrosis 26.5% y tumor viable 12.5%. El grupo pronóstico tiene asociación con la histología de la masa retroperitoneal. Las masas con histología de necrosis tuvieron menor tamaño con media 6.5 cm mientras que otras histologías tuvieron tamaño promedio de la masa residual de 10.4 cm. Conclusiones La LNDRP-PC es el estándar de tratamiento en masas residuales retroperitoneales después de quimioterapia y puede generar sobre-tratamiento hasta en 50% de los casos. El teratoma en la histología testicular está relacionado mayor tamaño de la masa residual retroperitoneal. Las características histológicas de la masa residual son comparables con otras series.

Objective The aim of the study is to describe factors and characteristics related with the post-chemotherapy residual mass histology in patients who undergoing RPLND. Methods Clinical, surgical and pathological data were retrospectively recorded from medical records of patients with diagnosis of germ cell tumor and post-chemotherapy residual retroperitoneal tumor in a cancer referral center over a period of 12 years. The association between the data collected and the post-chemotherapy residual tumor histology was assessed. Results Sixty-four patients were included with average age of 28.1 years. The mean residual mass size was 6.7 cm. The histology of the mass was teratoma in 60.9%, necrosis 26.5% and viable tumor 12.5%. Prognostic group was associated with the mass histology. Mass with necrosis histology was smaller with mean size of 6.5 cm, while other histologies had an average mass size of 10.4 cm. Conclusion PC-RPLND is the standard of management of retroperitoneal residual mass after chemotherapy and could over treat in up to 50% of cases. Teratoma component in testicular histology is related to increase size of the residual mass. Histology findings of the retroperitoneal mass are comparable with other series.

Microlitiasis testicular como factor de riesgo de Cáncer testicular - Estudio de casos y controles / Testicular Microlithiasis: A Risk Factor for Testicular Cancer ­ A Case Control Study

Introducción Con una prevalencia entre el 1,5% y el 5,6%, la microlitiasis testicular es un hallazgo incidental. Aunque se ha propuesto una posible asociación entre la microlitiasis testicular y el cáncer testicular dicha relación no ha sido comprobada. Objetivos Establecer la relación entre microlitiasis testicular y cáncer testicular. Métodos Se realizó un estudio de casos y controles con la base de datos de un hospital de la ciudad de Bogotá de pacientes atendidos entre 2007 y 2017. Tanto casos como controles debían tener entre 5 y 35 años de edad, sin otros antecedentes que aumentaran el riesgo de cáncer testicular (criptorquidia, antecedente de cáncer testicular contralateral). Los casos debían tener reporte ecográfico y patológico del cáncer testicular así como una historia clínica completa de valoración por Urología. Los controles fueron pacientes que consultaron por otros cuadros de molestia testicular a quienes se les descartó ecográficamente la presencia de cáncer. Resultados Se identificaron 24 casos y 96 controles. Al momento de calcular los riesgos relativos indirectos, se obtuvieron un OR crudo de 7,86 (95% CI 2,3 - 26,86) y un OR ajustado por tabaquismo de 10,66 (95% IC 3,29 - 34,55). Al ajustar por edad, historia de cáncer familiar y antecedente de varicocele, no se encontraron diferencias. Conclusión Existe una aparente asociación entre microlitiasis testicular y cáncer testicular. A pesar de eso, estudios con tamaños de muestra más grande serían beneficiosos. Así mismo, al no poder determinar la existencia de una asociación temporal que permita hablar de causalidad entre las dos condiciones, esos resultados deben tomarse con cautela.

