Merkel cell carcinoma metastatic to the testis: report of a rare diagnosis and review of the literature

Merkel cell carcinoma is an aggressive malignancy that frequently recurs/disseminates, but metastases to the genitourinary tract are rare. Only eight cases of Merkel cell carcinoma metastatic to the testis are reported. We describe the ninth case of this event and provide a review of the literature. A 58-year-old man diagnosed with Merkel cell carcinoma of the wrist, presented, 37 months later, a recurrence in the form of a testicular metastasis. The tumor consisted of a monotonous proliferation of small, blue, round cells, with immunoexpression of neuroendocrine markers and the typical dot-like paranuclear immunostaining for cytokeratin 20, in the absence of immunostaining for cytokeratin 7. The patient is alive with no evidence of disease. Clinicians should be aware of the possibility of metastatic dissemination to the testis since genital examination/imaging is not part of routine follow-up for these patients, but timely orchiectomy may be curative.

Importancia del conocimiento de de la Microlitiasis testicular por el médico general / Important of knowing about testicular microlithiasis for the family physician

Introducción: Conocemos como microlitiasis testicular a la afección en la cual se da la formación de calcificaciones en el interior del testículo. Su etiología es desconocida, y presenta mayor prevalencia en la edad adulta que en la pediátrica. Esta patología muestra su diagnóstico por medio de estudios imagenológicos. Caso clínico: Paciente de 17 años, el cual acude por dolor pélvico de un mes de evolución, y al cual se le diagnostica esta entidad tras los estudios complementarios. En el siguiente estudio se realiza una revisión bibliográfica de los aspectos relevantes de la patología y tratamiento, así como, la relación que existe entra la microlitiasis testicular y la neoplasia de testículo, infertilidad y patologías de base genética, tópicos de sumo interés para el médico general de atención en nivel primario de salud, considerando el manejo de control y prevención que debe aplicarse día a día en la consulta médica. Conclusiones: El conocimiento de las complicaciones que podrían presentarse en el paciente portador de microlitiasis testicular, obligan al médico a mostrar una actitud prudente ante esta patología, considerando el aspecto preventivo de la atención primaria de salud(AU)

Introducción: Conocemos como microlitiasis testicular a la afección en la cual se da la formación de calcificaciones en el interior del testículo. Su etiología es desconocida, y presenta mayor prevalencia en la edad adulta que en la pediátrica. Esta patología muestra su diagnóstico por medio de estudios imagenológicos.m Caso clínico: Paciente de 17 años, el cual acude por dolor pélvico de un mes de evolución, y al cual se le diagnostica esta entidad tras los estudios complementarios. En el siguiente estudio se realiza una revisión bibliográfica de los aspectos relevantes de la patología y tratamiento, así como, la relación que existe entra la microlitiasis testicular y la neoplasia de testículo, infertilidad y patologías de base genética, tópicos de sumo interés para el médico general de atención en nivel primario de salud, considerando el manejo de control y prevención que debe aplicarse día a día en la consulta médica. Conclusiones: El conocimiento de las complicaciones que podrían presentarse en el paciente portador de microlitiasis testicular, obligan al médico a mostrar una actitud prudente ante esta patología, considerando el aspecto preventivo de la atención primaria de salud(AU)

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.

Seminoma: reporte de un caso / Seminoma: case report

De las patologías testiculares, las neoplasias son las más comunes en estos órganos. Se presenta el caso de paciente de 32 años de edad, con diagnóstico de seminoma con único antecedente de trauma testicular hace 12 años. Los hallazgos quirúrgicos fueron cordones espermáticos engrosados y masa testicular derecha de 10 x 10 cm. Acompañándose de un proceso linfoproliferativo que involucra región retroperitoneal y que engloba la aorta abdominal y desplaza la vena cava inferior hacia la derecha. La lesión mide 125.9 x 56.8 x 118.1 mm ubicada en región supra e infrapúbica. El diagnóstico anatomopatológico del tumor testicular es de un Seminoma clásico. Discusion: El seminoma es una neoplasia testicular rara (Estados Unidos reporta aproximadamente 0.4 casos por millón de habitantes) de crecimiento lento, que se puede acompañar o no de dolor es común en el adulto mayor, y muy raro en pacientes jóvenes. En este caso, la neoplasia se presentó a los 23 años y fue de crecimiento lento y dolorosa en el testículo derecho...(AU)

