Case Of Testicular Tumor Research Articles

Age related differences in primary testicular lymphoma: A population based cohort study.

Primary testicular non-Hodgkin's lymphoma (PTL) is a very rare disease, comprising 1% of all non-Hodgkin's lymphoma and <5% of all cases of testicular tumors. With a median age at diagnosis of 67 years, PTL is the most common testicular malignancy in men aged >60 years. There is limited published data on PTL incidence and outcomes in younger patients. The aim of this study is to compare the clinical parameters and survival outcomes between the patients older and younger than 50. The SEER database was queried for all patients diagnosed with PTL between 1983 and 2017. Data collected consisted of demographic, and clinical parameters, including staging, pathological assessments, and survival data. Patients were stratified according to their age and compared. There was a total of 1,581 patients diagnosed with PTL between the year 2000 and 2017, of whom 215 (13.6%) were younger than 50 years old. The median age at diagnosis was 41 (interquartile range [IQR] 1-50), and 72 (IQR 51-95) years old for patients ≤50 and patients > 50 years of age, respectively. Comparison of younger and older patients detected similarities in disease laterality (92% vs. 94%, P = 0.38) and Ann Arbor stage I to II at diagnosis (76% vs. 75%, P = 0.59). The most common diffuse large B-cell lymphoma (DLBCL) subtype was more common in older patients (61% vs. 87%, P < 0.001). Radical orchiectomy (71% vs. 79%, P = 0.004) and radiation treatment (40% vs. 37%, P = 0.49) rates were comparable between both groups. However, a higher proportion of younger patients underwent chemotherapy (83% vs. 72%, P < 0.001). Patients ≤50 and >50 years old had a hazard ratio (HR) of 0.63 (95% CI: 0.57-0.71) and 0.34 (95% CI: 0.31-0.37), respectively, for 10-year OS with a median survival time for patients >50 of 5.75 years (95% CI: 5.25-6.33), P < 0.001. Patients ≤50 years old had a HR of 0.33 (95% CI: 0.26-0.40) compared to HR of 0.40 (95% CI: 0.37-0.43) in patients >50 years old for cumulative disease-specific mortality (DSM, P = 0.0204). Age >50 years was associated with worse DSM with a HR of 1.39 (95% CI: 1.05- 1.86, P = 0.024). Ann Arbor stage II and higher was also associated with worse DSM, while undergoing surgery, radiotherapy, and chemotherapy were associated with improved DSM. PTL is the most common testicular malignancy in men older than 60 years of age, but more than a quarter of the patients are younger than 60 and more than 13% are ≤50 years. Younger patients are more likely to receive chemotherapy and radiation, and overall do better in terms of DSM. Being younger, having a lower Ann Arbor stage and being treated with chemotherapy and radiotherapy increase the chances of survival.

The value of contrast-enhanced ultrasonography in differential diagnosis of primary testicular germ cell tumors and non-germ cell tumors over 50 years old.

Unlike young and middle-aged patients, seminoma is not common in patients with primary testicular tumors over the age of 50, so it cannot follow the general ideas and norms for diagnosing and treating testicular tumors, and its characteristics need to be considered separately. The conventional ultrasonography and contrast-enhanced ultrasonography (CEUS) findings of primary testicular tumors in patients over 50 years old were retrospectively analyzed and compared with the pathological results to compare the diagnostic value of these two methods. Of the 13 primary testicular tumors, 8 were primary lymphomas. Conventional ultrasound of 13 cases of testicular tumors showed hypoechoic with rich blood flow, and it was difficult to identify the type accurately. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of conventional ultrasonography in diagnosing non-germ cell tumors (lymphoma and Leydig cell tumor) were 40.0%, 33.3%, 66.7%, 14.3%, and 38.5%, respectively. CEUS findings: 7 of 8 lymphomas showed uniform hyperenhancement. 2 cases of Leydig cell tumors showed uniform high enhancement. 2 cases of seminoma and 1 case of spermatocytic tumor showed heterogeneous enhancement, with necrosis in the interior. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate of non-germ cell tumor diagnosis according to the non-necrotic area of CEUS were 90.0%, 100.0%, 100.0%, 75.0% and 92.3%, respectively. Compared with conventional ultrasound, the difference was statistically significant (P=0.039). Primary testicular tumors in patients over 50 years old are mainly lymphoma, and CEUS is significantly different between germ cell tumors and non-germ cell tumors. Compared with conventional ultrasound, CEUS can distinguish testicular germ cell tumors from non-germ cell tumors more accurately. Preoperative ultrasonography is significant for accurate diagnosis and can guide clinical treatment.