Introduction Testicular microliathiasis is an incidental finding with a prevalence that varies between 1,5% and 5,6%. Although a possible association between testicular microlithiasis and testicular cancer has been proposed, this relationship has not been proven. Objective To establish the association between testicular microlithiasis and testis cancer. Methods A case-control study was conducted with the database of a hospital in the city of Bogotà, Colombia, of patients treated between 2007 and 2017. Both cases and controls should be between 5 and 35 years of age, with no other history that would increase the risk of testicular cancer (cryptorchidism, antecedent of contralateral testicular cancer). The cases had to have an ecographic and pathological report of testicular cancer as well as a complete clinical history of assessment by Urology. Likewise, the control group were patients who attended during the same period, with other testicular problems, such as: hydrocele, varicocele or inguinal hernia and with ultrasound findings that ruled out testicular cancer. Results We identified 24 cases and 96 controls. We found a crude OR of 7.86 (95% CI 2.3­26.86) and an OR adjusted for smoking of 10.66 (95% CI 3.29­34, 55). When adjusting for age, family cancer history and varicocele history, no differences were found. Conclusion There is an apparent association between testicular microlithiasis and testicular cancer. Despite this, studies with larger sample sizes would be beneficial. Likewise, since it cannot determine the existence of a temporary association that allows to speak of causality between the two conditions, these results must be taken with caution.

Trends in cancer incidence in Uruguay: 2002 -2015 / Tendencias de la incidencia de cáncer en Uruguay: 2002-2015

Abstract Background: Uruguay is the south American country which has the highest cancer incidence and mortality rates. The National Cancer Registry collects data on cancer cases nationwide since 1989 and has reached high quality standards in the last decades. This is the first report on incidence trends. Methods: Data from the National Cancer Registry of all new cases of invasive cancer from twelve sites diagnosed in 2002-2015 was analyzed. Age-standardized rates were calculated. Trends of incidence rates were analyzed using joinpoint regression models. Results: For both, men and women, incidence rates trends for all cancer sites, colo-rectal and bladder cancer remained stable. Esophageal and gastric cancers descended while thyroid and kidney cancer incidence increased. In men lung cancer decreased; testicular cancer increased, and prostate cancer increased at the beginning of the period and decreased in the final years. In women, lung cancer increased, breast cancer remained stable and cervical cancer presented a significant decline from 2005 to 2010 and reached a plateau since then. Conclusion: Cancer incidence dynamics are complex and affected not only by Public Health policies such as tobacco control, vaccination and screening programs, but also by environmental and life style changes and the attitude of the medical community towards the application of diagnostic and therapeutic tools. The aim of this paper is to analyze cancer incidence time trends in the country and provide possible explanations to them.

Resumen Introducción: Uruguay es el país de Sudamerica que tiene las mayores tasas de incidencia y mortalidad por cáncer. El Registro Nacional de Cáncer recoge los datos de cáncer de todo el país desde 1989 y en las últimas décadas ha alcanzado los más altos estándares de calidad. Este es el primer reporte de tendencias de incidencia de cáncer de Uruguay. Métodos: Se analizaron los datos de todos los casos de cáncer invasivo diagnosticados entre 2002 y 2015 incluidos en el Registro Nacional de Cáncer y los de once topografías en particular. Se calcularon las tasas de incidencia estandarizada y se analizaron las tendencias utilizando los modelos de regresión de Joinpoint. Resultados: Las tasas de incidencia de cáncer colorrectal, vejiga y todos los sitios reunidos se mantuvieron estables tanto en hombres como en mujeres. La tasa de incidencia de cáncer de estómago y esófago disminuyeron mientras que las de tiroides y riñón aumentaron. En los hombres, el cáncer de pulmón disminuyó, el cáncer de testículo aumentó y el de próstata aumentó en un lapso inicial y decreció en los últimos años. En las mujeres el cáncer de pulmón aumentó y el de mama se mantuvo estable mientras que el cáncer de cérvix presentó un descenso significativo entre 2005 y 2010 alcanzando una meseta desde entonces. Conclusión: La dinámica de la incidencia de cáncer es compleja y está afectada no sólo por las políticas de Salud Pública como las campañas de control de tabaco, vacunación y programas de tamizaje sino por los cambios ambientales y de los estilos de vida y la actitud de los médicos respecto a la aplicación de técnicas diagnósticas y terapéuticas. En este trabajo se analizan las tendencias de incidencia en el país y se plantean posibles explicaciones para los cambios.

