Clinicopathologic characteristics and prognostic analysis of testicular diffuse large B-cell lymphoma / 中华血液学杂志

Objective: To analyze the clinicopathologic characteristics and prognosis of testicular diffuse large B-cell lymphoma (DLBCL) . Methods: A retrospective analysis was performed on 68 patients with testicular DLBCL admitted to Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine from October 2001 to April 2020. The gene mutation profile was evaluated by targeted sequencing (55 lymphoma-related genes) , and prognostic factors were analyzed. Results: A total of 68 patients were included, of whom 45 (66.2% ) had primary testicular DLBCL and 23 (33.8% ) had secondary testicular DLBCL. The proportion of secondary testicular DLBCL patients with Ann Arbor stage Ⅲ-Ⅳ (P<0.001) , elevated LDH (P<0.001) , ECOG score ≥ 2 points (P=0.005) , and IPI score 3-5 points (P<0.001) is higher than that of primary testicular DLBCL patients. Sixty-two (91% ) patients received rituximab in combination with cyclophosphamide, adriamycin, vincristine, and prednisone (R-CHOP) -based first-line regimen, whereas 54 cases (79% ) underwent orchiectomy prior to chemotherapy. Patients with secondary testicular DLBCL had a lower estimated 5-year progression-free survival (PFS) rate (16.5% vs 68.1% , P<0.001) and 5-year overall survival (OS) rate (63.4% vs 74.9% , P=0.008) than those with primary testicular DLBCL, and their complete remission rate (57% vs 91% , P=0.003) was also lower than that of primary testicular DLBCL. The ECOG scores of ≥2 (PFS: P=0.018; OS: P<0.001) , Ann Arbor stages Ⅲ-Ⅳ (PFS: P<0.001; OS: P=0.018) , increased LDH levels (PFS: P=0.015; OS: P=0.006) , and multiple extra-nodal involvements (PFS: P<0.001; OS: P=0.013) were poor prognostic factors in testicular DLBCL. Targeted sequencing data in 20 patients with testicular DLBCL showed that the mutation frequencies of ≥20% were PIM1 (12 cases, 60% ) , MYD88 (11 cases, 55% ) , CD79B (9 cases, 45% ) , CREBBP (5 cases, 25% ) , KMT2D (5 cases, 25% ) , ATM (4 cases, 20% ) , and BTG2 (4 cases, 20% ) . The frequency of mutations in KMT2D in patients with secondary testicular DLBCL was higher than that in patients with primary testicular DLBCL (66.7% vs 7.1% , P=0.014) and was associated with a lower 5-year PFS rate in patients with testicular DLBCL (P=0.019) . Conclusion: Patients with secondary testicular DLBCL had worse PFS and OS than those with primary testicular DLBCL. The ECOG scores of ≥2, Ann Arbor stages Ⅲ-Ⅳ, increased LDH levels, and multiple extra-nodal involvements were poor prognostic factors in testicular DLBCL. PIM1, MYD88, CD79B, CREBBP, KMT2D, ATM, and BTG2 were commonly mutated genes in testicular DLBCL, and the prognosis of patients with KMT2D mutations was poor.

Disulfiram enhances the antitumor activity of cisplatin by inhibiting the Fanconi anemia repair pathway / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

A series of chemotherapeutic drugs that induce DNA damage, such as cisplatin (DDP), are standard clinical treatments for ovarian cancer, testicular cancer, and other diseases that lack effective targeted drug therapy. Drug resistance is one of the main factors limiting their application. Sensitizers can overcome the drug resistance of tumor cells, thereby enhancing the antitumor activity of chemotherapeutic drugs. In this study, we aimed to identify marketable drugs that could be potential chemotherapy sensitizers and explore the underlying mechanisms. We found that the alcohol withdrawal drug disulfiram (DSF) could significantly enhance the antitumor activity of DDP. JC-1 staining, propidium iodide (PI) staining, and western blotting confirmed that the combination of DSF and DDP could enhance the apoptosis of tumor cells. Subsequent RNA sequencing combined with Gene Set Enrichment Analysis (GSEA) pathway enrichment analysis and cell biology studies such as immunofluorescence suggested an underlying mechanism: DSF makes cells more vulnerable to DNA damage by inhibiting the Fanconi anemia (FA) repair pathway, exerting a sensitizing effect to DNA damaging agents including platinum chemotherapy drugs. Thus, our study illustrated the potential mechanism of action of DSF in enhancing the antitumor effect of DDP. This might provide an effective and safe solution for combating DDP resistance in clinical treatment.