Testis tumor associated to microlithiasis / Tumor de testiculo asociado a la microlitiasis / Tumor de testiculo associado a microlitiase

OBJECTIVE: To discuss the relationship between testicular microlithiasis and testis tumors in children and to consider the chances of testis preserving surgery in specific cases. CASE DESCRIPTION: Pre-adolescent presenting testicular microlithiasis and a larger left testis, corresponding to a cystic testicular tumor. The tumor was excised, with ipsilateral testis preservation. Histology diagnosed a testis dermoid tumor. COMMENTS: The relationship between testis tumors and testicular microlithiasis is ill defined in children. Pediatric urologists need to develop specific follow-up protocols for pre-pubertal children. .

OBJETIVO: Discutir las implicaciones de la microlitíasis testicular en el niño con relación al riesgo oncológico implicado y la posibilidad de cirugía de preservación testicular en casos elegidos. DESCRIPCIÓN DEL CASO: Pre-adolescente presentando aumento microlitíasis testicular y aumento del testículo izquierdo, con lesión tumoral quística. La lesión fue resecada, con preservación del testículo y diagnóstico histológico de tumor dermatoide testicular. COMENTARIOS: La relación entre tumores de testículo y microlitíasis testicular es mal definida en niños y hay la necesidad de desarrollar protocolos de seguimiento específicos para esa franja de edad. .

OBJETIVO: Discutir as implicações da microlitíase testicular na criança com relação ao risco oncológico envolvido e a possibilidade de cirurgia de preservação testicular em casos escolhidos. DESCRIÇÃO DO CASO: Pré-adolescente apresentava microlitíase testicular e aumento do testículo esquerdo, correspondendo a tumor testicular cístico. Ressecou-se o tumor, com preservação do testículo. O diagnóstico histológico foi de tumor dermoide testicular. COMENTÁRIOS: A relação entre tumores de testículo e microlitíase testicular é mal definida em crianças e há a necessidade de desenvolver protocolos de seguimento específicos para essa faixa etária. .

Lower gastrointestinal bleeding as a result of fistula between the iliac artery and sigmoid colon in patient with advanced testicular cancer

Fistula between arteries and the gastrointestinal tract are a rare cause of gastrointestinal bleeding, but potentially fatal. The recognition and early treatment can modify the patient prognosis. We report a case of a patient with previous surgery for seminoma of cryptorchidic testicle, with massive lower gastrointestinal bleeding. We performed the diagnosis and surgical treatment of the fistula between left external iliac artery and sigmoid colon. The patient was successfully treated by external iliac artery ligation and left colectomy.

Cáncer de testículo seminoma estadio II controversias en la estadificación / Testicle cancer seminoma stage II controversies in his stratification

Nuestro objetivo es cuestionar la definiciónde los estadios II A - II B - II C en pacientes con diagnóstico de cáncer de testículo (seminoma clásico). La evaluación de los ganglios linfáticos retroperitoneales se realiza con una TAC de abdomen y pelvis, siendo este un aspecto importante de la estadificación clínica y la planificación del tratamiento de cáncer de testículo. El seminoma en estadio II se divide en enfermedad voluminosa (ganglios lumbo-aórticos mayor de 5 cm: II C) y no voluminosa (ganglios lumbo-aórticos menor de 5 cm: II AIIB). Estas definiciones de cm son variables, para algunos autores consideran el eje más largo, y para otros, es el eje que corresponde al diámetro transversal de los ganglios comprometidos. El tratamiento estándar va a depender del tamaño de las adenopatías. Se efectúa una revisión de la estadificación del cáncer de testículo. El N no debería definirse en función del largo del eje mayor de los ganglios retroperitoneales, debería efectuarse por el volumen de los mismos. El volumen de las adenopatías puede definirse en forma precisa utilizando una TAC, las imágenes obtenidas se introducen en un sistema de planificación 3 D, se definen los ganglios retroperitoneales (contornean o dibujan) y luego se puede establecer conexactitud del volumen de las misma