Clinical challenge: a case of testicular tumor disguised as a prenatal testicular torsion

BackgroundNeonatal tumors account for a minority of prepubertal testicular tumors. Similarly, testicular torsion in the neonate within the intrauterine or postnatal period is a rare event with an estimated incidence of 6 per 100,000. Testicular salvage is almost never achieved in cases of prenatal testicular torsion and there is still no consensus on the ideal management.Case presentationA neonate with prenatal testicular torsion that underwent inguinal orchiectomy. On pathological examination, an uncharacterizable, multicystic, and well-delineated testicular tumor was identified. Although rare, testicular tumor presenting as neonatal testicular torsion should be considered in the differential diagnosis of an acute neonatal scrotum.ConclusionsThis case highlights that an inguinal approach for surgical exploration in prenatal testicular torsions may be preferred given the risk, albeit extremely low, of an underlying testicular tumour.

A Clinical Study of Scrotal Swelling and its Various Treatment Modalities

Aim: To study the etiology, clinical presentation, investigations, treatment modalities &amp; their outcomes, post operative complications for scrotal swellings and follow up. Materials and Methods: The cases admitted to the surgical wards over a period of one and a half years i.e., November 2018 to May 2020, formed the material for this study. During this period 100 cases with h/o scrotal swelling admitted in various surgical units, selected at random were studied in detail as per proforma. Sampling Method: A Simple Random Sampling Results: 100 cases of scrotal swellings were studied and compared based on age, occupational distribution, mode of presentation, duration of symptoms, predisposing factors, treatment modalities and post operative complications. Conclusions: Scrotal swelling was commonest symptom. The other symptoms included pain/ heaviness of scrotum, fever, etc. • Definitive surgery was done in 90 cases. • Various forms of hydrocele constituted a major portion of the study (50 cases). • Varicocele was the second commonest cause comprising of 13 cases. • A total of 9 cases of Fournier”s gangrene, 6 cases of torsion of testis including one with scrotal abscess. • There were 09 cases of epididymo-orchitis, 4 cases of testicular tumor, 3 cases each of sebaceous cyst and encysted hydrocele of cord and 2 cases of hydrocele with hernia. Keywords: Treatment modalities; Scrotal swellings; Hydrocoele; Varicocele; Outcome.

CLINICOPATHOLOGICAL PATTERN OF TESTICULAR TUMORS A 3-YEARS EXPERIENCE AT A TERTIARY CARE UROLOGY CENTER

Objective: To evaluate the clinical presentation of testicular tumors and their histological pattern present in our setup.&#x0D; Study Design: Case series.&#x0D; Place and Duration of Study: Armed Forces Institute of Urology (AFIU) Rawalpindi, from Jul 2016 to Jun 2019.&#x0D; Methodology: The documents of all the cases of testicular tumors presenting in the last 3 years were retrieved and their relevant clinical detail: age, clinical presentation, side of involvement, operative procedure conducted and the histopathology report were documented.&#x0D; Results: Thirty two patients of testicular tumors were documented over a period of three years, making 10.66 cases reporting per year. The mean age was 30.10 ± 15.42 years, with the youngest 3 months old infant and the eldest being 58 years of age. The tumors were commonest on the right (59.3%) with 81.2% presentation as swelling of testis. Radical orchiectomy was performed in 90.6% of the cases and retro peritoneal lymph node dissection (RPLND) in 6.2%. Germ cell tumors were found in 71.8% cases with mixed germ cell tumorbeing the commonest histopathology seen in 31.2% of the cases followed by the seminoma (25%) and non-Hodgkin lymphoma (12.5%).&#x0D; Conclusion: Testicular tumors were relatively uncommon in our part of the world with a limited number of cases presenting to a tertiary care urology center. The presentation was variable but a rising trend in non-Hodgkin lymphoma results in a decrease in the overall number of germ cell tumors.

