Contralateral Testicle Research Articles

Follow‐up results regarding fixation of contralateral testis after testicular torsion in children

AbstractThe aim is to investigate the possible advantages and disadvantages of contralateral testicular fixation (CTF) for boys with testicular torsion (TT) by long‐term clinical follow‐up results. A retrospective cohort study was conducted on TT boys at Children’s Hospital of Chongqing Medical University from September 2005 to December 2020. The baseline characteristics, intraoperative findings, and clinical follow‐up results were compared between TT patients underwent orchiopexy with or without CTF, and orchiectomy with or without CTF, respectively. The χ2 test and the Fisher’s Exact test were used to compare dichotomous outcomes, and the Mann‐Whitney U test was used to compare continuous outcomes without normal distribution. A total of 140 cases were included in this study. The bell clapper deformity was found in 30.4% of all torsed testes underwent orchiopexy, 16.4% during contralateral testicular exploration, and only 10.9% in bilateral sides. Contralateral testicular volume, adverse events, and paternity rates were comparable between patients underwent orchiopexy with or without CTF, and no subsequent contralateral TT observed during follow‐up. However, those patients underwent orchiectomy without CTF had more incidence of scrotal discomfort than those had orchiectomy with CTF (P = 0.027). In addition, one boy suffered subsequent contralateral TT after orchiectomy without CTF. The incidence of bell clapper deformity was lower in this research than that of literature reports. CTF would not induce testicular volume loss, atrophy or scrotal pain. Contralateral testicular discomfort and even subsequent TT could be more easily observed during follow‐up in patients without CTF. We still recommend routine surgical fixation of contralateral testicle during surgery.

Современные подходы к фиксации яичка после устранения внутриоболочечной тестикулярной торсии.

Introduction. Testicular torsion is the most common emergency urological pathology of boys. If it is impossible to exclude TT, a testicular revision is necessary. In every third case, the torsed testicle is not viable and an orchidectomy is performed. If the testicle is recognized as viable during the operation, then questions arise about the choice of fixation technique, suture material, as well as the need and timing of fixation of the contralateral testicle. The presence of a large number of possible complications after testicular fixation shows the relevance of studying actual experience on this problem. The purpose of the study: to evaluate the experience of using various methods of testicular fixation. Materials and methods. We searched for relevant publications in the PubMed and e-Library databases using the keywords «testicular torsion», «testicular fixation», «emergency urology», «testicular detorsion», «orchidectomy», «orchidopexy». As a result of the search, 43 sources were selected and included in the literature review. Results. We analyzed articles that published the results of using testicular fixation methods. The described methods were divided into four groups: 1. Various options for fixation with interrupted sutures without modeling the tunica vaginalis. 2. Fixation options with fenestration, eversion or excision of the tunica vaginalis. 3. Techniques using the «dartos pouch» method with or without fixation. 4. Exotic fixation techniques. Conclusion. There are very few publications devoted to the analysis of experience in using various methods of testicular fixation during torsion. An anatomical anomaly of the «bell clapper» type is detected in most cases with TT and with contralateral fixation. Currently, fixation techniques with eversion of the tunica vaginalis are not widely used. Leading guidelines on pediatric urology recommend the use of 3-point non-absorbable sutures and fixation using the «dartos pouch» method for testicular fixation after detorsion; however, there is an understanding that the used fixation methods are not universal, not effective and secure enough, which determines the relevance of new research on the «method of choice» for testicular fixation in case of TT.

The management of testicular torsion: A survey of Turkish pediatric surgeons and pediatric urologists.

This study aimed to evaluate the approaches of pediatric surgeons and pediatric urologists in Türkiye regarding the diagnosis and treatment of testicular torsion (TT) and their adherence to the European Association of Urology (EAU) pediatric urology guideline. A survey consisting of 19 questions, accompanied by an annotation describing the objective of the study, was emailed to pediatric surgeons and pediatric urologists in June and July 2023. Of the 95 respondents, 62.1% had over 10 years of experience, and 48.4% treated more than five cases of TT annually. Of the participants, 87.4% stated that scrotal Doppler ultrasonography (US) was always used, and 12.6% stated that US was used in cases of doubtful diagnosis. Concerning treatment, 14.7% reported performing manual detorsion, 70.5% never did, and 14.7% did so only if the operating room was unavailable soon. A total of 92.6% of participants opted for emergency surgery. Among participants who perform manual detorsion, 71.4% perform surgery within 24 hours after successful manual detorsion. Regarding fixation of the contralateral testicle, 14.7% never performed it, and 27.4% did so only when they performed an orchiectomy on the torsion testicle. While most participants follow EAU pediatric urology guidelines by performing emergency surgery, the rate of manual detorsion is low. Few participants stated that emergency surgery may not be performed after manual detorsion. While all of the participants performed fixation of the torsion testicle in accordance with the guidelines, the same adherence was not observed in the contralateral testicle.