The aim of this paper is to question the definition for phases II A- II B- II C, en patients with testicular cancer (classic seminoma) diagnosis. The evaluation of retroperitoneal lymphatic glands is performed with an abdomen and pelvis CAT, which represents an important study in the stage clinical staging and in the planning for the treatment of the testicular cancer. The phase II seminoma is divided into bulky disease (lumbo-aortic glands bigger than 5 cm: II C) and non bulky disease (lumbo-aortic glands smaller than 5 cm: II A-II B). These sizes are variable as some authors take into account the longest axis while for others the axis to take into account is that corresponding to the transversal diameter of the affected glands. The standard treatment will depend on the lymphatic node size. A revision of the testicular cancer phases is carried out. Is the following N, should not be defined according to the retroperitoneal glands and the biggest axis length, but according to their volume. The lymphatic nodes volume can be precisely and defined through the use of CAT, where they obtained images are loaded into a 3D planning system, the retroperitoneal glands are defined (outlined or drawn) and afterwards the volume can be exactly defined for us

Testicular capillary hemangioma - A case report of a rare tumor.

Testicular hemangioma is a very rare benign vascular neoplasm, mostly occurring in children and young adults. We present a case of capillary hemangioma of the testis in a twenty three years old male who presented with painless mass in the right scrotum of 2 months duration. He was diagnosed with a right testicular tumor based on the physical examination, ultrasonography and magnetic resonance imaging studies. Serum tumor markers were normal. Right radical orchiectomy was performed. On histology, the tumor was diagnosed as capillary hemangioma of the testis. Immunohistochemical staining for CD31 and factor VIII confirmed the vascular nature of the tumor. To our knowledge, there are only twenty two cases of testicular hemangiomas reported in the literature. Although it is a rare tumor, surgeons and pathologists should be aware of it especially with the negative tumor marker findings. Intra-operative frozen section examination may be requested as tumor enucleation with testicular sparing surgery is considered adequate.

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.

Dermatomiositis asociada a cáncer testicular mixto en paciente joven: reporte de un caso y revisión de la literatura / dermatomyositis associated with testicular cancer in young patient: a case report and literature review

La dermatomiositis se caracteriza por su compromiso cutáneo y muscular, siendo rara su asociación a cánceres seminomatosos y no seminomatosos en un mismo paciente. Se presenta el caso de un paciente de sexo masculino, de 31años, con tres meses de mialgias y eritema heliotropo en cara acompañado de erupción máculo-papular en áreas fotoexpuestas y yuxta-articulares, asociado a un aumento de volumen testicular izquierdo. La CK, beta-HCG, GOT, GPT, LDH, y alfa-feto proteína estaban elevadas. La biopsia muscular informó miositis intersticial y el estudio histopatológico testicular evidenció un cáncer testicular mixto con seminoma, teratocarcinoma y carcinoma embrionario. No presentó metástasis. Se trató con prednisona y orquiectomía, constatándose disminución progresiva del compromiso cutáneo en los meses siguientes a la cirugía. Los reportes publicados enfatizan medir alfa-feto proteína y beta-HCG, y examinar los testículos en pacientes jóvenes con dermatomiositis. Todos los casos publicados presentaron una evolución rápida. La sobrevida está relacionada con el volumen tumoral y la elevación de marcadores. La resolución del cuadro dermatológico dependerá de la sospecha precoz y el oportuno tratamiento de la patología de base.

Dermatomyositis is characterized for skin and muscular involvement, being rare its association with seminomatous and non seminomatous germ cell cancers, both in the same patient. The clinical case is a male patient 31 years old, with a story of three months of mialgies and heliotrope rash in face, and maculopapular lesions in photoexposed and juxta-articular areas, associated with left testicle increased in size. CK, beta-HCG, GOT, GPT, LDH, and alpha-fetoprotein were elevated. Muscular biopsy informed interstitial myositis; the histopathological study of a testicle tissue biopsy showed mixed testicular cancer with seminoma, teratocarcinoma, and embryonal carcinoma. No metastasis were found. He was treated with prednisone and orchiectomy, watching a progressive decrease of the cutaneous involvement over the next months after surgery. Literature reports remark to measure alpha-fetoprotein and beta-HCG, and to exam both testicles in young patients with dermatomyositis. All published cases had a rapid evolution. Survival is related with tumor size and elevation of serum markers. Resolution of the dermatologic features will depend on clinical suspicious and opportune treatment of the cancer.

