Rising testicular cancer incidence in Spain despite declining mortality: an age-period-cohort analysis.

BACKGROUND: Testicular cancer, primarily affecting young men, has seen an alarming rise globally. This study delves into incidence and mortality trends in Spain from 1990 to 2019 using the Global Burden of Disease (GBD) database and the Age-Period-Cohort (A-P-C) model. METHODS: We analyzed GBD data on testicular cancer cases and deaths in Spain, calculating age-standardized rates (ASIR and ASMR) and employing Joinpoint regression to identify significant shifts. The A-P-C model further dissected the effects of age, period, and birth cohort on these trends. RESULTS: A striking doubling in testicular cancer incidence was observed, from 3.09 to 5.40 per 100,000 men (1.9% annual increase), while mortality rates remained stable and even decreased in younger age groups (0.34 to 0.26 per 100,000, 0.8% annual decrease). Joinpoint analysis revealed four distinct periods of increasing incidence, with a recent slowdown. The A-P-C model highlighted a consistent rise in incidence risk with each successive generation born after 1935, contrasting with a progressive decline in mortality risk across cohorts, particularly marked for those born since the 1960s. CONCLUSION: While mortality rates are encouraging, Spain reflects the global trend of escalating testicular cancer incidence. The A-P-C analysis suggests a generational influence, but the underlying causes remain elusive. Further research is crucial to understand these trends and implement effective prevention strategies to combat this growing health concern.

The Melanoma-Associated Antigen Family A (MAGE-A): A Promising Target for Cancer Immunotherapy?

Early efforts to identify tumor-associated antigens over the last decade have provided unique cancer epitopes for targeted cancer therapy. MAGE-A proteins are a subclass of cancer/testis (CT) antigens that are presented on the cell surface by MHC class I molecules as an immune-privileged site. This is due to their restricted expression to germline cells and a wide range of cancers, where they are associated with resistance to chemotherapy, metastasis, and cancer cells with an increasing potential for survival. This makes them an appealing candidate target for designing an effective and specific immunotherapy, thereby suggesting that targeting oncogenic MAGE-As with cancer vaccination, adoptive T-cell transfer, or a combination of therapies would be promising. In this review, we summarize and discuss previous and ongoing (pre-)clinical studies that target these antigens, while bearing in mind the benefits and drawbacks of various therapeutic strategies, in order to speculate on future directions for MAGE-A-specific immunotherapies.

Impacto de una maniobra educativa sobre el conocimiento y actitud de la autoexploración testicular / Impact of an educational intervention on the knowledge of testicular self-examination and attitudes toward it

Introducción: Se ha descrito que la autoexploración testicular se realiza en un bajo porcentaje de los adolescentes. Objetivo: Evaluar el impacto de una maniobra educativa a corto y largo plazo (6 meses) sobre el conocimiento y la actitud de los adolescentes varones en la autoexploración testicular. Métodos: Se realizó un cuasiexperimento, antes y después en adolescentes varones. Se validó un cuestionario para evaluar el conocimiento y la actitud (conciencia, intenciones y comportamiento) sobre la autoexploración testicular. La maniobra educativa consistió en una charla informativa de manera grupal que incluía esquemas y folletos. Se les aplicó el cuestionario antes y después de la maniobra educativa. Se citaron a los 6 meses posteriores y se les dio nuevamente la charla aplicándose un cuestionario antes y después de la misma. Resultados: Se incluyeron 139 adolescentes con una mediana para la edad de 14 años. El conocimiento (18,3% vs. 78,9% p=0,02) y la actitud (5,6% vs. 53,5% p=0,02) mejoraron posteriormente a la primera charla informativa. A los 6 meses de seguimiento (n=98) el conocimiento no se modificó (87,0% vs. 93,0% p=0,671); sin embargo, la actitud mejoró tras la segunda charla (58,0% vs. 78,0% p=0,009). Conclusión: Una maniobra educativa sobre la autoexploración testicular mejoró la proporción de una adecuada actitud (5,6% vs. 53,5%) y conocimiento (18,3% vs. 78,9%) en los adolescentes. El reforzamiento de la maniobra a los 6 meses mejora la proporción de adolescentes con una adecuada actitud (53,5% vs. 86,4%). (AU)