Transcriptome modulation following administration of luteolin to bleomycin-etoposide-cisplatin chemotherapy on rat LC540 tumor Leydig cells.

Leydig cell tumours represent 1%-3% of all cases of testicular tumours in men. Such tumours respond poorly to radiation or chemotherapy, including bleomycin-etoposide-cisplatin (BEP) combinatorial therapy. In this study, we investigated an alternative approach involving luteolin to improve the efficacy of chemotherapy. LC540 tumour Leydig cells were treated with BEP (bleomycin 40µg/ml, etoposide 4µg/ml, cisplatin 8µg/ml) and/or luteolin 10µM for comparison with DMSO-treated cells. We performed a transcriptome analysis using RNA-Seq to characterise changes in biological processes and signalling pathways. Treatments of LC540 tumour Leydig cells with luteolin significantly decreased the expression of genes involved in cholesterol biosynthesis, while increasing the expression of genes related to glutathione conjugation (p<.05). Genes being significantly upregulated in response to BEP treatment were involved in the response to toxic substances and transcriptional regulation. Oppositely, genes being significantly downregulated by BEP treatment were enriched for intracellular signal transduction, cell migration, cell adhesion, reproductive system development and cholesterol biosynthesis. BEP chemotherapy proved to be effective in increasing gene expression related to apoptosis of tumour Leydig cells. However, addition of luteolin to BEP treatment had no other effects on biological processes or pathways related to cancer treatment.

Testis Sparing Surgery in Pediatric Testicular Tumors.

Simple SummaryTestis sparing surgery (TSS) is a safe treatment option in selected cases of testicular tumors in adults, focusing on technical feasibility, oncologic safety, preserving of testicular function, and long-term outcome. This surgical technique is also increasingly being considered in children, as benign tumors are more common in this population. With this systematic review, we aim to evaluate outcome of TSS and to investigate under which circumstances TSS can be considered safe in boys with testicular tumors. Based on the current practice described in this systematic review, combined with the outcome of TSS, we would like to suggest an algorithm to guide clinicians in determining the appropriate surgical treatment in prepubertal patients less than 12 years of age with a testicular tumor. TSS may lead to improved testicular function and quality of life in boys with testicular tumors. Objective: The purpose of this review is to evaluate the outcomes of testis sparing surgery (TSS) and to investigate under which circumstances TSS can be considered a safe treatment option in pediatric patients with testicular tumors. Methods: A database search was performed in Cochrane, Pubmed, and Embase for studies that focused on TSS as treatment for testicular tumors in the pediatric population, excluding reviews and single case reports. Results: Twenty studies, describing the surgical treatment of 777 patients with testicular tumors, were included in the analysis. The majority of pediatric patients with benign germ cell tumors (GCTs) (mean age: 3.7 years) and sex cord-stromal tumors (SCSTs) (mean age: 6.6 years) were treated with TSS, 61.9% and 61.2%, respectively. No cases of testicular atrophy occurred. Four of the benign GCTs, i.e., three teratomas and one epidermoid cyst, recurred. No cases of recurrence were reported in patients with SCSTs. Of the 243 malignant GCTs (mean age: 4.2 years), only one patient had TSS (0.4%). Conclusion: TSS is a safe treatment option for prepubertal patients less than 12 years of age with benign GCTs and low grade SCSTs.

