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)

Seminoma metastásico de primario gonadal / Metastatic seminoma of primary gonadal

El seminoma es la neoplasia testicular más frecuente alcanzando hasta el 50% de todos los casos de cancer del testículo. Dependiendo de su naturaleza, seminomatoso o no seminomatoso, las conductas de manejo y tratamiento médico quirúrgicas varían según los centros, los protocolos de manejo y la experiencia de los equipos de atención. Objetivos. Promover la discusión de adyuvancia o neoadyuvancia en caso de seminoma clásico. Paciente y Método. Presentar un caso de seminoma clásico tratado quirúrgicamente con orquidectomía y una década después se presenta con extensión metastásica mediastinal y retroperitoneal. Conclusiones. Para la etiología no seminomatosa, se establece la orquidectomía seguida de vigilancia; mientras que en caso de origen seminomatoso la discusión se basa en el momento del rol de la cirugía, radiación y quimioterapia, por lo tanto, se debe individualizar cada paciente según las características clínicas manifestadas. (AU)

Seminoma is the most common testicular neoplasm, reaching up to 50% of all cases of testicular cancer. Depending on its nature, seminomatous or non-seminomatous, the management behaviors and surgical medical treatment vary according to the centers, the management protocols and the experience of the care teams. Objective. Promote the discussion of adjuvant or neoadjuvant in case of classic seminoma. Patient and Method. To present a case of classic seminoma treated surgically with orchidectomy and a decade later it presents with mediastinal and retroperitoneal metastatic extension. Conclusions. For non-seminomatous etiology, orchidectomy followed by surveillance is established; while in the case of seminomatous origin, the discussion is based on the time of the role of surgery, radiation and chemotherapy, therefore, each patient must be individualized according to the clinical characteristics manifested. (AU)

The relationship of neutrophil to lymphocyte ratio with testicular cancer

ABSTRACT Purpose: To assess the relationship between testicular germ cell tumors (TGCT) and neutrophil to lymphocyte ratio (NLR) and to determine whether this ratio can be used as a serum tumor marker. Material and Methods: Sixty-one patients with testicular germ cell tumors were included into the study. Patients were grouped as localized and non-localized. Histologically patients were categorized as seminoma and nonseminomatous germ cell tumors. Complete blood cell count was measured the day before surgery and at the postoperative 1st month. Preoperative and postoperative mean NLR values were compared. Results: Thirty-six patients (59%) had seminomas and 25 patients (41%) had nonseminomatous testicular cancer. Forty-five patients (73.8%) had localized and 16 patients (26.2%) had non-localized testicular cancer. There was a statistically significant difference between preoperative and postoperative mean NLR of the localized patients (p=0.001) but no such difference was detected for non-localized patients (p=0.576). Nineteen patients with localized seminomas had normal preoperative serum tumor markers. There was a significant difference between preoperative and postoperative mean NLR in this group of patients (p=0.010). Twenty-six patients with localized tumors had preoperative increased serum tumor markers which normalized after orchiectomy. Mean NLR of these patients significantly decreased from 3.10±2.13 to 1.62±0.59 postoperatively (p=0.010). Conclusions: NLR appears to be a useful marker for TGCT. It is successful in predicting localized and non-localized disease in early postoperative period.

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)

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

Presentación de un caso de seminoma mediastinal / Presentation of a patient presenting with mediastinal seminoma

Se estudió un paciente masculino, de 20 años de edad, que sólo refería como síntoma dolor en hombro izquierdo de 1 año de evolución. De forma fortuita se le realiza rayos X de tórax y se observa ensanchamiento mediastinal. Se diagnosticó, por citología, un seminoma extragonadal de localización mediastinal

A male patient aged 20 was studied presenting a painful symptom in his left shoulder of a year of course. In a causal way he undergoes thorax Ray-X observing mediastinum widening. According to cytology an extra-gonadal seminoma of mediastinum location was diagnosed

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.