The unusual and potentially fatal growing teratoma syndrome

Objective: Growing teratoma syndrome consists of germ cell tumors that grow following chemotherapy despite complete eradication of the malignant cells and normalization of the tumor markers. They can metastasize to any site, particularly the retroperitoneum, mediastinum and cervical region. Here we report our experience with this rare syndrome and stress the need for early recognition and treatment to avoid the subsequent morbidity and mortality associated with it. Patients and Methods: We reviewed the hospital records of patients suffering from testicular tumors with retroperitoneal metastasis treated at our hospital between January 2002 and December 2006. We included those who underwent radical orchiectomy, followed by chemotherapy and retroperitoneal lymphadenectomy for persistence of post-treatment large tumor, but whose tumor markers had normalized. Results: In this period, fourteen patients underwent retroperitoneal lymphadenectomy for persistence of tumor masses and normalization of tumor markers. Of these, the result of the anatomo-pathological examination was teratoma in six cases. Two of these patients evolved poorly and died from the disease; one because we were unable to fully remove the lesion, with subsequent renal insufficiency from bilateral ureteral obstruction and colonic obstruction with sepsis and the other due to cachexia because of the impossibility of removing the cervical and thoracic masses. Conclusions: Patients suffering from growing teratoma syndrome need to be recognized and treated surgically as soon as possible to avoid the negative consequences of morbidity and death, as occurred in two of our patients.

Polyarthritis associated with testicular tumour.

Rarely rheumatological features may dominate and is the cause of missed or delayed diagnosis of a malignant lesion. A case is presented wherein the patient with embryonal type of testicular tumour masqueraded with symmetrical polyarthritis with small joint involvement. p53 antigen was detected in testicular tissue. Such an example is indeed unreported in literature to the best of our knowledge.

Primary testicular non-Hodgkin's lymphoma: a review article

Primary testicular non-Hodgkin's lymphoma was first described as a clinical entity in 1866. It is a rare disease and accounts for 1 percent of all non-Hodgkin's lymphoma, 2 percent of all extranodal lymphomas and 5 percent of all testicular neoplasms. It is the most common testicular tumor in males between sixty and eighty years of age. Testicular non-Hodgkin's lymphoma is unique in its high incidence of bilateral involvement (8-38 percent), and it is also the most common bilateral testicular tumor. Testicular non-Hodgkin's lymphoma has a predilection for spreading to non-contiguous extranodal sites, especially the central nervous system. Advanced-stage disease is usually managed with doxorubicin-based chemotherapy. For early-stage disease, opinion is divided regarding systemic chemotherapy following orchidectomy. The high incidence of spreading, especially to the central nervous system, leads to advocacy of the use of central nervous system prophylaxis with intrathecal chemotherapy. Prospective multicenter trials incorporating a large number of patients may lead to better guidelines for optimal management of this subtype of non-Hodgkin's lymphoma.

O linfoma primário do testículo (LPT) foi descrito como uma entidade clínica pela primeira vez em 1866. É uma doença rara e corresponde a 1 por cento de todos os linfomas não-Hodgkin, 2 por cento de todos os linfomas extranodais e 5 por cento de todos as neoplasias testiculares. É o tumor testicular mais comum em homens entre 60 e 80 anos de idade. LPT é único em sua elevada incidência de envolvimento bilateral (8-38 por cento), sendo o tumor testicular bilateral mais comum. Tem uma predileção por disseminação para regiões extranodais não-contíguas, especialmente para o sistema nervoso central (SNC). Estágios avançados da doença são usualmente tratados com quimioterapia à base de doxorubicina. Para os estágios mais precoces, as opiniões são divergentes quanto à quimioterapia associada à orquiectomia. A alta prevalência de disseminação, especialmente para o SNC, sugere o uso de quimioterapia intratecal como profilaxia. Estudos prospectivos multicêntricos incluindo um grande número de pacientes poderiam resolver a questão com relação ao manejo deste subtipo de linfoma não-Hodgkin.