Introduction: There is evidence that the percentage of adolescents that practice testicular self-examination is low. Objective: To assess the short-term and long-term (6 months) impact in male adolescents of an educational intervention on the knowledge of testicular self-examination and attitude toward it. Methods: We conducted a quasi-experimental pre-test post-test study in male adolescents. A questionnaire was validated to assess knowledge on testicular self-examination and attitudes towards it (awareness, intentions, and behaviour). The educational intervention was group-based and consisted in an instructional talk with the aid of diagrams and brochures. The questionnaire was administered before and after the intervention. A follow-up was scheduled 6 months later, and the talk was delivered again, with administration of the questionnaire before and after. Results: The study included 139 adolescents with a median age of 14 years. We found an improvement in knowledge (18.3% vs. 78.9%; P=.02) and attitude (5.6% vs. 53.5%; P=.02) after the initial intervention. At the 6-month follow-up (n=98), there was no change in knowledge (87.0% vs. 93.0%; P=.671), but attitude improved after the second intervention (58.0% vs. 78.0%; P=.009). Conclusion: An educational intervention on testicular self-examination improved the proportion of adolescents with an adequate attitude (5.6% vs. 53.5%) and adequate knowledge (18.3% vs. 78.9%). The repetition of the intervention at 6 months increased the proportion of adolescents with an adequate attitude (53.5% vs. 86.4%). (AU)

Impact of an educational intervention on the knowledge of testicular self-examination and attitudes toward it.

INTRODUCTION: There is evidence that the percentage of adolescents that practice testicular self-examination is low. OBJECTIVE: To assess the short-term and long-term (6 months) impact in male adolescents of an educational intervention on the knowledge of testicular self-examination and attitude toward it. METHODS: We conducted a quasi-experimental pre-test post-test study in male adolescents. A questionnaire was validated to assess knowledge on testicular self-examination and attitudes towards it (awareness, intentions, and behaviour). The educational intervention was group-based and consisted in an instructional talk with the aid of diagrams and brochures. The questionnaire was administered before and after the intervention. A follow-up was scheduled 6 months later, and the talk was delivered again, with administration of the questionnaire before and after. RESULTS: The study included 139 adolescents with a median age of 14 years. We found an improvement in knowledge (18.3% vs 78.9%; P = 0.02) and attitude (5.6% vs 53.5%; P = 0.02) after the initial intervention. At the 6-month follow-up (n=98), there was no change in knowledge (87.0% vs 93.0%; P = 0.671), but attitude improved after the second intervention (58.0% vs 78.0%; P = 0.009). CONCLUSION: An educational intervention on testicular self-examination improved the proportion of adolescents with an adequate attitude (5.6% vs 53.5%) and adequate knowledge (18.3% vs 78.9%). The repetition of the intervention at 6 months increased the proportion of adolescents with an adequate attitude (53.5% vs 86.4%).

Linfoma testicular primario. A propósito de 2casos nuevos / Primary testicular lymphoma. Two new case reports

El linfoma testicular primario es una entidad muy poco frecuente; sin embargo, su curso clínico es desfavorable, con una elevada tasa de recaídas y baja supervivencia. A propósito de su baja prevalencia, presentamos 2casos con la actualización en el tratamiento y evolución. (AU)

Primary testicular lymphoma is a very rare entity. However, its clinical course is poor with a high recurrence and low survival rate. Given its low prevalence, we present 2cases with an update on the treatment and progression of this disease. (AU)

[Primary testicular lymphoma. Two new case reports]. / Linfoma testicular primario. A propósito de 2casos nuevos.

Primary testicular lymphoma is a very rare entity. However, its clinical course is poor with a high recurrence and low survival rate. Given its low prevalence, we present 2cases with an update on the treatment and progression of this disease.

[Male infertility and urologic cancers: Advances in studies].

Male infertility is one of the most common diseases in andrology. Studies show that male infertility is significantly correlated with the incidence and mortality of tumors, especially malignant tumors in the genitourinary system, such as testis cancer and prostate cancer. The relationship of male infertility with genitourinary system tumors involves various aspects, mainly including changes in chromosome mutations, epigenetic marks, hormonal imbalance, and congenital deformity. Besides, some chronic diseases are shown to be significantly associated with male infertility, and semen quality or fertility status may be biomarkers of the overall health of males. In-depth studies of the correlation between male infertility and these factors are very important for an insight into the pathogenesis and prevention of the related diseases.