False-Positive Hypermetabolic Lesions on Post-Treatment PET-CT after Influenza Vaccination

We report a case of a 59-year-old man with testicular germ cell tumor who showed new hypermetabolic lesions at the left axillary lymph nodes on a post-treatment positron emission tomography-computed tomography (PET-CT) scan. The hypermetabolic lesions were found to be caused by an influenza vaccination 10 days prior to the PET-CT scan and disappeared without additional treatment. To date, he is alive with complete remission.

Tumores germinales de localización mediastinal en gemelos idénticos / Germinal tumors of mediastinal location present in identical twins

Se notificó el caso de un paciente de 30 a±os, gemelo idéntico, con un seminoma extragonadal de localización mediastinal, cuyo hermano había fallecido 2 años antes como consecuencia de complicaciones asociadas a la cirugía de tórax, en un intento por resecar masa tumoral residual después de tratamiento con quimioterapia por tumor germinal de localización mediastinal.

Authors inform on the case of an identical twin patient aged 30 presenting with an extragonadal semimoma of mediastinal location, whose brother died 2 years ago from complications associated with a thoracic surgery to resect a residual tumor mass after chemotherapy from germinal tumor of mediastinal location.

Respuesta completa al tratamiento en un caso de seminoma del mediastino / Complete answer to treatment in a case of seminoma of the mediastinum

Se presenta y discute el caso de un paciente de 46 años con antecedentes de la enfermedad de Hansen y cuadro clínico de dolor torácico, tos seca y derrame pleural de cuatro meses de evolución. Se le diagnosticó por biopsia de las partes blandas a nivel de esternón un seminoma de mediastino avanzado que infiltra la pared torácica y recibió tratamiento con poliquimioterapia basada en cisplatino y radioterapia hace seis años y se mantiene controlado de su enfermedad.

It is present and discusses a case of a 46 year-old patient with antecedents of the Hansen´s disease and clinical picture of thoracic pain, dry cough and pleural effusion of four months of evolution. It was diagnosed by biopsy of the soft parts to sternum level an advanced seminoma of the mediastinum that infiltrates the thoracic wall and he received treatment with polychemotherapy based on cisplatin and radiotherapy six years ago and he stays controlled of his illness.

Factores pronósticos en seminoma / Prognostic factors in seminoma

Pacientes y métodos: Se revisaron 714 pacientes con Seminoma diagnosticados en el INEN (1990-2005). Se describe, las características clínicas, respuesta al tratamiento, seguimiento y sobrevida. Resultados: La mediana de edad fue 33 años (rango: 15-80). El sitio primario de presentación fue testicular (97.2%), mediastinal (2.2%), RTP (0,6%). El (54%) fue ECI, (26.6%) EC II, (15.8%) ECIII. Los sitios de compromiso de enfermedad fueron RTP (12%), Supraclavicular (6%). Mediastinal (4.6%). Pulmonar (4.2%), hepática (2.4%). La calificación de riesgo fue 83% BR, 17% RI. La mediana de seguimiento fue 65 meses. Los pacientes con EC I que recibieron RT la Sobrevida Global (SG) a los 5 y 10 años fue de 99% y 98% frente a 85% en pacientes que sólo fueron observados. En pacientes EC II-III que recibieron quimioterapia, la SGa los 5 y 10 años fue en BR: 98% y 86%, en RI: 73% y 72%. Los factores pronóstico para la SG fueron: Edad > 50 años (p=0.023, RR=2.8), EC II (p <0.001 RR=19.3). EC III (p<0.001, RR=54.0), metástasis hepática (p=0.025, RR=3). Conclusión: La sobrevida de nuestro grupo de pacientes estuvo en relación a los factores pronósticos edad, EC y metástasis hepática. La calificación del riesgo no fue factor pronóstico. Es necesario estudios que incluyan la biología molecular del tumor y análisis genéticos para identificar factores pronósticos y crear dianas terapéuticas según clasificación molecular.