Seminoma clásico extragonadal en estadio III / Classical extragonadal seminoma in stage III

Resumen Histológicamente, los tumores testiculares de células germinales pueden clasificarse como tumores de tipo no seminoma y seminoma. De este último se reconocen tres variantes: "anaplásica", "espermatocítica" y "clásica", la cual puede ser gonadal o extragonadal. En este subtipo el tumor tiene origen en las células germinales, aunque no inicia en las gónadas sino en otras regiones anatómicas como el mediastino o el retroperitoneo. Presentamos el caso de un paciente de 19 años quien inicialmente presentó un cuadro clínico compatible con síndrome de vena cava superior y trombosis yugular. El diagnóstico de la neoplasia se obtuvo mediante biopsia por toracotomía.

Abstract Histologically, germ cell testicular tumors can be classified as nonseminoma and seminoma tumors. Of the latter, three variants are recognized: "ana plastic", "spermatocytic" and "classical", which may be gonadal or extrago nadal. In this subtype, the tumor originates in the germ cells, although it does not start in the gonads but in other anatomical regions such as the mediastinum or the retroperitoneum. We present a case of a 19-year-old patient who initially presented clinical sintomatology compatible with su perior vena cava syndrome and jugular thrombosis. The diagnosis of the neoplasm was obtained by thoracotomy biopsy.

Mieloma múltiple con metástasis cutáneas y testiculares recurrente después trasplante autólogo de médula ósea: relato de caso / Multiple myeloma with recurrent skin and testis metastases after an autologous bone marrow transplantation: report of a case

Se relata el caso de un paciente masculino de 56 años con mieloma múltiple (MM) y presencia de plasmocitomas en tejido celular subcutáneo y en testículo. El paciente tenía el antecedente de MM tratado con quimioterapia y trasplante autólogo de médula ósea y que después de 4 años de remisión de la enfermedad presentó recidiva ósea, la misma que fue tratada con quimioterapia e inmunoterapia. No hubo respuesta satisfactoria a los primeros ciclos del tratamiento con progresión de la enfermedad ósea y surgimiento de nódulos en dorso, puño y testículo sospechosos de recidiva de la enfermedad. Se procedió a resección de las lesiones en el dorso y puño que, en el examen anatomopatológico, fueron compatibles con neoplasia maligna y la prueba de inmunohistoquímica confirmó que se trataba de metástasis del MM. Se optó por la continuidad del tratamiento hasta completar los 12 ciclos propuestos, pero no hubo mejoría de las lesiones además de la aparición de nuevas lesiones en tejido celular subcutáneo y región perianal, con empeoramiento clínico. El paciente falleció después de dos meses de cuidados paliativos.

We present the case of a 56-year old male subject with multiple myeloma (MM) and with plasmacytomas in both the subcutaneous tissues and testis. He had a past history of MM who underwent chemotherapy and autologous bone marrow transplantation. After four years with disease remission, he presented with bone relapse, and he received chemotherapy and immunotherapy. There was no satisfactory response to the first cycles of therapy, and there was progression of bone disease, and nodes suspicious of disease recurrence arose in the back, fists, and testes. Both back and fist lesions were resected. The anatomopathological examination showed they were compatible with malignancy, and immunohistochemistry testing confirmed MM metastases. It was decided to continue therapy for the 12 cycles originally proposed, but there was no improvement in the aforementioned lesions. New lesions appeared in subcutaneous tissues and the perianal region, and the patient's clinical condition worsened. He died after two months receiving palliative care.