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

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

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

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

Manejo de pacientes con tumores de células germinales en primera recaída / Management of patients with germinal cell tumors in first relapse

Resumen Los tumores de células germinales (TCG) son las neoplasias malignas más comunes y afectan especialmente a hombres jóvenes de 15 a 35 años de edad. Los pacientes con estadios 2 y 3 que recaen ofrecen un gran reto para el tratamiento inicial de la primera recaída. La terapia óptima para estos pacientes depende de su tratamiento inicial y está pobremente definida. Las opciones incluyen regímenes de segunda línea de quimioterapia a dosis convencionales que combinan cisplatino e ifosfamida, con vinblastina, etopósido o paclitaxel, o quimioterapia de altas dosis con soporte de células madre. En vista de que todavía no hay evidencia concluyente en los ensayos clínicos, las indicaciones para el uso de quimioterapia de altas dosis permanecen poco claras y se basan en estudios fundamentalmente retrospectivos. El tratamiento en la segunda recaída debe individualizarse según el paciente y el tratamiento previo. La resección quirúrgica de masas residuales luego de la quimioterapia es un elemento clave para una terapia exitosa en pacientes con marcadores tumorales negativos. Actualmente, en Venezuela los pacientes que presentan recaídas deben recibir tratamiento con cualquiera de los regímenes establecidos que se utilizan a dosis convencionales en segunda línea. En algunos casos, los pacientes deben recibir tratamiento en centros de oncología con un manejo multidisciplinario que permita el acceso a tratamiento con altas dosis de quimioterapia y a cirujanos oncólogos expertos en esta patología.

Abstract Germ cell tumors (GCT) are the most common malignant neoplasms affecting young men aged 15 to 35 years. Patients with previous stage 2 and 3 who relapse offer a great challenge to the Medical team. The optimal therapy for these patients with recurrent disease is still poorly defined. Options include second-line chemotherapy regimens at conventional doses which combine cisplatin and ifosfamide, with vinblastine, etoposide or paclitaxel, or alternatively high-dose chemotherapy with stem cell support. As there is still no conclusive evidence from clinical trials, the indications for the use of high-dose chemotherapy remain unclear. Most of the present literature is based in retrospective studies. Second relapse treatment options should be individualized according to the patient and his previous treatment. Surgical resection of residual masses in patients with negative markers after chemotherapy is a key element for successful therapy. Currently, patients in Venezuela who have relapses should receive treatment with any of the established regimens that are used at conventional doses in the second line, however in some cases they should receive treatment in an oncology center with a multidisciplinary team having access to treatment with high dose chemotherapy and to oncologist surgeons who are experts in this area.

Lymph node density in retroperitoneal lymph node dissection as a novel marker for predicting recurrence in patients with germ cell testicular cancer: A case-control study and long-term clinical experience of a tertiary referral hospital. / La densidad de los ganglios linfáticos en la linfadenectomía retroperitoneal como marcador novel para predecir la recurrencia en pacientes con cáncer testicular de células germinales: estudio de casos y controles y experiencia clínica a largo plazo de un hospital de referencia terciario.

INTRODUCTION AND OBJECTIVES: In this retrospective study, we aimed to evaluate lymph node (LN) density in retroperitoneal lymph node dissection (RPLND) to analyze whether residual mass after chemotherapy might behave as predicting factor for recurrence in patients with germ cell testicular cancer (GCTC). MATERIALS AND METHODS: The data of 185 patients that were operated between 12/2004 and 02/2017 because of GCTC were reviewed retrospectively. LN density was calculated. The patients were compared statistically in terms of demographic features, tumor characteristics, serum tumor marker levels, treatment strategies, and pathological results according to GCTC subtypes. Correlation analysis was performed to determine the parameters related to recurrent disease. RESULTS: The median follow-up was 79 (31-179) months and the median age of the patients was 23 (16-71). The median tumor size was 4 (1-18) cm. Five (2.7%) patients had metastatic disease at initial diagnosis. Seminoma, non-seminomatous-GCT and mix type-GCTC was detected in 62 (33.5%), 60 (32.4%) and 63 (34.1%) patients, respectively. Following inguinal orchiectomy, 48 (25.9%) patients underwent follow-up, 126 (68.1%) patients underwent chemotherapy and 11 (5.9%) patients underwent radiotherapy. A total of 21 (11.4%) patients underwent post-chemotherapy RPLND. Early and late recurrence was seen in 3 (1.6%) and 2 (1.1%) of the patients, respectively. A mild to moderate, negative, but significant correlation was found between the recurrence and the number of LNs containing metastatic deposits and LN density (r= -0.490, P=.024 and r= -0.450, P=.041, respectively). CONCLUSIONS: There was a negative correlation between the number of LNs containing metastatic deposits and LN density and recurrent disease.