Transformación de teratoma en rabdomiosarcoma / Transformation of teratoma in rabdomiosarcoma

Los teratomas son tumores germinales malignos compuestos por dos o más capas de tejido, que ocasionalmente se transforman en estirpes con crecimiento agresivo. Se presenta el caso de un paciente de 29 años con un tumor germinal gonadal localizado en testículo, cuya evolución fue desfavorable por presentar transformación en un fenotipo correspondiente a un rabdomiosarcoma. La patología aquí descripta deviene del crecimiento diferencial de un componente ya existente en el tumor original o la transformación en un linaje somático que se hace dominante. Los tumores transformados como el del caso descripto son raros y presentan características diferentes de la mayoría de las neoplasias germinales respecto del comportamiento, el pronóstico y la sensibilidad a los tratamientos establecidos.

Teratomas are malign germ cell tumors composed of two or more tissue layers. When there is specific organ differentiation they are called mature teratoma. They rarely grow aggressively. We report the case of a 29 year-old man with a diagnosis of gonadal germ cell tumor whose evolution was unfavorable owing to transformation into a different phenotype corresponding to a rhabdomyosarcoma. This phenomenon occurs through differential growth of a single histological component of the original tumor or transformation of a somatic lineage that becomes dominant. Transformed tumors such as the one herein described differ from most germ cell neoplasms regarding behavior, prognosis, and susceptibility to established treatments.

PET-CT para el manejo de pacientes con cáncer testicular tipo seminoma con masa residual post quimioterapia / PET-CT for the management of testicular seminoma patients with post-chemotherapy residual masses

INTRODUCCIÓN En pacientes con cáncer testicular avanzado tipo seminoma que tienen lesiones residuales post quimioterapia de más de 3 cm, el PET-CT podría seleccionar un subgrupo susceptible de ser manejado con seguimiento, evitando una resección quirúrgica innecesaria de tumor no viable. MÉTODOS Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES Identificamos tres revisiones sistemáticas que en conjunto incluyeron 11 estudios primarios, de los cuales, ninguno es un ensayo aleatorizado. Concluimos que el uso de PET-CT en la evaluación de masas residuales post quimioterapia en pacientes con cáncer testicular tipo seminoma podría evitar un porcentaje importante de cirugías innecesarias (certeza de la evidencia baja). Además, el uso de PET-CT podría presentar balances riesgo/beneficio y costo/beneficio favorables en el manejo de pacientes con cáncer testicular tipo seminoma. Sin embargo, se requieren revisiones sistemáticas y estudios primarios que evalúen directamente el impacto diagnóstico del test.

INTRODUCTION The use of PET-CT could select a subgroup of advanced testicular seminoma patients that display post-chemotherapy residual masses measuring >3 cm and could be managed with surveillance, avoiding unnecessary surgical resection of unviable tumor masses. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified three systematic reviews that included eleven primary studies; none of these were randomized trials. We concluded the assessment of postchemotherapy residual masses by PET-CT in testicular seminoma patients may prevent unnecessary surgeries, but the certainty of the evidence is low. Furthermore, PET-CT could also offer a favorable risk/benefit and cost/benefit ratio for the management of testicular seminoma patients. However, systematic reviews and primary studies assessing the direct diagnostic impact of PET-CT are required.