Biopsychosocial needs of survivors of testicular cancer and evidence of validation of a brief scale / Necessidades biopsicossociais de sobreviventes de câncer de testículo e evidência de validação de escala breve

The favorable prognosis of testicular cancer does not minimize immediate and late biopsychosocial implications. This study sought to determine these needs, and to evaluate the evidence of validation of a brief and specific scale for this population. A sample of 29 survivors of testicular cancer (n = 29) was assessed for distress (Distress Thermometer), anxiety and depression (Hospital Anxiety and Depression Scale), quality of life and cognitive impairment (Functional Assessment of Chronic Illness Therapy-General and Cognitive Function), and specific needs (Cancer Assessment for Young Adults-Testicular). It was observed a high prevalence of distress (41.4%), a low prevalence of anxiety (6.9%) and depression (6.9%), and a moderate impact on quality of life and cognition. Self-image and sexual function were the most preponderant problems. The evidence of validation of Cancer Assessment for Young Adults-Testicular12 was verified in the psychometric analysis. Notably, biopsychosocial needs identified on global scales, and particularly in Cancer Assessment for Young Adults-Testicular12, assisted in understanding these specificities and in therapeutic planning.

O prognóstico favorável do câncer de testículo não minimiza as implicações biopsicossociais imediatas e tardias. Este estudo objetiva determinar essas necessidades e avaliar a evidência de validação de escala breve e específica para essa população. Uma amostra de 29 pacientes sobreviventes de câncer de testículo foi avaliada quanto ao distress (Termômetro de Distress), ansiedade e depressão (Escala de Ansiedade e Depressão), qualidade de vida e prejuízo cognitivo (Functional Assessment of Chronic Illness Therapy-General e Cognitive Function) e demandas específicas (Cancer Assessment for Young Adults-Testicular12). Observou-se alta prevalência de distress (41,4%), baixa prevalência de ansiedade (6,9%) e depressão (6,9%) e moderado impacto na qualidade de vida e cognição. Autoimagem e função sexual foram os problemas mais preponderantes. A evidência de validação do Cancer Assessment for Young Adults-Testicular12 foi constatada na avaliação psicométrica. Notavelmente, as necessidades biopsicossociais identificadas nas escalas globais e, particularmente no Cancer Assessment for Young Adults-Testicular12, auxiliaram no entendimento dessas especificidades e no planejamento terapêutico.

Hematoma retroperitoneal como presentación de cáncer testicular / Retroperitoneal hematoma debut as testicular cancer

Resumen Introducción: El hematoma retroperitoneal (HR) es una enfermedad infrecuente con una elevada morbimortalidad, siendo complicado cuando se presenta con dolor y shock hipovolémico. Presentación del caso: Paciente del sexo masculino, de 20 años de edad, sin antecedentes mórbidos. Ingresa en Urgencias por dolor abdominal en el flanco izquierdo, irradiado a dorso y testículo ipsilateral, de 6 h de evolución, de inicio súbito e intensidad severa; el paciente está pálido, hemodinámicamente estable, sin signos de irritación peritoneal. Se solicita pielo-TC por sospecha de litiasis ureteral, que muestra un extenso HR, probable aneurisma aórtico roto. Una angio-TC informa HR adyacente y anterior a psoasilíaco izquierdo, de20 × 11 × 8,5 cm, volumen 972 cc, adenopatías retroperitoneales paraaórticas bilaterales sangrantes y múltiples nódulos pulmonares bilaterales indicativos de diseminación secundaria. Se constata testículo derecho duro, de tamaño normal, eco testicular con masa sólida quística, que indica de lesión orgánica. Discusión: Trauma y enfermedad tumoral son las principales causas de HR. El cáncer testicular suele presentarse en pacientes jóvenes, requiriendo una pronta derivación y estudio debido a su rápida progresión. En nuestro caso, el HR fue un hallazgo imagenológico, destacando que el sangrado de un conglomerado de adenopatías es anecdótico.