A clinicopathological study of scrotal swellings in adults

Scrotal swelling is one of the common problem in all age groups and are commonly encountered in surgical outdoor. In our study 100 patients were included who presented with scrotal swelling in surgical outdoor.Factors such as age, presenting complaint, laterality were analysed, a definite diagnosis was made on the basis of USG and histology. Collected data was then analysed and compared to previous studies. In this study hydrocele forms the most common cause of scrotal swelling consisting of 33%.Next common cause was epididymoorchitis (31%).Other causes include 12% cases of varicocele,6% cases each of epididymal cyst and scrotal abscess, 5% cases of testicular tumour, 3% cases of sebaceous cyst and testicular torsion each and only 1% of spermatocele.

Frequency and morphological study of testicular germ cell tumor.

Objectives: To assess the frequency of various histopathological types of testicular germ cell tumor in our study population. The prime identification of testicular germ cell tumor is important to prevent the advance stage of cancers. The present study was design to assess the frequency of different morphological types of testicular germ cell tumor which have a mirror effect on the treatment and prognosis of tumor. Study Design: Cross sectional study. Setting: Department of pathology, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre Karachi. Period: 10 years period from 1st January 2006 to 31st December 2015. Material and Methods: A 34 cases of testicular germ cell tumor were studied for morphological features using all properly formalin fixed, paraffin embedded surgical pathological testicular specimens received during the above period. All relevant clinical information was recorded on designed proformas. Section were taken and stained with hematoxylin and eosin. Data entered and analysed through computer software SPSS version 21. Results: The result of study showed that the frequency of testicular germ cell tumor was 0.80% among all malignancy in male. Out of 36 cases of testicular tumor, 34 (94.5%) were germ cell tumors and remaining 02 (5.5%) cases were sex cord stromal tumor. Among 34 cases of germ cell tumor 12 (35.2%) cases of mixed germ cell tumor found which was the most common between them, followed by seminoma 10 (29.4%) cases. However 05(14.7%) of yolk sac tumor, 04 (11.6%) of teratoma and 03(8.8%) of embryonal tumor were found. Conclusion: Results revealed that frequency of different types of testicular germ cell tumor in this study were in accordance to national and international studies. However the incidence of tumor varies noticeably in different geographical areas. Different pattern of seminomas and non – seminomas also may be emerging.

Histopathological Spectrum of Testicular Tumors in a Tertiary Care Centre

Background&#x0D; Testicular tumors are rare type of tumors affecting adolescents and young adults. However, in many western countries, its incidence has been increasing. These tumors contribute for 1–2% of all malignant tumors and most malignancy in men in the age-group of 15–25 years. This study was undertaken to analyse the histopathological pattern of testicular tumors at the tertiary level hospital in Assam Medical College, Dibrugarh highlighting pathological findings, diagnostic evaluation and laterality.&#x0D; Objective&#x0D; The purpose of the study was to analyse the histopathological pattern, age-wise distribution and laterality of testicular tumors.&#x0D; Materials and Method&#x0D; This one year study was performed in the Department of Pathology, Assam Medical College, Dibrugarh, India from January 2018 to December 2018. For the study, the orchidectomy specimens received in Pathology department were subjected to routine histopathological processing followed by a detailed gross and microscopic examination. Tumor typing and subtyping were done according to WHO classification (2004).&#x0D; Results&#x0D; A total of 12 cases of testicular tumors were included in the present study. Out of these 12 cases, right testis was affected in 58.4% of cases whereas left testis was affected in 41.6% cases. Germ cell tumor was the most common type accounting for 91.5% of tumors followed by Sex cord stromal tumor (8.5%). Most tumors were seen between the age-group of 21–30 years.&#x0D; Conclusion&#x0D; Testicular tumors are uncommon in our population. Study of testicular tumor is important for pathologist because grossly identifiable benign pathology may harbour focus of malignancy. At the end, we conclude that despite new technique in imaging and tumour marker assay, the diagnosis of testicular tumor is dependent on HPE only.