On thin ice: barriers to adoption of surveillance for patients with stage I testicular seminoma. Survey of US radiation oncologists

ABSTRACT Purpose: Most men with stage I testicular seminoma are cured with surgery alone, which is a preferred strategy per national guidelines. The current pattern of practice among US radiation oncologists (ROs) is unknown. Materials and Methods: We surveyed practicing US ROs via an online questionnaire. Respondent's characteristics, self-rated knowledge, perceived patient compliance rates with observation were analyzed for association with treatment recommendations. Results: We received 353 responses from ROs, of whom 23% considered themselves experts. A vast majority (84%) recommend observation as a default strategy, however this rate drops to 3% if the patient is believed to be noncompliant. 33% of respondents believe that survival is jeopardized in case of disease recurrence, and among these respondents only 5% support observation. 22% of respondents over-estimate the likelihood of noncompliance with observation to be in the 50-80% range. Responders with a higher perceived noncompliance rate are more likely to recommend adjuvant therapy (Fisher's exact p<0.01). Only 7% of respondents recommend observation for stage IS seminoma and 45% administer adjuvant RT in patients with elevated pre-orchiectomy alpha-fetal protein levels. Conclusions: Many US ROs over-estimate the likelihood that stage I testicular seminoma patients will be noncompliant with surveillance and incorrectly believe that overall survival is jeopardized if disease recurs on surveillance. Observation is quickly dismissed for patients who are not deemed to be compliant with observation, and is generally not accepted for patients with stage IS disease. There is clearly an opportunity for improved physician education on evidence-based management of stage I testicular seminoma.

During twenty years of Cisplatin-based therapy the face of nonseminomatous testicular germ cell tumors is still changing: an evaluation of presentation, management, predictive factors and survival

Purpose: To assess the changing presentation and treatment of nonseminomatous testicular germ cell tumors (NSGCT) and to investigate predictive factors for the status of metastasis at diagnosis and on relapse and death. Materials and Methods: Retrospective record review of 147 patients that underwent inguinal orchiectomy from 1987-2007. Follow-up data was available for 102 patients (median follow-up: 80 months (0-243); 96 patients alive). Results: Mean patients age increased (p = 0.015) and more patients were diagnosed in clinical stage I (CSI) (p = 0.040). The fraction of yolk sac (YS) elements inclined (p = 0.030) and pT2 tumors increased (p < 0.001). Retroperitoneal lymph node dissection (RPLND) declined whereas more patients were treated with chemotherapy (p < 0.001; p = 0.004). There was an increase in relapse free (RFS) and cancer specific survival (CSS) due to an improvement in patients with disseminated disease (p = 0.014; p < 0.001). The presence of YS and teratoma elements showed a reduction in the odds ratio (OR) for metastasis at diagnosis (p = 0.002, OR: 0.262; p = 0.009, OR: 0.428) whereas higher pT-stage was associated to their presence (p = 0.039). Patients with disseminated disease (CS > I) showed a declined CSS compared to CSI patients (p = 0.055). The presence of YS elements was associated to an improved RFS (p = 0.038). Conclusions: In our single institution study the face of NSGCT markedly changed over 20 years even after the introduction of Cisplatin-based chemotherapy. These changes were accompanied by an improvement in RFS and CSS. When dealing with NSGCT patients such observations now and in the future should be taken into account. .

Significado de la sexualidad en adultos jóvenes sometidos a quimioterapia por neoplasia testicular / Meaning of sexuality in young adults undergoing chemotherapy for testicular neoplasm

El cáncer es una enfermedad que provoca un fenómeno social y humano muy importante; así, el cáncer testicular es el tumor maligno más común en hombres entre los 15-35 años, siendo una de las neoplasias sólidas más curables. La presente investigación cualitativa descriptiva, con enfoque fenomenológico, pretende describir el significado que otorgan a su sexualidad seis adultos jóvenes que recibieron tratamiento con quimioterapia por cáncer testicular en la ciudad de Puerto Montt, de marzo a diciembre del 2010, respecto de su autoestima, relación de pareja y vida sexual. El análisis de datos se realizó utilizando el programa computacional Atlas Ti. Se observó que el significado que le otorga el adulto joven a su sexualidad está comprendido por la valoración propia y de su entorno, en función de la red de apoyo que cada uno tiene, donde la vida sexual sigue siendo importante, pero no trascendente ni primordial. La pareja es un aspecto que contribuye a la formación de un proyecto de vida y es en esa relación de pareja que la vida sexual se torna relevante. Por lo anterior, los efectos físicos ocasionados por el tratamiento, a pesar de las inevitables implicancias que conlleva, no condicionan la autoimagen, vida sexual ni la relación de pareja, lo que nos acerca a una gestión del cuidado, en estos pacientes, más integral e integradora, considerándolo un ser biopsicosocial en relación constante con el entorno.