Abstract Introduction: Retroperitoneal hematoma (RH) is a rare disease with high morbidity, being complicated when presented with pain and hypovolemic shock. Case report: Male, 20 years old, no morbid history. Arrive to Emergency Service for abdominal pain in the left flank radiating to the back and ipsilateral testis, 6 h of evolution, sudden onset, high intensity; pacient pale, hemodynamically stable without signs of peritoneal irritation. Pielo-TC is requested on suspicion of ureteral stones showing extensive RH, likely ruptured aortic aneurysm. CT angiography reports RH and adjacent preceding left iliopsoas, 20 × 11 × 8.5 cm, volume 972 cc, retroperitoneal bleeding bilateral para-aortic lymphadenopathy and multiple bilateral pulmonary nodules suggestive of secondary spread. Hard right testicle with normal size, testicular ultrasound pointing solid cystic mass, suggestive of organic lesion. Discussion: Trauma and tumor pathology are the main causes of RH. Testicular cancer usually occurs in young patients, requiring early referal and study because of its rapid progression. In our case, the HR was an imaging finding, highlighting that the bleeding of a cluster of lymph nodes is anecdotal.

Infiltración testicular por leucemia linfoblástica aguda, presentándose como masa testicular: reporte de un caso / Testicular infiltration due to acute lymphoblastic leukemia presented as a testicular mass: a case report

La leucemia linfoblástica aguda es una neoplasia predominante en pediatría, corresponde al 11% de las leucemias. En Colombia hay una incidencia anual en adultos de 1 por cada 100.000 habitantes. La recaída testicular es rara alcanzando solo del 0.9 a 8.8% de todos los casos y representa un signo de recurrencia que puede ser confundida con otros padecimientos testiculares. Se reporta el caso de un paciente masculino de 23 años de edad, con cuadro de 2 meses de evolución consistente en dolor y aumento de tamaño testicular, posterior a trauma, con antecedente de leucemia linfoblástica aguda tratada hace 4 años. Se realiza ecografía testicular que sugiere hidrocele a tensión. Es llevado a cirugía, donde se aprecia testículo con características neoplásicas por lo cual se realiza orquiectomía. Resultado de anatomía patológica concluye masa 12 cm correspondiente a infiltración por leucemia aguda, CD10 y CD34 positivo y Tdt negativo. El testículo es considerado santuario de células leucémicas, sin embargo excepcionalmente puede observarse formación de una masa simulando un tumor testicular

Acute lymphoblastic leukemia is a common pediatric neoplasia, comprising 11% of all leukemias. In Colombia, the annual incidence in adults is 1 out of 100,000 people. Testicular relapse is rare (accounting for only 0.9-8.8% of all cases) and represents a sign of recurrence which can be confused with other testicular conditions. We report the case of a 23-year- old male with testicular pain and swelling for 2 months after a trauma, and a history of acute lymphoblastic leukemia treated 4 years before. A testicular ultrasound suggested tension hydrocele. The patient was taken to surgery where a testis with neoplastic features was observed. Therefore, an orchiectomy was performed. The pathological anatomy revealed a 12-cm mass consisting of infiltration by leukemic cells, showing a positive expression for CD19, CD10, and a negative expression for TdT. The testes are considered a sanctuary site for leukemic cells. However, the formation of a mass that mimic a testicular tumor may exceptionally be observed

Caso Clínico: Tumor Testicular Germinal Puro Subvariedad Tumor de Saco Vitelino (Yolk Sac). / Case Report: Pure Germ Cell Testicular Tumor, Yolk Sac Subvariety

INTRODUCCIÓN: Los tumores germinales puros, y dentro de estos la subvariedad tumor de Yolk Sac (saco vitelino), son cánceres infrecuentes en el adulto cuya histología compleja está determinada por la multipotencialidad de las células germinales que dan su origen. Yolk Sac se clasifica como un tumor germinal puro que se diagnostica con estudios de imagen y marcadores tumorales, específicamente la AFP. CASO CLÍNICO: Paciente masculino de 42 años de edad y sin antecedentes patológicos que 6 meses antes de su ingreso y tras sufrir un traumatismo testicular, presenta masa en testículo derecho acompañada de dolor que se exacerba con la deambulación. Al examen físico destacó una masa testicular derecha indurada asociada dolor de moderada intensidad a la palpación. La ecografía testicular evidenció la presencia de neoplasia de testículo derecho, los marcadores tumorales estuvieron elevados, por lo que se realizó Orquidofuniculectomía radical derecha sin complicaciones. EVOLUCIÓN: Acude 6 meses luego de la intervención, se evidenció elevación de marcadores tumorales y TC que mostró metástasis retroperitoneal (cáncer testicular metastásico), por lo que recibió tratamiento a base de quimioterapia BEP completando cuatro ciclos; los exámenes de control indicaron remisión de la enfermedad. CONCLUSIÓN: Los tumores testiculares deben ser abordados cuidadosamente por la amplia gama de presentaciones histológicas debido a su origen, además se establece la importancia del diagnóstico y tratamiento oportunos tanto de la lesión primaria como de la enfermedad metastásica para mejores resultados.(au)