The role of preoperative albumin to globulin ratio in predicting prognosis in testicular cancer patients. / La relación albúmina/globulina preoperatoria como factor pronóstico en pacientes con cáncer testicular.

INTRODUCTION AND OBJECTIVES: In recent years, the incidence of testicular cancer has increased, but mortality rates have decreased thanks to the improvements in treatment. Although primary tumor characteristics and serum tumor markers are associated with metastasis and relapse, their predictive value is not reliable. Therefore, there is a need for new biomarkers that predict prognosis. In this study, we aimed to investigate the role of preoperative albumin to globulin ratio (AGR) in predicting retroperitoneal lymph node (RPLN) involvement, distant metastasis and prognosis in testicular cancer. MATERIAL AND METHODS: We retrospectively analyzed the medical records of all patients that underwent radical inguinal orchiectomy at our hospital between 2007 and 2018. AGR was calculated using the equation: AGR=serum albumin/(serum total protein-serum albumin). The predictive value of AGR for RPLN involvement and distant metastasis was evaluated using receiver operating characteristic analysis and its prognostic value was evaluated using Kaplan-Meier survival analysis. RESULTS: A total of 115 patients with a mean age of 33.4±7.7years were included in the study. In multivariate analysis, AGR less than 1.47 and the presence of lymphovascular invasion were detected as the factors predicting RPLN involvement and distant metastasis. The AGR of patients who had died was significantly lower than AGR of those who were alive, 1±0.2 versus 1.6±0.3 (P=.001). In Kaplan-Meier survival analysis, the mean survival of patients with higher AGR (>1.47) was found longer than patients with lower AGR (<1.47). CONCLUSIONS: Preoperative AGR is a biomarker that may be used in predicting RPLN involvement, distant metastasis and prognosis in testicular cancer.

Is testicular microlithiasis a really innocent condition? Its effects on oncological outcomes of germ cell testicular cancer: An observational study. / ¿Son las microlitiasis testicular realmente un síntoma sin transcendencia? Sus efectos en los resultados oncológicos en el cáncer de testículo: estudio observacional.

OBJECTIVES: Although it is a well known condition that presence of testicular microlithiasis (TM) with the co-occurrence of specific risk factors such as historyof previous germ cell testicular cancer (GCTC), infertility, undescended testes or atrophic testes have high risks for GCTC development, TM is still a controversial topic. Its effects on oncological outcomes have still not been investigated in detail. In this study, we aimed to evaluate whether the presence of TM has an effect on GCTC prognosis and oncological outcomes. METHODS: Seventy five patients among 93 patients who underwent radical orchidectomy between January 2010 and February 2016 were selected and divided into two groups. Group I consisted of 51 patients without TM. Group II consisted of 24 patients with TM. Each groups were compared in terms of demographic datas, prognostic risk factors, complete blood count parameters and oncological outcomes. RESULTS: During the median follow-up of 58 (1-106) months, a significantly higher local recurrence rate (54.2% vs. 3.9%, p<0.001) distant metastasis rate (58.3% vs. 5.9%, p<0.001) and lower cancer-specific survival rate (45.8% vs. 94.1%, p<0.001) were observed in patients with TM. In this group, the duration of recurrence-free survival (47.65±9.45 vs.101.96±2.80 months, p<0.001), metstais-free survival (49.50±8.88 vs. 100.00±3.36 months, p<0.001) and cancer-specific survival (54.37±8.76  vs. 100.19±3.25 months, p<0.001) were also statisticaly lower. In multivariate analysis, ß-hCG, LDH, neutrophil/lymphocyte ratio, monocyte/lymphocyte ratio and the presence of undescended testis were found as independent predictive factors for local recurrence, distant metastasis and cancer-specific survival. Red blood cell distribution width and the presence of testicular microlithiasis were found to be independent predictive factors for local recurrence. CONCLUSION: According to our results, bilateral TM was associated with higher rates of local recurrence, distant metastasis and cancer spesific mortality in presenceof risk factors, regardless of classic or limited microlithiasis.