Testis-sparing Surgery in the Treatment of the Normal Contralateral Testicle: A Prospective Multicenter Bench Study Following Radical Orchiectomy

Testis-sparing Surgery in the Treatment of the Normal Contralateral Testicle: A Prospective Multicenter Bench Study Following Radical Orchiectomy

A Survey of Current Practice in Operative Management of Testicular Torsion in Poland.

The primary aim of this study is to evaluate heterogeneity in the current management of testicular torsion (TT). A secondary aim is to investigate incidences of recurrent torsion and the methods used for primary fixation. An online multiple-choice questionnaire comprising 10 questions was distributed to paediatric surgeons and urologists. There were a total of 99 questionnaires distributed to representatives from 39 paediatric surgery and urology departments in Poland. The majority of participants agreed on fixation of the torsed testicle (98%). Use of sutures was reported by 95% of surgeons: absorbable by 48%, non-absorbable by 42%, and 4% using both. There was no consensus on the number of sutures. The contralateral testicle was always fixed by 69%, with 28% fixing it only in case of necrosis and amputation of the torsed testicle, and the remaining 2% never fixing the contralateral side. In case of negative scrotal exploration, 18% of surgeons would still fix the testis. The recurrence of torsion after prior fixation was identified by eight of the participants. The most commonly reported primarily used technique was absorbable sutures. There is a general consensus on the fixation of torsed testicles; however, other aspects remain controversial. Based on the survey and the literature review, the use of non-absorbable sutures rather than absorbable sutures would be advisable.

Primary testicular lymphoma: Clinical characteristics and oncological outcomes.

Primary testicular lymphoma (PTL) is a rare testicular malignancy, despite being considered the most common testicular tumor in patients older than 60 years. Primary testicular lymphoma represents only 1%-9% of testicular neoplasms. Few studies have been published regarding its clinical features and management. This study aimed to analyze the clinical characteristics and outcomes of PTL. Orchiectomy specimens of 15 patients with PTL diagnosed during 2000-2020 at our institution were retrospectively studied. We collected information on demographic data, clinical features, management aspects, and outcomes of PTL treatment. Kaplan-Meier survival curves and Cox regression analyses were used to study survival. The median patient age was 69 years (interquartile range, 61-72 years). The most prevalent clinical presentation was testicular swelling (80%), and only 13.33% of the patients presented with systemic symptoms. Central nervous system involvement was detected in 6 patients (40%). Of the 15 patients, 5 (33.33%) had stage IE and 10 (66.67%) had stage IVE lymphoma. Diffuse large B-cell lymphoma was the most common histological subtype. Twelve patients (80%) received chemotherapy. During follow-up, 4 patients (26.67%) relapsed. The recurrence rate in the contralateral testicle was 13.33%. The median cancer-specific survival was 21.58 months (95% confidence interval, 0-43.95 months). Univariate Cox regression analysis showed that central nervous system involvement and International Prognostic Index score were significantly associated with shorter cancer-specific survival. Primary testicular lymphoma has a high relapse rate and poor prognosis. Management strategies typically include radical orchiectomy and systemic chemotherapy. Central nervous system involvement and International Prognostic Index scores were associated with lymphoma-specific survival.

A case of prenatal strangulated inguinal hernia

The figures herein illustrate the case of a pregnant woman referred to our center for a nonprimary cytomegalovirus infection. After a normal second trimester ultrasound during a scan performed at 29 weeks, a nonvascularized dilatation of 30×35 mm of the left scrotum was noted in the fetus (Figure 1, Supplemental Material, Video1). The penis and the contralateral testicle were normal in appearance. This was at first hypothesized to represent a hydrocele, perhaps associated with testicular torsion or inguinal herniation.