BACKGROUND: Pure Germ Cell Tumors, and among them Yolk Sac tumor, are infrequent testicular cancer in adults whose complex and rare histology is determined by the multi-potentiality of germ cells that originate them. Yolk Sac is classified as a pure germ cell tumor that must be diagnosed with imaging studies and tumor markers, especially AFP. CASE REPORT: A 42-years old male patient with no pathological precedents who refers that 6 months before admission and after suffering a testicular trauma noticed a mass located in the right testicle which is accompanied by wandering pain. Physical examination revealed an indurated mass in the right testicle and palpation-associated pain. Ultrasound showed a testicular neoplasm and tumor markers were increased so a right orchiectomy was performed. EVOLUTION: The patient attended 6 months after procedure. Increase of tumor markers was evidenced and the CT scan showed a retroperitoneal metastasis (metastatic testicular cancer). The patient was treated with a 4-cycle based BEP chemotherapy because of those findings; follow up examinations indicated remission of disease. CONCLUSION: Testicular tumors must be faced carefully because of its wide range of histological presentations due to its origin. In addition, the importance of an opportune diagnosis and treatment of the primary lesion and metastatic disease has been established to obtain better results(au)

Recurrence of acute myeloid leukemia in cryptorchid testis: case report / Recidiva de leucemia mieloide aguda em testículo criptorquídico: relato de caso

A 23-year-old male with a history of bone marrow transplant for acute myeloid leukemia. He presented a large mass in the right inguinal region 5 years ago. Upon physical examination, right-sided cryptorchidism was observed. The tumor markers alpha-fetoprotein and beta-HCG were within normalcy range and lactate dehydrogenase was raised. Computed tomography of the abdomen and pelvis revealed right testicular mass in contiguity with the inguinal canal to the ipsilateral retroperitoneum, associated with right hydronephrosis. Due to the risk of germ-cell tumor in undescended testicle, the patient underwent radical right orchiectomy. The pathological examination showed recurrence of acute myeloid leukemia in the testis. He was referred to oncology for adjuvant therapy. Our literature review found no similar cases described.

Paciente de 23 anos, masculino, com antecedente de transplante de medula óssea por leucemia mieloide aguda. Há 5 anos, apresentou volumosa massa em região inguinal direita. No exame físico, foi constatada criptorquidia à direita. Os marcadores tumorais alfa-fetoproteína e beta-HCG encontravam-se dentro da normalidade, e a desidrogenase láctica estava aumentada. A tomografia computadorizada de abdomen e pelve revelou massa testicular direita com contiguidade pelo canal inguinal, até o retroperitônio ipsilateral, associada a hidronefrose direita. Devido ao alto risco de neoplasia germinativa em testículo criptorquídico, o paciente foi submetido à orquiectomia radical direita, cujo anatomopatológico revelou recidiva de leucemia mieloide aguda em testículo. Foi encaminhado para oncologia para terapia adjuvante. Nossa revisão não revelou nenhum caso semelhante na literatura.

Splenogonadal fusion and testicular cancer: case report and review of the literature / Fusão esplenogonadal e câncer testicular: relato de caso e revisão da literatura

A 36 year-old man after tests for assessing male infertility was diagnosed with primary infertility, bilateral cryptorchidism, nonobstructive azoospermia and discontinuous splenogonadal fusion. Carcinoma in situ was found in his left testicle, which was intraabdominal and associated with splenogonadal fusion. To our knowledge, this is the fourth case of splenogonadal fusion associated with testicular cancer reported. One should always bear in mind the possibility of this association for the left cryptorchid testicle.