Sociodemographic characteristics and etiology different scrotal swellings

Scrotal swelling has got wide spectrum of conditions, varying from hydrocele to testicular tumours. Therefore there is a need to study the common conditions, so many benign scrotal swellings and early testicular tumours can be cured by using different modalities scrotal swellings are presented with great anxiety and embarrassment. The cases admitted to the surgical wards in Medical College Hospital and Research Center, formed the material for this study. During this period 100 cases with h/o scrotal swelling admitted in various surgical units, selected at random were studied in detail as per proforma. Scrotal swelling was the commonest presenting symptom (100%). Pain or heaviness of scrotum was seen in 30 patients (30%) and fever was seen in 12 patients (12%). One case of testicular tumor presented with weight loss.

Organ-sparing partial orchietectomy for testicular adenomatoid tumor

The incidence of testicular tumors is relatively low which are mainly malignant, so the main way to treat testicular tumors is radical testicular resection. Testicular adenomatoid tumor is a rare testicular benign tumor, but is easily misdiagnosed as malignant tumors with removal of organs. This article aims to explore the clinical features of testicular adenomatoid tumor and its treatment. There were 133 cases of testicular tumor in the Peking University Third Hospital from May 1994 to November 2016. We conducted a retrospective analysis of three patients who underwent the treatment of partial orchiectomy with preservation of the organ and were pathologically diagnosed with testicular adenomatoid tumor after surgery. The follow-up was done by outpatient clinics and telephone inquiry after surgery. The related literature was also reviewed for further discussion. Of all the 133 patients, 116 had radical resection of the testis and 17 had partial testicular resection due to specific reasons (5 cases of epidermoid cyst, 4 cases of teratoma, 3 cases of seminoma, 3 cases of adenomatoid tumor, and 2 cases of Sertoli cell tumor). The mean age of the 3 patients was (42.67±10.97) years (30-49 years), the mean hospital stay was (9.00±5.20) d (6-15 d), the mean body mass index was (26.20±1.42) kg/m2 (25.00-27.76 kg/m2), the mean serum human choionic gonadotophin (HCG) was (1.15±0.11) IU/L (1.07-1.23 IU/L) (all normal) and the mean serum alpha-fetoprotein (AFP) was (2.12±0.66) μg/L (1.65-2.58 μg/L) (both were normal). Ultrasound features revealed a clear or unclear border, solid, moderate echo nodule tumor in the testis. The mean maximal diameter of the tumor was (1.00±0.44) cm (0.50-1.30 cm), and the mean duration of intraoperative warm ischemia time was (19.67±17.10) min (0-31 min) (only the last two cases). No recurrence or malignant transformation was observed during the follow-up. Testicular adenomatoid tumor is mainly based on the characteristics of ultrasound to determine preoperatively, but easy to be misdiagnosed with testicular radical resection. The recommended surgery for adenomatoid tumor is partial resection of the testis via the inguinal approach according to the frozen section pathology to determine whether to retain the organ.

Histopathological Spectrum of Testicular Tumors in a Tertiary Care Centre

Background Testicular tumors are rare type of tumors affecting adolescents and young adults. However, in many western countries, its incidence has been increasing. These tumors contribute for 1–2% of all malignant tumors and most malignancy in men in the age-group of 15–25 years. This study was undertaken to analyse the histopathological pattern of testicular tumors at the tertiary level hospital in Assam Medical College, Dibrugarh highlighting pathological findings, diagnostic evaluation and laterality. Objective The purpose of the study was to analyse the histopathological pattern, age-wise distribution and laterality of testicular tumors. Materials and Method This one year study was performed in the Department of Pathology, Assam Medical College, Dibrugarh, India from January 2018 to December 2018. For the study, the orchidectomy specimens received in Pathology department were subjected to routine histopathological processing followed by a detailed gross and microscopic examination. Tumor typing and subtyping were done according to WHO classification (2004). Results A total of 12 cases of testicular tumors were included in the present study. Out of these 12 cases, right testis was affected in 58.4% of cases whereas left testis was affected in 41.6% cases. Germ cell tumor was the most common type accounting for 91.5% of tumors followed by Sex cord stromal tumor (8.5%). Most tumors were seen between the age-group of 21–30 years. Conclusion Testicular tumors are uncommon in our population. Study of testicular tumor is important for pathologist because grossly identifiable benign pathology may harbour focus of malignancy. At the end, we conclude that despite new technique in imaging and tumour marker assay, the diagnosis of testicular tumor is dependent on HPE only.