Management of testicular torsion by a general surgeon isolated in Africa

RésuméL’apparition d’une douleur scrotale brutale et intense pose plusieurs problèmes quand elle survient chez un homme jeune en Afrique. Parmi les étiologies possibles, la torsion testiculaire est l’urgence chirurgicale à écarter, car au-delà de 6 heures d’évolution le pronostic fonctionnel du testicule est engagé. L’évolution septique vers une fonte purulente, en cas de torsion dépassée, est aussi possible. D’incidence légèrement inférieure à celle des pays occidentaux, la méconnaissance de cette pathologie par les acteurs de santé de proximité, la précarité ou l’isolement sanitaire de certaines populations dans certaines régions sous-médicalisées, contribuent aux retards diagnostique et thérapeutique. Cela conduit souvent à une évolution péjorative, la perte du testicule étant directement corrélée au délai de prise en charge. La torsion testiculaire a ainsi été identifiée comme l’une des principales causes d’infertilité masculine en Afrique. Pourtant, le diagnostic clinique et le traitement chirurgical nécessitent peu de moyens et restent accessibles dans un milieu à faibles ressources ou en conditions précaires. Cet article reprend le tableau clinique de torsion du cordon spermatique et la technique d’orchidopexie.

Body and testicular biometry of Crioulo stallions

ABSTRACT: Brazilian Association of Crioulo Horse Breeders (ABCCC) establishes minimal and maximal body biometrics evaluation; although, nothing is mentioned about testicular measurements. Body and testicular growth are associated and related to age. We described data regarding body and testicular biometry of Crioulo stallions, with a comparative study between young and adult categories. Evaluation was performed in 56 stallions, Crioulo breed, split in: youngsters (3 and 4 years-old, n=16) and adults (above 5 years-old, n=40). Body biometry included weight, height, cannon bone and chest circumference, body score condition and neck fat accumulation. Testicular biometry included height, length, width, volume, combined volume and daily sperm output (DSO). Statistical analyses included descriptive statistic, Pearson correlation, comparison between means by Kruskal Wallis, being P < 0.05 considered significant. There was no significant difference between the parameters of body and testicular biometrics between categories young and adult. In relation to height, the average was very close to the lower limit established, while chest and cannon bone circumference were above the minimum recommended by ABCCC. Cannon bone circumference presented a positive correlation with height. Most of stallions presented excessive body fat, with a body score condition above 8 (scale 1-9). Neck fat accumulation presented a positive correlation with body score condition. Testicular height, length, width and volume presented a positive correlation between the ipsi and contralateral testicle, total testicular volume and DSO. In conclusion, no difference in the body and testicular biometric evaluation was observed between young and adult Crioulo stallions. Testicular and body growth are associated and also related to age, so our finding suggested that after 3-4 years-old most of Crioulo stallions have already reached maximum growth.

Torção testicular tipo extravaginal em recém-nascido: Relato do diagnóstico em sala de parto

OBJECTIVE: To report a case of intrauterine testicular torsion diagnosed from the physical examination performed in the delivery room. CASE REPORT: Male newborn patient, natural birth. During the initial physical examination in the delivery room, the skin of the scrotum on the right was found to be slightly hyperchromic and more retracted, increased testicular volume on the right compared to the contralateral and hardened consistency, raising the diagnostic hypothesis of intrauterine torsion or testicular neoplasm. Ultrasonographic evaluation with color Doppler showed enlarged right testis, hyperechoic image suggestive of spermatic cord node and absence of blood flow signs within it. The newborn underwent surgical exploration with intraoperative finding of a necrotic testis, with subsequent orchiectomy and contralateral testis orchidopexy. Laboratory screening did not suggest testicular neoplasia. The anatomical specimen was sent for histopathological examination, which contains findings compatible with testicular torsion with absence of malignancy. CONCLUSIONS: Neonatal testicular torsion is a rare condition, but it is important to know this condition in order to be able to detect it during the physical examination of a newborn. Testicular torsion occurs when the spermatic cord twists on its own axis, which can lead to an ischemic infarction of the testis. Once the diagnosis is confirmed, a surgical exploration aims at the detortion of the testicle or its removal if this is not feasible, and may be considered an exploration and correction of the contralateral testicle as a prophylactic way of future torsion.