OBJETIVO: Aunque es bien conocida la presencia de microlitiasis testiculares con el desarrollo de cáncer testicular, la infertilidad, teste no descendido o atrofia testicular, aun es un tema controvertido. Los efectos en los resultados oncológicos no han sido estudiados en detalle. En este estudio, nuestro objetivo ha sido evaluar la presencia de microlitiasis en los resultados oncológicos del cáncer de testículo.MÉTODOS: Un total de 75 pacientes fueron incluidosen el análisis de un total de 93 pacientes que recibieron una orquiectomía radical entre enero 2010 y febrero 2016. Los pacientes se dividieron en 2 grupos: I- consta de 51 pacientes sin microlitiasis, II consta de 24 pacientes con microlitiasis. Ambos grupos fueron comparados en términos de variables demográficas, factores de riesgo, analítica sanguínea y resultados oncológicos. RESULTADOS: La mediana de seguimiento fue de 59 meses (1-106). Se observó un incremento significativo de la recurrencia local (54,2% vs. 3,9%, p<0,001), metástasis a distancia (58,3% vs. 5,9%, p<0,001) y bajada de la supervivencia cáncer especifica (45,8% vs. 94,1%, p<0,001) en pacientes con microlitiasis. En este grupo, la duración de la superviviencia libre de recurrencia (47,65±9,45 vs.101,96±2,80 meses,p<0,001), supervivencia libre de metástasis (49,50±8,88 vs. 100,00±3,36 meses, p<0,001) y supervivencia cáncer especifica (54,37±8,76 vs.100,19±3,25 meses, p <0,001) fueron también menores. Al estudio multivariado, ß-hCG, LDH, neutrophil/lymphocyte ratio, monocyte/lymphocyte y la presencia de testes no descendido fueron factores independientes predictores de recurrencia local, metástasis a distancia y supervivencia cáncer-especifica. La distribución de los hematíes y la presencia de microlitiasis fueron factores independientes de recurrencia local. CONCLUSIONES: Las microlitiasis bilaterales se asocian a mayor tasa de recurrencia local, metástasis a distancia y supervivencia cáncer especifica, independientemente de su tamaño.

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

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

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

Linfoma no Hodgkin. Presentación de una tumoración testicular / Non-Hodgkin lymphoma. Presentation of a testicular tumor

RESUMEN Se presenta un paciente de sexo masculino de 64 años, residente en la parroquia Lizarzaburu, Cantón Riobamba, provincia de Chimborazo, Ecuador, estudiado en el año 2014, con el objetivo de mostrar las particularidades del linfoma no Hodgkin, de localización testicular; detectado clínicamente como un aumento de volumen difuso e imagenológicamente como tumoración testicular, confirmado histopatológicamente. En esta localización, su forma de presentación puede asociarse a dificultades en su diagnóstico, incluso durante la interpretación de las láminas histológicas, como se evidencia en esta publicación. Por su poca frecuencia de presentación y como causa de este el linfoma no Hodgkin en particular, existe una escasa documentación bibliográfica sobre este tema. Se recogieron los datos de la historia clínica individual, familiar y hospitalaria, así como los resultados de exámenes realizados.

ABSTRACT We present a 64 year-old male patient, from Lizarzaburu parish, Cantón Riobamba, Chimborazo province, Ecuador. He was studied in 2014, for showing peculiarities of non-Hodgkin's lymphoma of testicular location; clinically detected as diffuse and imaging volume increase, as a histopathologically confirmed testicular tumor. As evidence in this publication, tumor appearance in this location can be associated with difficulties in its diagnosis, even during the interpretation of the histological slides. Due to the low testicular cancer frequency of appearance, and specially this kind of non-Hodgkin's lymphoma, literature on this subject is scarce. Individual data, family and hospital clinical history were collected as well as tests results.

Ophthalmological changes of the posterior segment in patients with testicular cancer in a mixed-race population of the General Hospital of Mexico. / Alteraciones oftalmológicas del segmento posterior en pacientes con cáncer testicular en población latino-mestiza del Hospital General de México.