Association between testicular microlithiasis, testicular cancer, cryptorchidism and history of ascending testis

OBJECTIVE: To prospectively determine the prevalence of testicular microlithiasis in symptomatic patients who were referred for scrotal ultrasound examination and to evaluate the possible association of testicular microlithiasis with testicular cancer and other conditions such as cryptorchidism or history of ascending testis. MATERIALS AND METHODS: 391 men who were referred to our institutions between July 2002 and May 2005 for any type of symptoms from the testicles, underwent physical and scrotal ultrasound examination. The presence of testicular microlithiasis, the number of lesions and the involvement of both testicles in relation to the symptoms as well as the coexistence of other lesions were studied. RESULTS: Eighteen (4.6 percent) of 391 men enrolled into the study had testicular microlithiasis. Two out of the eighteen patients (11 percent) had concomitant testicular cancer, which was confirmed by pathological evaluation of the orchidectomy specimen. One of the patients with testicular microlithiasis presented a rising in biochemical tumor markers (LDH, and HCG) and underwent orchidectomy one year later. Five of the remaining 373 (1.3 percent) patients without microlithiasis were diagnosed with testicular cancer. Thirty six men reported having a history of ascending testis, but none of them was found with testicular cancer. Two cases of testicular torsion in a cryptorchid position had testicular microlithiasis, but the orchidectomy specimen (after surgery) was negative for testicular cancer. The correlation between testicular cancer and testicular microlithiasis found in our study was statistically significant (p < 0.05). CONCLUSION: There seems to be an association between testicular microlithiasis and testicular cancer.

Reacción sarcoidal mediastinal en el seguimiento de un paciente con seminoma / Mediastinal sarcoidal reaction in follow up for seminoma

El cáncer de células germinales de testículo es el modelo de neoplasia curable. Las complicaciones a largo plazo son bien conocidas y el seguimiento incluye la pesquisa no sólo de la recaída, sino también de la aparición de segundos tumores y secuelas del tratamiento empleado. Un aumento de la incidencia de lesiones con granulomas tipo sarcoidosis se ha descripto en las últimas dos décadas en pacientes curados quienes en el seguimiento se presentan con nódulos pulmonares o adenopatías mediastinales.Se presenta el caso clínico de un paciente de 28 años quien durante el seguimiento clínico por un tumor seminomatoso, muestra en la tomografía axial computada y radiografía de tórax la presencia de adenopatías en mediastino, sin evidencia de enfermedad en abdomen y pelvis, el otro testículo normal y marcadores negativos.Ante esta peculiar situación, se realiza mediastinoscopia diagnosticándose reacción sarcoidal en ganglio mediastinal. Durante el seguimiento de pacientes con tumores germinales de testículo la presencia de adenopatías mediastinales exige contar con el diagnóstico histológico y tener en cuenta a la sarcoidosis en el diagnóstico diferencial

Testicular germ cell tumors constitute a model for curable neoplasia. Long-term complications are well-known and follow-up includes not only awareness of relapse, but also of the development of secondary tumors and treatment sequelae. In the last two decades, an increase in sarcoidosis incidence has been described in cured patients, who at follow-up present lung nodules or mediastinal lymph nodes. A 28 year-old patient who, on clinical follow up of a seminomatous tumor, presented mediastinal lymph nodes on CT scan and chest x-ray, without evidence of disease in pelvis or abdomen is presented. His other testicle was normal and he had negative tumor markers. Because of this rare presentation, a mediastinoscopy was performed and sarcoidosis like reaction was diagnosed. During follow-up of patients with testicular germ cell tumors, the presence of mediastinal lymph nodes requires a histological diagnosis and sarcoidosis should be considered as differential diagnosis

Cancer testicular: estudio de extension con TC de cuerpo entero

Today testicular cancer has good treatment and long-term survival. Thorax, abdomen and pelvis computerized tomography especially helical technique is the most important tool to evaluate dissemination. We analyzed retrospectively 85 patients studied in the Hospital Regional de Concepción between 2002-2005 with testicular tumors whom had complete laboratory and TC helical evaluation and correlated local invasion detected in surgery with CT staging for estimate prognostic survival in agree with European consensus on diagnosis and treatment of germ cell cancer. The mean age at the time of diagnosis was 31 years (Range 19-57). Forty three were seminoma and 42 non seminomatous tumors. Staging demonstrated 43 stage I, 20 stage II and 22 stage III. Our prognostic groups were different to other series with 71 percent of patient's good prognostic, 24 percent intermediate and only 5 percent bad prognostic (non seminomatous tumors). We think that the new technology helical can obviate chest x-ray in the initial evaluation of these patients.