Purpose: To determine the prognostic factors and to assess the relationship between selected pretreatment characteristics and survival in patients with seminoma. Patients and methods: 714 patients with seminoma diagnosed at INEN, Lima-Peru from 1990 to 2005 and were the subjects of the study. We describe the clinic behavior, response to treatment, follow up and survival. The overall patterns were compared in relation to clinical characteristics with Logrank/Breslow test. We identified the prognostic factor through the Cox model. The statistical evaluation was performed with 5% significance level. The results were processed with SPSS v. 12.0 program. Results: The median age was 33 years (15-80y). The presentation the primary site was testicular (97,2%), mediastinum (2,2%) and retroperitoneum (0,6%). 54.6% of them were CS I, 29,6% CS II, 15,8% CS III. The involved sites were lungs (4,2%), liver (2,4%) and Central Nervous System (0,6%). According to the IGCCCG risk classification, 83% were low risk (LR) and 17% intermediate risk (IR). The median follow up was 65 months. The patients with CS I, who received para-aortic radiotherapy (RT), had overall survival (OS) at 10 years of 98% in relation to 85% in patients with observation (p=<0.001). In CS II-III patients who received chemotherapy (CT), the OS at 5 and 10 years were 98% and 86% in LR, 73% and 72% in IR respectively. The prognostic factors for the OS were: age > 50 years (p=0.023, RR=2,8), CS II (p<0.001, RR=54.0) and liver metastasis (p=0.025, RR=3). Conclusions: In our study the survival was related with prognostic factor such as age, clinical stage and liver metastasis. The risk qualification was not prognostic factor in our population. We observe that in CS I, radiotherapy was significant in relation to observation in survival. Further studies of tumor biology, including genetic analysis are required to identify other parameters that may correlate with survival.

Seminoma intrabdominal en testículo no descendido (en adulto): reporte de caso / Seminoma in intraabdominal undescended testicle (an adult): case report

La criptorquidia se presenta en el 4% de los recién nacidos y en 1% al año de vida. Las complicaciones de las criptorquidias pueden ser funcionales y/o neoplásicas. Presentamos un caso de un varón de 41 años, que ingreso a la guardia, con dolor abdominal constante y progresivo, con masa visible y palpable de hipocondrio derecho, de 24 hs de evolución. Se realizó ecografía (US) abdominal, seguida de tomografía computada (TC). Se observó una masa de aspecto sólido en hipocondrio derecho en US. En la TC, la formación aparece en el lado izquierdo. Debido al curso del cuadro clínico se decidió intervenir quirúrgicamente. La anatomía patológica informó seminoma clásico intrabdominal en testículo no descendido y sugirió US testicular, la cual confirmó la ausencia del testículo derecho en la bolsa escrotal. Presentamos un caso de criptorquidia de localización intrabdominal, con degeneración en seminoma y torsión de pedículo, lo cual explica el cambio de localización de la formación.

Seminoma in an undescended testis. Cryptorchidism is present in aproximately 4% of full-term new born baby and approximately 1% of infants at 1 year of age. This has significantclinical implications, including sterility and testicular malignancy. We present a 41 year-old man with a 24 hours history of progressive abdominal pain. A right lower-quadrant mass wasobserved during physical examination.An abdominal ultrasound (US) and computed tomographic (CT) exam was performed. US showed a soft-tissue mass on the right side of the patientabdomen, and the CT scans showed the mass on the left side. The patient underwent surgery. Histological analysisrevealed a classic seminoma in an undescended testis. The testis ultrasonography showed absence the right testis. We present a report of a seminoma in an undescended testis,which suffer pedicle torsion and modified their localization in the abdomen.

Childhood primary mesenteric seminoma.

We report an 11-year-old child who presented with an abdominal lump and was diagnosed as having an extragonal primary mesenteric seminoma. Patient was treated with 4 cycles of combination chemotherapy cisplatin, etoposide and bleomycin; he is now disease free for 2 years. We discuss and review extragonadal germ cell tumors arising from the mesentery and their management.

Seminoma primário do mediastino / Primary mediastinal seminoma

O seminoma é um tumor maligno de células germinativas que possui como sitio primário preferencial os testículos, embora existam raros casos de localização extra-gonadal. Os autores relatam caso de seminoma primário de mediastino em paciente masculino, 26 anos de idade, que apresentava dispnéia progressiva, tosse seca, rouquidão, dor torácica eventual, obstrução óbvia da veia cava superior e massa volumosa e palpável no mediastino ântero-superior. O diagnóstico etiológico foi suspeitado pelos exames de imagem, anatomopatológico e marcadores séricos e firmado pelo estudo imuno-histoquimico. Não havia evidência de metástase à distância, mas o tumor estava localmente avançado. O tratamento proposto foi poliquimioterápico com esquema PEB (cispiatina, etoposide e bleomicina) e o paciente evoluiu sem maiores intercorrências.