Reconstrucción testicular con toma y aplicación de injerto autólogo de túnica albugínea contralateral por trauma penetrante de testículo por proyectil de arma de fuego. Reporte de caso y revisión de la literatura

Antecedentes:
 El trauma testicular y escrotal ocurre principalmente en jóvenes entre 15 y 40 años.
 El 50% de las heridas testiculares por arma de fuego terminan en orquiectomía.
 La presentación clínica es con dolor, edema, equimosis y hematoma; laceración de piel o exposición de tejido. El diagnóstico es clínico. La evidencia o sospecha de una ruptura testicular es una urgencia y requiere exploración quirúrgica inmediata. El manejo quirúrgico recomendado es con cierre primario de la túnica albugínea cuando es posible y orquiectomía cuando no es posible.
 Caso clínico:
 Presentamos el caso de un masculino de 20 años con trauma testicular por arma de fuego; condicionándole trauma izquierdo grado V y derecho grado IV. Se realizó orquiectomía simple izquierda y orquiectomía parcial derecha con reconstrucción testicular por medio de injerto de túnica albugínea contralateral. El paciente cursó con una evolución satisfactoria; al estudio ultrasonográfico Doppler de control se observó vascularidad conservada y hormonalmente niveles de testosterona en aumento.
 Discusión:
 La meta en el tratamiento del trauma testicular es preservar el tejido viable y reparar el testículo. El cierre primario está descrito ante una laceración de la túnica albugínea con bordes fácilmente identificables, lo cual no fue posible en este caso. Dentro de las reparaciones descritas existen injertos de túnica vaginalis, mallas de material reabsorbible y biológicas con resultados no concluyentes.
 El uso de túnica albugínea como reparación y protección del testículo contralateral, permitió una reconstrucción óptima; evitando el aumento de presión que se produce al usar la túnica ipsilateral y permitiendo la preservación del parénquima y fisiología testicular.

A patient-centric pathway for testicular cancer - A multicentre study investigating the uptake of semen cryopreservation and impact on treatment.

The option of semen cryopreservation following a diagnosis of testicular cancer shows a variable uptake with the option to cryopreserve before surgery often dependent on the preference of the treating clinician and the fertility laboratory resources available. To assess whether the introduction of a patient-centric pathway for managing suspected testicular cancer increases the uptake of semen cryopreservation and the impact of this on surgical waiting times. A multicentre retrospective analysis of patients treated as part of a patient-centric pathway was conducted for suspected testicular cancer at two specialist centres within a one-stop testicular clinic. Clinical information, including semen cryopreservation acceptance rate, time intervals to surgery and CT scan, TNM stage, histology and age, was recorded from an institutional database. Eighty nine patients (median age: 34years (range: 14-89)) underwent orchidectomy for suspected testicular cancer over a 15-month period after the introduction of a patient-centric testicular cancer pathway at two UK centres. The overall uptake of semen cryopreservation was 68.5% (n=61) with all men under the age of 33years accepting this option. A microdissection oncoTESE was performed in 9/61 (14.8%) patients who attempted cryopreservation but were found to be azoospermic. Pre-operative CT imaging was completed for 85.4% of patients, and the median time from initial outpatient consultation to orchidectomy was 9days. A patient-centric pathway ensures that the uptake of semen cryopreservation remains high particularly for those men within the common age for paternity. It also identifies men who may benefit from microdissection oncoTESE for complex cases such as tumours in solitary testicles, bilateral tumours or an atrophic contralateral testicle as well as those diagnosed with de novo azoospermia. The additional time taken for semen cryopreservation to be performed did not significantly delay orchidectomy or influence the decisions for adjuvant treatment.

Segmental Testicular Infarction Associated to Torsion: First Case Report in Childhood

Testicular torsion in children is not uncommon emergency problem which occur due to twist in the spermatic cord leading to ischemia or infarction to testicle. Hemorrhagic infarction can occur following testicular torsion is globally; however, in extremely rare situation, such infarction can be segmental. Segmental testicular infarction (STI) was reported in an infant due to epididymitis and a newborn with STI in 1 testicle with complete infarction in the contralateral testicle due to birth trauma. To best of our knowledge, our case of STI in a child associated with testicular torsion is the first described in the literature.