Cancer is a disease that causes social and human phenomenon very important, so the testicular cancer is the most common malignancy in men aged 15-35 years, one of the most curable solid neoplasms. This qualitative, phenomenological approach to describe the meaning they assign to their sexuality six young adults treated with chemotherapy for testicular cancer in the city of Puerto Montt, from March to December 2010, on their self-esteem, relationship partner and sexual life. Data analysis was performed by using the computer program Atlas Ti. It was noted that the significance the young adult gives to sexuality is understood by the self assessment and its environment, depending on the network of support that each one has, where the sexual life remains important, but not transcendent or primary. The couple is a key contributing factor to the formation of a life plan and is in that relationship that sexual life becomes relevant. Therefore, the physical effects caused by treatment, despite the inevitable implications involved, do not influence the self-image, sex life or relationship, which brings us to a careful management of these patients in a more comprehensive and inclusive way, regarding a biopsychosocial being in constant contact with the environment.

Linfadenectomía lumboaórtica asistida por robot en tumor residual postquimioterapia en cáncer testicular / Robotic-assisted laparoscopic retroperitoneal lymph node dissection in post chemotherapy residual mass in testis cancer

Introduction: The laparoscopic retroperitoneal lymph node dissection (L-RPLND) has shown results at least comparable to open surgery in terms of perioperative complications and oncological results, but its application in the post chemotherapy scenario is still matter of study. The development of robotic surgery and its advantages over laparoscopic surgery, make this an attractive option for complex procedures. We report our initial experience with robotic-assisted retroperitoneal lymph node dissection (R-RPLND). Methods: We describe the cases of two patients who underwent R-RPLND due to a Post Chemotherapy residual mass of a non-seminomatous testicular cancer. Results: Two patients, 27 and 30 years old, presented with retroperitoneal residual mass after 4 and 6 cycles of Bleomicin, Etoposide and Cis-Platinum. The first patient had a 4.3 cm left para-aortic mass and the other had a 6 cm mass behind the third portion of the duodenum. The mean surgical time was 255 minutes (210-300), with an estimated mean blood loss of 450 cc (100-800) and a mean hospital stay of 60 hours (72-48). The pathologic result was Teratoma in both cases. There was no periopera-tive morbidity. Conclusions: We believe that R-RPLND is a feasible and safe alternative in selected patients. However still needs more experience and longer follow up to asess its oncological outcome.

Introducción: La linfadenectomía retroperitoneal lumboaórtica laparoscópica (LRLA-L) ha demostrado resultados al menos comparables a la cirugía abierta en términos de complicaciones peri operatorias y resultados oncológicos. Sin embargo, su aplicación en el escenario postquimioterapia es todavía materia de estudio. El desarrollo de la cirugía robótica y sus ventajas sobre la cirugía laparoscópica hacen de este tipo de cirugía una opción atractiva para procedimientos más complejos como esta intervención postquimioterapia. Reportamos nuestra experiencia inicial en Linfadenectomía lumboaórtica laparoscópica robóticamente asistida postquimioterapia. Métodos: Describimos el caso de dos pacientes sometidos a una a una linfadenectomía retroperitoneal lumboaórtica asistida por robot (LRLA-R), portadores de una masa retroperitoneal postquimioterapia secundaria a un carcinoma testicular de células germinales no seminoma. Resultados: Dos pacientes, de 27 y 30 años de edad, con una masa retroperitoneal residual después de 4 y 6 ciclos de Bleomicina, Etoposido y Cis-Platinum respectivamente. El primer paciente presentó una masa para-aórtica izquierda de 4,3 cm y el segundo paciente una masa en relación a la tercera porción del duodeno de 6 cm. El tiempo operatorio promedio fue de 255 minutos (210-300) con un sangrado promedio estimado de 450 ml (100-800). El tiempo promedio de hospitalización fue de 60 hrs (48-72). En ambos casos el resultado histológico evidenció la presencia de Teratoma. No se presentaron complicaciones perioperatorias. Conclusiones: Creemos que la LRLA-R en pacientes con masa residual post-quimioterapia es una técnica reproducible y segura en pacientes seleccionados, sin embargo, todavía es necesario un mayor número de pacientes y tiempos de seguimiento para poder evaluar los resultados oncológicos.