Solid pseudopapillary neoplasm (SPN) of the testis: Comprehensive mutational analysis of 6 testicular and 8 pancreatic SPNs.

Recently, we came with the theory of a possible relationship between a group of testicular and pancreatic tumors. We used one case of a pancreatic analogue solid pseudopapillary neoplasm of the testis composed partially of areas reminiscent of solid pseudopapillary neoplasm (SPN) of the pancreas and partially of structures identical to primary signet ring stromal tumor of the testis (PSRSTT) as a connecting link between these two entities. After demonstrating that PSRSTT and pancreatic analogue SPN of the testis share the same immunoprofile and genetic features characteristic for pancreatic SPN, we came to the conclusion that pancreatic analogue SPN of the testis and PSRSTT represent a morphological spectrum of a single entity and that both are related to the pancreatic SPN. The aim of this study is to present a series of 6 cases of testicular tumors, which lacked the signet ring cell component and were thus morphologically very similar to the SPN of the pancreas. The goal of this study is to compare the genetic background of these testicular tumors that are obviously related to the PSRSTT/pancreatic analogue SPN of the testis with the series of 8 pancreatic SPN. The mutational analysis revealed an oncogenic somatic mutation in the exon 3 of the CTNNB1 (β-catenin) gene in all analyzable (5/6) testicular and all pancreatic (8/8) tumors. The immunoprofile (positivity with β-catenin, CD10, vimentin, NSE, CD56, and negativity with inhibin, calretinin, chromogranin) was identical in all testicular and pancreatic tumors. This study expanded the morphological spectrum of the PSRSTT/pancreatic analogue SPN of the testis by adding 6 cases without the signet ring cell component. Considering the obvious analogy of PSRSTT/pancreatic analogue SPN of the testis/SPN of the testis and their relationship to the pancreatic SPN we propose the collective term "solid pseudopapillary neoplasm of the testis" for these tumors. The mutational profile of the SPN of the testis and pancreas was the same in both groups of tumors which we consider as a final proof that SPN of the testis is identical to the SPN of the pancreas.

De Novo Urologic Malignancies in Renal Transplant Recipients

BackgroundImmunosuppressed organ transplant patients have an elevated risk of malignancies. The aim of this study was to determine the incidence of urologic malignancies in renal transplant recipients, as well as to evaluate their monitoring, treatment, and outcomes. MethodsWe conducted a retrospective single-center study of 2897 renal transplants between January 1987 and December 2016. Recipients presenting with de novo urologic malignancies were evaluated. We retrospectively assessed the stage of the disease, treatment performed, and subsequent oncologic outcome. Patients with a history of preexisting cancers were excluded. ResultsSixty-one de novo urologic malignancies were recorded in 58 patients. The overall incidence of urologic malignancies was 2.2%. We identified 29 cases of prostate cancer, 23 of renal cell carcinoma, 6 of transitional cell carcinoma of the bladder, and 1 case of penile carcinoma. No cases of testicular tumors were found. The mean age at tumor diagnosis was 58.7 ± 10.1 years. The median time between renal transplantation and tumor development was 84 months (range, 2–310 months). Fifty-six (96.6%) patients received deceased donor kidneys. The overall survival rate at 5 years after diagnosis of urologic tumor was 82.8%. Tumor-related death was reported in 13.8% of patients. Nineteen (32.8%) patients had graft loss. Of these, 8 patients had no functional graft when the diagnosis of urologic tumor was made. The therapeutic options did not differ from those used in nontransplanted patients. ConclusionsDue to the increased incidence of tumors and possibly worse prognosis, renal transplant recipients should be screened more regularly.