Squamous cell carcinoma of the testis and paratesticular tissue

Testicular tumors occur in 1–1.5 % of cases in the structure of the general oncological morbidity among men and constitute 5 % among tumors of the urogenital tract. In Western Europe, 3–6 new cases are recorded a year per 100 thousand male population. Nevertheless, in relation to young men, this particular type of neoplasm is not only the most common oncological pathology (up to 60 % of all neoplasms), but also the main cause of cancer mortality. Risk factors for developing ovarian cancer include a family history, previous development of a tumor in the contralateral testicle, and components of testicular dysgenesis syndrome (cryptorchidism, hypospadias, spermatogenesis disorders leading to infertility). Tumors of paratesticular tissues are much less common and most of them are benign. Squamous cell carcinoma rarely develops as a primary tumor of the testis and / or paratesticular tissue, isolated cases have been described in the English literature. Secondary damage to the scrotum organs is more frequent, but such situations are usually found in patients of an older age group. This article presents the clinical case and the final results of treatment of a patient with squamous cell carcinoma of paratesticular tissue.

Non-palpable testis: is management consistent and objective?

Diagnostic laparoscopy is recommended for boys with non-palpable testis (NPT) by American and European guidelines with the decision to pursue inguinal exploration based upon testicular vessel appearance. We hypothesized that management decisions are not consistent with the guidelines, and that assessment of vessels is subjective. Pediatric urologist management decisions were evaluated via an electronic survey to determine impact of contralateral testicle size, sonographic findings, surgeon region, and years in practice. In a digital image survey, surgeons were asked to interpret gonadal vessel status of 32 consecutive cases of NPT with absent abdominal testis as normal, atretic, or blind-ending to determine intra- and inter-rater reliability. Of the 339 participants, more Europeans (49%) chose sonography as the first management step for NPT compared to US surgeons (12%). Regardless of sonographic findings, over 80% chose laparoscopy as the first step. In the presence of normal, atretic, and blind-ending vessels, the decisions to proceed with inguinal/scrotal exploration were 88%, 68%, and 17%, respectively. Contralateral hypertrophy and sonography findings had no significant impact on the decision to proceed with inguinal/scrotal exploration. The visual gonadal vessel survey showed surgeon interpretation of normal or blind-ending vessels had moderate inter-rater reliability. Surgeons did not agree on normal status 37% of the time and did not agree on atretic status 66% of the time. There was no statistical difference between European and US respondents (P=0.23). Intra-rater reliability was fair for blind-ending vessels. When the first interpretation was blind-ending, the same surgeon changed interpretation of the same image 39% of the time. There was no statistical difference by years of practice. Non-visualization of NPT on sonography and contralateral testis size had no significant impact upon management decisions. Surgeons chose to pursue inguinal/scrotal exploration based upon laparoscopic gonadal vessel status. However, these interpretations were subjective with low inter- and intra-rater reliability.

Effect of Pediatric Testicular Torsion on Testicular Function in the Short Term

PurposeTo evaluate short-term testicular outcome after torsion in children. MethodsFifty-four children and adolescents were evaluated after 6 months of the operation for testicular torsion. Testicular volume was measured and circulating Inhibin B, FSH, LH and testosterone levels were checked. ResultsDelay from the onset of symptoms to surgery was shorter in the orchidopexy group (n = 47), than in the orchiectomy group (n = 7, p = 0.001). In the orchidopexy group, the median volume of the affected testis was 83% (IQR 43–104) of the contralateral testis (p = 0.002). The plasma hormone levels in orchidopexy and orchiectomy groups were: 148 ng/l (IQR 108–208) vs. 129 ng/l (IQR, 123–138, p = 0.269) for Inhibin B; 4.5 IU/L (IQR2.6–6.9) vs. 11.7 IU/L (IQR 4.3–12.8, p = 0.037) for FSH; 2.9 IU/L (IQR 1.3–3.7) vs. 4.8 (IQR 3.0–5.6, p = 0.066) for LH; and 13.6 nM (IQR 6.5–18.0) vs. 14.5 nM (IQR 6.7–15.9, p = 0.834) for testosterone. The association between FSH, LH as well as testosterone levels was most clear with the volume of the contralateral testis (Rho = 0.574, p < 0.001, Rho = 0.621, p = 0.001 and Rho 0.718, p < 0.001 respectively). ConclusionsTesticular function is mainly dependent on the volume of contralateral testicle after testicular torsion. However, testis preserving surgery tends to maintain better function than orchiectomy. Type of studyRetrospective review. Level of evidenceIII

Differentiation of testicular seminoma and nonseminomatous germ cell tumor on magnetic resonance imaging.