INTRODUCTION: The curing of a testicular tumour is currently feasible in more than 95% of patients, and in 80% of those with metastases. Until now, there has been no study or series of cases that describe the ocular changes of the posterior segment associated with testicular cancer. OBJECTIVE: To evaluate patients with a diagnosis of testicular cancer in order to determine the presence of changes in the posterior segment and the relationship to the stage. MATERIAL AND METHOD: An observational, cross-sectional, and descriptive study was conducted on 21 male patients (42 eyes) with a diagnosis of testicular cancer. Age, histological type, time of evolution, stage, treatment, and comorbidities were recorded, as well as visual acuity measurement (LogMAR), biomicroscopy of the anterior segment, and photographic records of the posterior pole and peripheral retina. RESULTS: The mean age was 29 years (18-43 years). All (100%) of the patients were treated surgically. The most frequent histological type was classic seminoma (42.8%), followed by the mixed germinal tumour (38.0%). At the time of evaluation, 42.8% of patients had a stage II, and 23.8% had distant metastasis. The changes in the posterior segment were: vascular tortuosity (14.2%), retinopathy associated with cancer (9.5%), choroidal metastasis (9.5%), pigmentary changes of the retinal pigment epithelium (9.5%), and retinal metastasis (4.7%). CONCLUSIONS: It is possible to find changes at the level of retinal pigment epithelium, as well as vascular tortuosity, retinopathy associated with cancer, and choroidal and/or retina metastases.

Glyoxalases in Urological Malignancies.

Urological cancers include a spectrum of malignancies affecting organs of the reproductive and/or urinary systems, such as prostate, kidney, bladder, and testis. Despite improved primary prevention, detection and treatment, urological cancers are still characterized by an increasing incidence and mortality worldwide. While advances have been made towards understanding the molecular bases of these diseases, a complete understanding of the pathological mechanisms remains an unmet research goal that is essential for defining safer pharmacological therapies and prognostic factors, especially for the metastatic stage of these malignancies for which no effective therapies are currently being used. Glyoxalases, consisting of glyoxalase 1 (Glo1) and glyoxalase 2 (Glo2), are enzymes that catalyze the glutathione-dependent metabolism of cytotoxic methylglyoxal (MG), thus protecting against cellular damage and apoptosis. They are generally overexpressed in numerous cancers as a survival strategy by providing a safeguard through enhancement of MG detoxification. Increasing evidence suggests that glyoxalases, especially Glo1, play an important role in the initiation and progression of urological malignancies. In this review, we highlight the critical role of glyoxalases as regulators of tumorigenesis in the prostate through modulation of various critical signaling pathways, and provide an overview of the current knowledge on glyoxalases in bladder, kidney and testis cancers. We also discuss the promise and challenges for Glo1 inhibitors as future anti-prostate cancer (PCa) therapeutics and the potential of glyoxalases as biomarkers for PCa diagnosis.

Tumor de células de sertoli esclerosante. Reporte de un caso / Sclerosing sertoli cell tumor. Case report

RESUMEN El tumor esclerosante de células de Sertoli del testículo es una entidad patológica infrecuente, con todo, que solo se han descrito 22 casos en la literatura científica. Son descritos como tumores unilaterales que en su mayoría se presentan entre la tercera y sexta década de vida, siendo carentes de malignidad, sin embargo, en ninguno de los casos reportados se han realizado seguimientos por periodos prolongados. Se presenta un caso clínico cuyo objetivo es socializar el primer caso de tumor esclerosante de células de Sertoli (SSCT), diagnosticado por el departamento de patología de la Universidad industrial de Santander, que se registra en Colombia. Después de tres años de seguimiento clínico el paciente no presenta recidiva, así como tampoco otras lesiones tumorales. Se considera la orquiectomia el tratamiento curativo.(AU)

SUMMARY Sclerosing tumor of Sertoli cells of the testis is an infrequent pathological entity, only 22 cases have been described in the scientific literature. They are described as unilateral tumors that mostly occur between the third and sixth decade of life, being devoid of malignancy, however, in none of the cases have been followed for prolonged periods. We present a clinical case whose objective is to socialize the first case of Sertoli cell sclerosing tumor (SSCT), diagnosed by the pathology department of the industrial university of Santander, which is registered in Colombia. After three years of clinical follow-up, the patient does not present recurrence, as well as other tumor lesions. Orchiectomy is considered the curative treatment.(AU)

[German national second-opinion network for testicular cancer and penile carcinoma : Two sources for evidence-based information]. / Nationale Zweitmeinungsnetzwerke Hodentumoren und Peniskarzinom : Zwei "Evidenz-Pipelines".