Reporte de un caso de tumor desmoplásico de células pequeñas redondas / Case report: patient with round cell desmoplastic tumor

Introducción: El tumor de células pequeñas redondas desmoplásico (TCPRD), es una neoplasia agresiva maligna poco frecuente que afecta a adolescentes y adultos jóvenes. Usualmente son intraabdominales asociados con un mal pronóstico. Existen algunas publicaciones donde incluyen manifestaciones paratesticulares. Caso: Reportamos un caso de un joven de 29 años que consulta por aumento de volumen del hemiescroto izquierdo de 3 meses de evolución. Al examen destacaba 2 nódulos duros uno en relación al polo inferior y el otro al epidídimo de aproximadamente 2 cm. Alfafetoproteína y beta HCG eran normales. Se decide exploración quirúrgica donde biopsia rápida confirma tumor que se origina en las envolturas y que infiltra hacia el testículo. La biopsia definitiva informó tumor desmoplásico de células pequeñas redondas. El estudio de extensión con tomografía axial computarizada y radiografía de tórax no mostró metástasis. El paciente recibió 2 ciclos de QMT con ciclofosfamida, etoposido, adriamicina y cisplatino, con buena tolerancia, evolucionando con depresión medular moderada que se recupera. Actualmente 6 años después del diagnóstico el paciente se encuentra en remisión completa. Discusión: Al parecer y según los últimos reportes de la literatura, la ubicación paratesticular ha mostrado mejor pronóstico en comparación con los tumores abdominales. Se debe incluir este diagnóstico diferencial al enfrentarse con tumores paratesticulares.

Introduction: Small round cell desmoplastic tumor (SRCDT) is an infrequent malignant tumor that affects adolescents and young adults. Usually they occur in the abdomen. Paratesticular manifestations have been reported. Case report: A 29 year old male presented with a 3 month history of a mass in the left scrotum. Physical exam showed 2 hard nodules in the scrotum. Serum levels of alpha-fetoprotein and beta-HCG were normal. The patient was submitted to surgery. Frozen section confirmed a tumor arising in the paratesticular area with involvement of the testis. Permanent sections showed a SRCDT. CT scans and chest x-rays showed no metastases. The patient received two courses of ciclophosphamide, etoposide, adryamicin and cisplatinum. Treatment was well tolerated. The patient is in complete remission at 6 years following the diagnosis. Discussion: Paratesticular location seems to have a better prognosis compared to intraabdominal tumors. SRCDT should be included in the differential diagnosis of paratesticular tumors.