A Case of Testicular Tumor with Cervical Lymphadenopathy as the Initial Symptom

A Case of Testicular Tumor with Cervical Lymphadenopathy as the Initial Symptom

Epidemiological Profile and Histopathological Aspects of Malignant Tumors of Testicle in Yaounde and Douala (Cameroon)

Objective: Determine the epidemiological profile and histopathological aspects of testicular cancer in the two major cities of Cameroon, Yaounde and Douala. Patients and methods: It was a retrospective cross-sectional descriptive study conducted in the reference structures approved for anatomopathological examination in Yaounde and Douala. The study was conducted over a 17-year period (2001-2017). We included all cases of histologically confirmed testicular tumors. Variables included frequency, year of diagnosis, sociodemographic data, clinical aspects, types of sampling, gross macroscopy, and histological types. Results: We collected 81 cases of testicular tumors (49 benign tumors and 32 malignant tumors), with a mean age of diagnosis of 36.27 ± 18.9 years. For malignant tumors, the mean age was 40.25 ± 25.02 years, the predominant age group was 20-29 years (25%), the predominant type of specimen was the orchidectomy %, the predominant histological types were germ cell tumors with 30% seminomas. Conclusion: Testicular tumoral pathology affects more young man and is dominated by seminoma-type germ tumors.

頸部リンパ節腫脹を初発症状とした精巣腫瘍例

頸部リンパ節腫脹を初発症状とした精巣腫瘍例

Unusual association of testicular yolk sac tumor with pectus excavatum in an 18-month-old child: A case report

Testicular tumors are rare in children, but highly treatable and usually curable. In children, testicular tumor accounts for ~ 1–2% of all tumors. Among testicular tumors, germ cell tumors have a bimodal age distribution. One peak occurs in the first 2 years of life and the second peak occurs in young adults 15–35 years of age. Germ cell tumors in children are distinct from that in adults in term of their behavior, histological nature, metastasis, and the treatment needed. Here, we present a case of testicular tumor with a chest wall deformity in an 18-month-old male child. This is the first case of testicular yolk sac tumor in an 18-month-old male child with chest wall deformity (pectus excavatum).

Robot assisted retroperitoneal lymph-node dissection after adjuvant therapy: different indications.

Today, access to technology through robotic surgery has allowed urologists to have a valuable tool in order to perform various robot -assisted laparoscopic procedures. Robotic surgery allows reproducing complex techniques such as retroperitoneal or extended pelvic lymphadenectomy. The aim of the study was to report our series of robot assisted retroperitoneal lymphadenectomy and to demonstrate its technical and oncological feasibility. A retrospective analysis on 7 patients (four cases of testicular tumors, one prostate adenocarcinoma, and two bladder urothelial carcinomas), who underwent retroperitoneal para-aortic, interaorto-cava and extended pelvic lymphadenectomy by robot assisted laparoscopic surgery, was conducted. We analyzed demographic, oncologic and operative data (surgical time, blood loss, and hospital stay). Demographic and operative data showed a mean age of 49 years (18-65), mean BMI of 26.1 kg/m2(23.7-29.1), mean operative time of198 minutes (180-220), mean estimated blood loss of 88 mL, and mean hospital stay of 3.6 days (3-5). No intraoperative complications occurred. Themean number of dissected nodes was 12 (3-20). Histopathology findings showed one case of postchemotherapy recurrenceof seminoma and six cases of fibrosis. At a mean postoperative follow-up of 39 months (7-75) no patients showed disease recurrence. Our case series demonstrated that the robot assisted approach isa feasible and reproducible option in skilled robotic surgical referral centers. The surgeons' experience and the optical magnification, associated to the degree of freedom offered by robotic assisted laparoscopy allow achievinga precise lymph node dissection, also in advanced oncologic patients.