BACKGROUND: The second-opinion network for testicular cancer is an internet-based platform addressing physicians treating testicular cancer patients. They are offered a second-opinion before determining further therapy after orchiectomy and completion of staging. THEME: The high rate of discrepancies between the first and second opinion in more than 30 % supports the assumption of a deficit in the implementation of treatment guidelines. In 2015, approximately 22 % of the newly diagnosed cases with testicular cancer in Germany were covered by this system. According to the present interim analysis, the second-opinion platform helps to avoid overtreatment of testicular cancer patients. The high acceptance of the project and the encouraging results of this interim analysis gave rise to considerations to apply the second-opinion model to penile carcinoma. Data from the UK and the Netherlands show that the second-opinion network for penile cancer could help to improve treatment standards and results in Germany. Current data and the intended further development of the system are discussed.

ONCO-TESE: Obtaining spermatozoa after radical orchiectomy for testicular tumour and azoospermia.

OBJECTIVE: There is the possibility of diagnosing azoospermia in cases of testicular tumours in patients who wish to preserve fertility. Our objective is to present a technique for obtaining spermatozoa from testicles with ex vivo tumours in order to preserve fertility in these patients. MATERIAL AND METHODS: A 34-year-old patient was referred for azoospermia. The physical examination revealed a node in the lower pole of the left testicle. In the scrotal ultrasound, the testicle presented disperse microcalcifications and a 1-cm hypoechoic mass in the lower pole. The tumour markers were negative, and the CT showed no distant disease. Left radical orchiectomy was performed, along with the placement of a testis prosthesis. Bench surgery was then performed, with extraction of the seminiferous tubules in the upper pole. RESULTS: Of the submitted samples, 4 progressive and 1 nonprogressive motile spermatozoa were identified per field. Two samples were cryopreserved. The pathological report indicated the presence of a seminoma measuring 1.3 × 1 cm, with free margins and with no invasion of the rete testis (stage I). An assisted reproduction technique (intracytoplasmic sperm injection) was performed on the patient's partner with the frozen spermatozoa, which resulted in pregnancy and the subsequent birth of a healthy child. CONCLUSION: We propose this technique as the method of choice for obtaining spermatozoa from patients who simultaneously present azoospermia and testicular tumours and who wish to preserve their fertility.

[Bilateral and synchronous testicular teratoma: a case report and literature review]. / Teratoma testicular bilateral sincrónico: reporte de un caso y revisión de la literatura.

BACKGROUND: Testicular germ-cell carcinoma is the most frequent neoplasm in males aged 15 to 35 years old. It is bilateral in 2% to 3%, and synchronous in 20% to 25% of the cases. CLINICAL CASE: The case is presented of a 19 year-old male, with abdominal pain. Physical examination revealed abdominal mass in the umbilical region, and the computed tomography scan showed a retroperitoneal tumour, with α-fetoprotein, lactate dehydrogenase, and human chorionic gonadotropin above limits. Testicular ultrasound showed bilateral lesions. Exploratory laparotomy was performed, identifying an unresectable retroperitoneal tumour. Biopsies were taken, reporting mixed germ cell tumour composed of choriocarcinoma and embryonal carcinoma. Six cycles of chemotherapy were given, based on bleomycin, etoposide and cisplatin, with partial tumour response. Later on, the patient underwent bilateral radical orchiectomy, with pathology reporting a synchronous bilateral testicular teratoma. A second line of chemotherapy was given, based on vincristine, etoposide, ifosfamide and cisplatinum. Nevertheless, the disease progressed, with metastatic dissemination and the patient died. DISCUSSION: Germ cells tumours can present in primary extra-gonadal locations. It is difficult to distinguish a retroperitoneum primary germ cell tumour from metastatic disease of a clinically undetected gonadal tumour or one that has regressed, like the situation described in the case presented. CONCLUSIONS: Ninety percent of patients diagnosed with germ cell tumours can be cured. However, delay in diagnosis correlates with an advanced clinical stage and poor prognosis.