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

Spermatocytic seminoma associated with undifferentiated sarcoma: A rare case report.

The presence of sarcomatous element transforms the usually innocuous spermatocytic seminoma into a highly aggressive neoplasm. We report a case of spermatocytic seminoma with undifferentiated sarcomatous component in a 43-year-old male, presented with testicular mass since two and a half years. Orchidectomy was performed and after 9 months, the patient presented with recurrent scrotal mass with bilateral pulmonary metastases.

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

Detection of testicular cancer in men presenting with infertility

PURPOSE: Infertility is one of the less common presenting features associated with testicular tumors. We evaluated the histologic and biochemical findings, and pregnancy outcome in patients presenting with infertility who were found to have testicular tumors. METHODS: Seven patients with infertility were found to have testicular cancer over a 15-year period. All patients had a testicular ultrasound evaluation. The indications for the ultrasound were testicular pain in 2 patients, suspicious palpable mass in 4, and to rule out the presence of germ cell neoplasia in a patient with carcinoma in situ detected on a previous biopsy. Physical exam, histological findings, hormonal levels, tumor markers, and pregnancy outcome results were recorded from the patients medical charts. RESULTS: Two men had elevated serum follicle stimulant hormone and luteinizing hormone levels, 1 of them had an abnormally low serum testosterone level. Tumor markers were normal in all patients. In 4 patients the tumor was on the right side and in 3 on the left. The histological diagnoses were seminoma (n = 5), Leydig cell tumor (n = 1), and carcinoma in situ (n = 1). Of the 7 patients, 5 underwent adjuvant radiation therapy. Two patients had sperm cryopreserved. Follow up on fertility status was available in 6 cases. One patient has established a pregnancy and 5 did not achieve a pregnancy after treatment for their cancer. CONCLUSIONS: Most of the men who have testicular cancer and male infertility have a seminona. Therefore, men who present with infertility should be thoroughly investigated to rule out such serious, concomitant diseases along with their infertility

Persistent Müllerian Duct Syndrome (PMDS) with testicular seminoma.

Persistent Mullerian Duct Syndrome (PMDS) is characteristically associated with unilateral or bilateral cryptoorchidism. Like other undescended testis, these gonads are at an increased risk of malignant transformation. We report a case of intra abdominal seminoma in cryptorchid testis of a patient with the Persistent Mullerian Duct Syndrome, hitherto uncommonly reported in India.

Microlitíase testicular associada à neoplasia de células germinativas / Testicular microlithiasis associated with germ cell neoplasy

A calcificaçäo intratubular do testículo, também conhecida como microlitíase testicular, é patologia rara e de etiologia incerta, descoberta durante a investigaçäo de sintomas testiculares inespecíficos. Apresenta padräo ultra-sonográfico característico, diferente daquele observado em outros tipos de calcificaçöes. Sua associaçäo com outras patologias foi descrita, inclusive com tumores testiculares, motivo pelo qual o paciente com microlitíase testicular deve merecer atençäo especial no que diz respeito à investigaçäo