Tumores testiculares bilaterais por hiperplasia congênita de restos adrenais / Bilateral testicular tumors caused by congenital adrenal rest hyperplasia

OBJETIVOS: Tumores testiculares são uma rara condição associada à hiperplasia adrenal congênita (HAC) que decorrem da hiperplasia de restos adrenais intratesticulares (HRA), raramente ocorrendo associados a neoplasias malignas. Sua diferenciação histológica com tumores de células de Leydig é muito difícil, podendo levar a orquiectomias desnecessárias. O objetivo deste relato foi apresentar esse dilema diagnóstico em um paciente com HAC e tumores testiculares bilaterais. MÉTODOS: Relatou-se o caso de um paciente masculino, 16 anos, com diagnóstico de HAC desde os 3 anos de idade, que apresentava tumorações testiculares endurecidas, indolores e de crescimento lento, sendo encaminhado para orquiectomia bilateral. RESULTADOS: Foi decidido por tratamento conservador com prednisona, havendo significativa diminuição do volume testicular e normalização dos níveis de andrógenos. CONCLUSÃO: Este caso demonstra a importância de sempre se considerar a hipótese de HRA intratesticulares no diagnóstico diferencial dos tumores testiculares. A investigação e a conduta devem ser conduzidas de maneira cautelosa para se evitar orquiectomias desnecessárias.

OBJECTIVES: Testicular tumors are a rare condition associated with congenital adrenal hyperplasia (CAH), originated from intratesticular adrenal rest tumors, and they are rarely associated with malignant tumors. Their histological differentiation from Leydig-cell tumors is quite difficult, which would lead to inappropriate orchiectomies. Thus the objective of this report was to present this diagnostic dilemma. METHODS: Reported the case of 16-yr-old boy with previous diagnosis of CAH with bilateral testicular enlargement who was recommended to be submitted to a bilateral orchiectomy. RESULTS: Considering this findings, it was decided to treat conventionally with prednisone with significant reduction of testicular volume, and normalization of androgens levels. CONCLUSION: This case shows the importance of intratesticular adrenal rest tumors in the differential diagnosis of testicular tumors. Cautious approach during investigation and treatment are recommended to avoid inappropriate orchiectomies.

Long-term clinical outcome in patients with stage-i nonseminomatous germ cell cancer: a critical review of own treatment modalities in a retrospective study

PURPOSE: The optimal management of patients with clinical stage I non-seminomatous germ cell testicular cancer (NSGCT I) was considered controversial until the European Germ Cell Cancer Consensus Group determined unambiguous treatment strategies. In order to assess the long-term outcome we evaluated the data of patients with NSGCT I. MATERIALS AND METHODS: In a retrospective evaluation, we included 52 patients with a mean age of 26 years (range 15-58) who were treated with different modalities at our department between 1989 and 2003. Mean follow-up was 5.9 years (range 2-14 years). After orchiectomy, 39 patients were treated with chemotherapy, 7 patients underwent retroperitoneal lymph node dissection and 6 men were managed using a surveillance strategy. Survival, recurrence rate and time of recurrence were evaluated. The histological staging and treatment modality was related to the relapse. RESULTS: Tumor specific overall mortality was 3.8 percent. The mortality and relapse rate of the surveillance strategy, retroperitoneal lymph node dissection and chemotherapy was 16.7 percent / 50 percent, 14.3 percent / 14.3 percent and 0 percent / 2.5 percent respectively. All relapsed patients in the surveillance group as well as in the RPLND group had at least one risk factor for developing metastatic disease. CONCLUSIONS: Following the European consensus on diagnosis and treatment of germ cell cancer in patients with NSGCT Stage I any treatment decision must be individually related to the patient according to prognostic factors and care capacity of the treating centre. In case of doubt, adjuvant chemotherapy should be the treatment of choice, as it provides the lowest risk of relapse or tumor related death.

Ciclo único de quimioterapia adyuvante en cáncer testicular no seminoma Etapa I / Single cycle adyuvant chemotherapy in stage I nonseminomatous testis cancer