The seminoma is a malignant germ cell tumor that is rarely placed in an extra-testicular position. A 26 years old male patient with primary mediastinal seminoma was studied. His symptoms were: progressive dyspnea, unproductive cough, hoarseness, occasional chest pain, obvious superior vena cava obstruction, and a huge and palpable mass located in the upper anterior mediastinum. Image exams, serum markers and histological study led to diagnosis, of seminoma which was confirmed by immunohistochemical study. There was no evidence of distant metastatic disease although it was locally advanced. After the beginning of the treatment with chemotherapy, the patient's symptoms were improved.

Análisis inmunohistoquímico de los genes de reparación en cáncer testicular / Immunohystochemical analysis of the mismatch repair genes in testicular cancer

Las lesiones del DNA que permiten las mutaciones son más frecuentemente las modificaciones, pérdidas o errores en la incorporación de nucleótidos, sin embargo, numerosas vías enzimáticas permiten la reparación de estos errores. La mejor vía de reparación descrita actualmente es a través de los genes de reparación del sistema del mismatch repair genes(MMR).Se seleccionó entre el material anatomopatológico del Departamento de Anatomía Patológica de la Universidad Católica de Chile, 118 casos de tumores testiculares, de los distintos tipos histológicos que tuvieran un seguimiento clínico completo. La fecha de la cirugía testicular fue realizada entre enero de 1995 y diciembre de 1999. Todas las muestras fueron sometidas a estudio inmuno histoquímico (IHQ)para hMLH1 y hMSH2. Creemos que ambos genes se encuentra altamente expresados en los tumores localizados y su grado de expresión disminuye conforme el tumor es más avanzado (más indiferenciado). Esta observación nos permite plantear que tal vez estos genes son capaces de actuar en las primeras fases de la tumorogénesis. En resumen, el análisis IHQ aparece como una herramienta útil para ver la expresión de hMSH2 y hMLH1 en tumores testiculares, especialmente cuando se correlaciona con elementos pronóstico, entendiendo sinduda que el desarrollo de los tumores es multifuncional.

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

Cryptorchid testicular tumour presenting with torsion

An undescended, cryptorchid testis is predisposed to 3 to 40 times risk of malignancy. Torsion of a cryptorchid testis is more difficult to diagnose than a normally placed testis. We present a case of a 25-year-old man with acute abdomen due to the torsion of an intra-abdominal testis. Case Reports: A 25-year-old male reported in the Emergency Department of the Liaquat University Hospital [LUH], Hyderabad, with a history of lower abdominal pain for 3 days not responding to parenteral analgesics and vomiting. There was history of several similar past attacks resolving spontaneously. On examination, the patient was anxious, pyrexial and dehydrated with a pulse rate of 110/min. The abdomen was very tender, more so in the umbilical and sub-umbilical region. The right scrotum was empty. Digital rectal examination [DRE] revealed mild tenderness anteriorly. His leukocyte count was raised [20 x 109 /l]. Plain abdominal x-ray showed a few air-filled bowel loops in the lower abdomen. Ultrasound examination showed a well defined, mixed echogenecity mass in the pelvis. Laparotomy was performed on the same day through a right paramedian incision. A swollen and congested testis, not gangrenous, approximately 15 x 10 cms in size, was identified deep in the pelvis, which had partially twisted on its pedicle. The testis was delivered and orchidectomy was done. Postoperative recovery was uneventful. Histology revealed seminoma with marked necrosis in the removed testis. The patient was subsequently investigated to stage the tumour whence no evidence of metastases was found. The patient was referred to the Atomic Energy Medical Centre [AEMC], Jamshoro, for radiotherapy. A follow-up of nine months showed no evidence of recurrence or metastases