Introducción. La evaluación con tomografía computada (TC) de tórax, abdomen y pelvis de pacientes con cáncer testicular es importante para determinar la extensión de su enfermedad y los controles post-tratamiento. Quienes presentan metástasis son candidatos a quimioterapia lo que permite una supervivencia mayor al 80 por ciento en el largo plazo. Objetivos: Estimar la frecuencia de invasión regional y a distancia usando TC de cuerpo entero en los diferentes tipos histológicos de cáncer testicular y correlacionar con las pautas de pronóstico del Consenso Europeo para el diagnóstico y tratamiento de este tipo de cáncer. Material y método: Nuestro estudio incluyó 85 pacientes con cáncer testicular diagnosticados por clínica y estudio ecotomográfico en el Hospital Regional de Concepción entre los años 2002 a 2005. A todos ellos se les realizó TC tórax-abdomen-pelvis para estadificación. Los estudios fueron realizados con escáner helicoidal usando en forma rutinaria contraste oral y endovenoso no iónico en dosis estándar de 150 ml. Las imágenes axiales y reconstruidas fueron analizadas por radiólogos del servicio de imagenología. Se consigno la presencia, y ubicación de linfonódulos metastásicos y metástasis. El estudio histológico del tumor testicular se relacionó con su estadificación según la TC de cuerpo entero, siendo luego agrupados en grupos pronósticos para estimar probabilidad de sobrevida. Resultados: En nuestra casuística, los tumores testiculares afectan a varones con un promedio de edad de 31 años y en un rango de 19 a 57 años. Según TNM (AJCC staging system 1997): en etapa I estaban 43 pacientes (50,6 por ciento), en etapa II 20 (23,5 por ciento) y en etapa III 22 (25,9 por ciento). En 43 pacientes el tipo histológico fue seminoma clásico puro y en 42 no-seminoma. De los 42 pacientes con tumores no seminomas: cinco presentaron carcinoma em-brionario puro y 20 mixto, coriocarcinoma mixto se observo en seis, teratoma maduro en siete y en un paciente teratoma inmaduro. Sólo tres casos presentaron teratocarcinomas. Conclusión: La proporción de seminomas y no seminomas se correlaciona con la literatura nacional e internacional, excepto con un estudio del grupo español. Nuestros grupos pronósticos difieren con los del Consenso Europeo para el diagnóstico y tratamiento del tumor testicular. Pensamos que la Rx de tórax se podría obviar en la evaluación inicial y usar solamente TC de tórax, abdomen y pelvis en los centros que cuenten con tecnología helicoidal, ya que de esta forma evitamos una reevaluación en los casos de radiografía sospechosa o con signos de diseminación secundaria, usando una sola inyección de contraste, apnea y tiempo de examen.

Bilateral leydig cell tumor and male infertility

Leydig cell tumor is a rare form of testicular neoplasm which comprises 1-3% of all testicular tumors and only about 3% of these tumors are bilateral. A few Leydig all tumor have been described in patients with klinefelter's syndrome so far.: The patient described in this case report was a 24 year-old man with chief complaint of infertility for one year. Physical examination, semen analysis, testes sonography and hormonal assay were done for him. Right side simple orchiectomy was performed for patient. This tumor is always benign in children and approximately 90% are benign in adults. Clinical presentation is testicular enlargement, gynecomastia, sexual activity disturbances such as decreased libido, infertility and azoospermia. We recommend complete exam and karyotype in patients with infertility and azoospermia

Testicular tumour with features of sex cord tumor with annular tubules associated with cryptorchidism and infertility--a case report.

Sex cord tumor with annular tubules (SCTAT) is a rare tumor seen in the ovary usually associated with Peutz-Jeghers syndrome. Testicular SCTAT are more infrequent and only four such cases have been reported in the literature. A 28-year-male presented with infertiliy. He had a history of orchiopexy 10 years back for right-sided inguinal testes. A right testicular biopsy done to investigate the cause of infertility revealed testicular atrophy with a focus suspicious of SCTAT. The right-sided orchiectomy revealed two firm nodules of 0.5 and 0.2 cms of SCTAT and sertoli cell nodule (SCN) respectively on microscopy. He did not have any features of Peutz-Jeghers or any other dysgenetic syndrome. He is asymptomatic after follow up of 26 months. This is the fifth case of testicular SCTAT and the first with SCN.