El cáncer de testículo es la neoplasia sólida más frecuente en el hombre entre los 15-35 años de edad y su incidencia a nivel mundial ha aumentado en los últimos 40 años. Ello puede ser el resultado de efectos exógenos, como influencia prenatal, o predisposición genética. A pesar del aumento de la incidencia, su mortalidad ha disminuido a cifras menores del 5 por ciento gracias a la combinación de métodos diagnósticos adecuados, marcadores tumorales sensibles y tratamientos efectivos. El tratamiento de esta enfermedad es un ejemplo de manejo multimodal del cáncer, ya que luego de orquiectomía el paciente puede requerir cirugía de estadiaje, radioterapia o quimioterapia complementaria o entrará a un régimen de observación vigilada, dependiendo de la histología y etapa tumoral. En el caso del tumor testicular de células germinales no seminomatoso (NSCGT) etapa I (pT1-4NxMoSo), la recomendación es determinar la presencia de factores pronósticos que pueden predecir la presencia de ganglios retroperitoneales metastásicos luego del tratamiento o recaída luego de orquiectomía con linfadenectomía retroperitoneal. Los principales factores de riesgo analizados son la etapa del tumor primario >pT1, invasión vascular y/o linfática, presencia de carcinoma embrionario, ausencia de elementos de tumor de saco vitelino y marcadores tumorales elevados preorquiectomía.

The cancer of testicle is the most frequent solid neoplasia in the man between 15-35 years of age and his(her,your) incident worldwide has increased in the last ones 40 años. It can be the result of exogenous effects, as prenatal influence, or genetic predisposition. In spite of the increase of the incident, his(her,your) mortality has diminished minor numbers(figures) of 5 percent thanks to the combination of diagnostic methods tumour sensitive scoreboards and treatments efectivos. The treatment of this disease is an example of multimodal managing of the cancer, since after orquiectomía the patient can need surgery of estadiaje, radiotherapy or complementary chemotherapy or it(he,she) will enter to a regime(diet) of monitored observation, depending on the histology and tumour stage. In case of the tumor testicular of cells they germinate Not seminomatoso (NSCGT) stage I (pT1-4NxMoSo), the recommendation is the presence of factors determines forecasts(predictions) that can predict the presence of ganglions retroperitoneales metastásicos after the treatment or relapse after orquiectomía with linfadenectomía retroperitoneal. The principal factors of risk analyzed are the stage of the primary tumor> pT1, vascular and / or lymphatic invasion, presence of carcinoma Embryonic, absence of elements of tumor of sack vitelino and tumour high scoreboards preorquiectomía.

Extensive deep vein thrombosis as a complication of testicular cancer treated with the BEP protocol (bleomycin, etoposide and cisplatin): case report

CONTEXT: There are no reports in the literature of massive deep venous thrombosis (DVT) associated with cisplatin, bleomycin and etoposide (BEP) cancer treatment. CASE REPORT: The patient was a 18-year-old adolescent with a nonseminomatous germ cell tumor of the right testicle, with the presence of pulmonary, liver, and massive retroperitoneal metastases. Following radical orchiectomy, the patient started chemotherapy according to the BEP protocol (without routine prophylaxis for DVT). On day 4 of the first cycle, massive DVT was diagnosed, extending from both popliteal veins up to the thoracic segment of the inferior vena cava. Thrombolytic therapy with streptokinase was immediately started. On day 2 of thrombolytic therapy, the patient developed acute renal failure, due to extension of the thrombosis to the renal veins. Streptokinase was continued for six days and the outcome was remarkably favorable.

CONTEXTO: Não há relatos na literatura de trombose venosa profunda (TVP) extensa associada ao protocolo de quimioterapia cisplatina, bleomicina e etoposite (BEP). RELATO DO CASO: O paciente era um adolescente de 18 anos com um tumor germinativo não-seminomatoso no testículo direito, com metástases pulmonares, hepáticas e retroperitoneais. Após orquiectomia radical, o paciente começou a receber quimioterapia de acordo com o protocolo BEP (sem profilaxia rotineira para TVP). No quarto dia do ciclo, TVP massiva foi diagnosticada, estendendo-se das veias poplíteas até o segmento inferior da veia cava torácica. Tratamento trombolítico foi iniciado imediatamente com estreptoquinase. No segundo dia da terapia trombolítica, o paciente desenvolveu insuficiência renal aguda, devido ao acometimento das veias renais pela trombose. Estroptoquinase foi mantida por seis dias e o paciente teve evolução surpreendentemente favorável.

Primary testicular lymphoma--A case report.