Um homem de 36 anos, depois de ser submetido a exames para avaliação de infertilidade masculina, foi diagnosticado com infertilidade masculina primária, criptorquidia bilateral, azoospermia não obstrutiva e fusão esplenogonadal descontínua. Carcinoma in situ estava presente no testículo esquerdo, que tinha localização intra-abdominal e estava associado à fusão esplenogonadal. Esse é o quarto caso de fusão esplenogonadal associada a câncer testicular, segundo nossa avaliação. Deve-se sempre ter em mente a possibilidade dessa associação em testículos criptorquídicos à esquerda.

Tumores de testículo em crianças e adolescentes / Testicular tumors in children and adolescents

OBJETIVO: Avaliar comparativamente aspectos clínicos e epidemiológicos dos tumores de testículo na infância e adolescência. MÉTODOS: Análise retrospectiva dos prontuários de pacientes com neoplasias de testículo ou paratesticulares. Foram classificados como crianças os menores de 10 anos e como adolescentes os pacientes entre 10 e 20 anos. Os resultados obtidos foram comparados por meio do teste para duas proporções: teste não paramétrico de Mann-Whitney e teste de log-rank. RESULTADOS: No período de janeiro de 1992 a julho de 2009, foram admitidos 60 pacientes: 34 crianças e 26 adolescentes com neoplasias de testículo ou paratesticulares. As principais manifestações foram tumor e dor na bolsa escrotal. A queixa de dor foi mais comum em adolescentes (p = 0,006). Estes apresentaram tempo médio de história de 4,9 meses, mais prolongado do que crianças, com 2,3 meses (p = 0,01). Os tipos histológicos encontrados foram: tumores de células germinativas em 32/60 (53 por cento), rabdomiossarcomas (RMSs) em 23/60 (38,3 por cento) e outros em 5/60 (8,3 por cento). Os adolescentes apresentaram maior frequência de RMSs, metástases em linfonodos (p = 0,003) e a distância (p = 0,035). As diferenças na sobrevida dos pacientes estudados não foram estatisticamente significantes, havendo apenas indicativo de que a sobrevida, nos casos de RMS, é maior nas crianças (p = 0,072). CONCLUSÕES: Os adolescentes com tumor testicular apresentaram maior tempo de história, tipo histológico agressivo e doença avançada ao diagnóstico quando comparados às crianças, a despeito da pequena amostra.

OBJECTIVE: To perform a comparative assessment of the clinical and epidemiological aspects of testicular tumors in childhood and adolescence. METHODS: Retrospective analysis of medical records of patients with testicular or paratesticular neoplasms. Patients under 10 years were classified as children and patients between 10 and 20 were classified as adolescents. The obtained results were compared through the two-sample test for proportions: non-parametric Mann-Whitney test and log-rank test. RESULTS: 60 patients were admitted in the period from January 1992 to July 2009: 34 children and 26 adolescents with testicular or paratesticular neoplasms. The main manifestations were testicular tumor and scrotal pain. Pain complaints were more common in adolescents (p = 0.006), who presented a mean time from disease onset to diagnosis of 4.9 months, longer than children, who presented a period of 2.3 months from disease onset to diagnosis (p = 0.01). Histological types were as follows: germ cell tumors in 32/60 (53 percent), rhabdomyosarcomas (RMSs) in 23/60 (38.3 percent), and other in 5/60 (8.3 percent). Adolescents presented a higher incidence of RMSs, lymph node metastases (p = 0.003) and distant metastases (p = 0.035). Differences in survival rates among the studied patients were not statistically significant, the only indicative being that survival in RMS cases is longer for children (p = 0.072). CONCLUSIONS: Compared to children, adolescents with testicular tumor presented longer time from disease onset to diagnosis, aggressive histological type and advanced illness at diagnosis, despite the small sample analyzed.