Primary lymphoma of the testis is more commonly seen in the elderly age group. A 45-year-old Hindu male with histopathological diagnosis of non-Hodgkin's lymphoma of the right testis presented after orchiectomy of the right testis. The patient was put on two cycles of chemotherapy consisting of cyclophosphamide, vincristine, adriamycin and prednisolone at 3- weekly interval followed by external radiation therapy. During follow-up after 7 years he developed left facial nerve palsy and left sided haemiparesis. On CT scan of the brain multiple space occupying lesions were seen in both the hemispheres of the brain. He was put on cranial radiation therapy with intrathecal methotrexate injections. He responded favourably with the treatment.

Observación y quimioterapia profiláctica en el manejo de tumores de células germinales no seminomatosos (estadio I): experiencia del Hospital San Juan de Dios / Observation and prophylactic chemotherapy in management of non seminomatose germinal cell tumours, stadium I: urology service of San Juan de Dios Hospital experience

No existe consenso respecto del manejo de los pacientes con tumor de células germinales no seminomatoso (TCGNS) en estadio I, pudiendo ofrecerles linfadenectomía lumboaórtica, quimioterapia u observación. Presentamos la experiencia del Servicio de Urología del Hospital San Juan de Dios en el manejo de los TCGNS en estadio I. Material y método: Se realizó estudio descriptivo retrospectivo. Se analizaron las historias clínicas de todos los pacientes con tumores testiculares que acuden a control al policlínico de testículo, seleccionando a los pacientes con TCGNS en estadio I. Entre septiembre de 1990 y junio de 2004, se diagnosticaron 48 pacientes con una edad promedio, al momento del diagnóstico, de 28,4 años (15-71). Se analizaron las siguientes variables: lateralidad, tipo histológico, agrupándolos según variedad en pura o mixta, marcadores tumorales, factores de riesgo histológico, tratamiento, número y tipo de controles, periodo de seguimiento y recaída. Resultados: 28 (58,3 pr ciento) tumores fueron derechos; 11 (22,9 por ciento) pacientes presentaron TCGNS puro (6 carcinoma embrionario, 4 teratocarcinoma, 1 tumor de saco vitelino), de los 37 (77,1 por ciento) pacientes con TCGNS mixtos, 23 (47,9 por ciento) presentaban algún grado de carcinoma embrionario; 28 (58,3 por ciento) pacientes tuvieron marcadores tumorales positivos, todos los cuales se negativizaron tras la orquiectomía radical; 18 pacientes tuvieron factor de riesgo en sus biopsias (permeación vascular o linfática, invasión de rete testis o de cordón espermático o de albugínea). A los pacientes con factor de riesgo y a aquellos con un riesgo social de poca adhesión al seguimiento se les sometió a 2 ciclos de quimioterapia con PEB, completando un total de 28 pacientes (58,3 por ciento). A los pacientes se les controló un promedio de 10,4 veces (3-36) con un promedio de 5,1 radiografías de tórax (1-17), 4 ecografías (1-13) y 2,5 TAC (1-11). Presentaron recaída 2 pacientes (4,2 por ciento), ambo...

Nonseminomatous testi9cular cancer

Testicular cancer is the most common solid malignancy in young men between the ages of 20 and 40 years. Its incidence is increasing worldwide. The success achieved in its treatment has not been seen in any other cancer. This communication will present some of the controversies in the management of nonseminomatous germ cell tumors, the changes that were introduced over the last two decades to decrease the toxicity from treatment and will discuss the most up-to-date treatment of every clinical stage of the disease

Testicular schistosomiasis mimicking tumour

Schistosomiasis or bilharziasis is a disease caused by Schistosoma. When infecting men the most common parasites are Schistosoma mansoni, Schistosoma japonicum and Schistosoma haematobium. The Schistosoma mansoni is the only endemic parasite in Brazil. We present a case of testicular schistosomiasis simulating malignancy. The case was treated successfully by excisional biopsy and praziquantel therapy. A review of the literature is discussed.