Magnetic resonance imaging (MRI) has excellent soft tissue resolution, as well as multidirectional and multisequence scanning technology, making it an important supplementary method in the diagnosis of testicular tumor.To explore the utility of preoperative MRI for the differential diagnosis of testicular seminoma and nonseminomatous germ cell tumors (NSGCTs).The medical records from 39 patients with testicular tumors that were examined preoperatively with MRI and treated with urologic surgery at our institution between January 2015 and March 2019 were retrospectively reviewed. Testicular tumors were confirmed by pathology and classified as seminoma (n = 20) or NSGCT (n = 19). Two radiologists analyzed the testicular tumors on preoperative MRI for morphology: multiple nodules or a single mass; presence/absence of a capsule; signal compared to the normal contralateral testicle (isointense, hypointense, hyperintense, or mixed); enhancement; septa; and hemorrhagic or cystic degeneration. Characteristics of seminomas and NSGCT were compared using the Chi-square or Fischer exact test.MRI showed that the majority (95%; 19/20) of seminomas were nodular. There were significant differences in the presence/absence of a capsule (P = .001), T1-weighted imaging (T1WI) signal intensity (P = .047), T2-weighted imaging (T2WI) signal intensity (P < .001), septa (P < .001), and hemorrhagic or cystic degeneration (P < .001) between seminomas and NSGCT.Seminomas were more likely to have no capsule, isointensity on T1WI, hypointensity on T2WI, and had narrow obviously enhanced fibrovascular septa without hemorrhagic or cystic degeneration; NSGCT was more likely to have a capsule, a mainly mixed signal on T1WI and T2WI, most of them had no fibrovascular septa, and hemorrhagic or cystic degeneration was common in malignant NSGCT.This study suggests that preoperative MRI can distinguish seminoma from NSGCT. We propose that preoperative MRI of the scrotum is an effective technique that should be widely adopted for the management of scrotal disease.

EFFECT OF NIFEDIPINE ON APOPTOSIS, NECROSIS AND VIABILITY OF GERMINAL EPITHELIAL CELLS IN THE CONTRALATERAL TESTICLE AND PLASMA TESTOSTERONE LEVELS IN MALE WHITE RATS (RATTUS NORVEGICUS, WISTAR STRAIN) AFTER UNILATERAL TESTICULAR TORSION

Objective: To compare the number of apoptosis, necrosis and viability of germinal epithelial cells in the contralateral testicle (CT) and plasma testosterone (PT) levels in white male rats which administered Nifedipine after unilateral testicular torsion (TT) compared with control group. Material &amp; Methods: This research was an experimental study using male white rats (Rattus Norvegicus, Wistar strain) aged 10-12 weeks and body weight 150-200 gram. A total of 30 rats were then randomly divided into 5 groups (n=6) which were negative control group (KN), positive control group (KP1 and KP2) and Nifedipine-administered group (N1 and N2). Each group performed unilateral left side torsion of testicular of 1080o anticlockwise except the KN group. There was 4-hour ischemic duration in the KP1 and N1 groups while 10 hours in the KP2 and N2 groups. Administration of Nifedipine 30 minutes before detorsion by intraperitoneal injection dosed 100 μg/kgBW. All groups performed right orchidectomy and plasma blood sampling. Measurement of apoptosis, necrosis and viability of germinal epithelial cells in the CT using flowcytometry. Measurement of PT levels using Enzyme-Linked Immunosorbent Assay (ELISA). Results: The number of apoptosis, necrosis and viability of contralateral testicular germinal epithelial cells and PT levels in the KN group compared with KP1 and KP2 groups were significantly different (p&lt;0.05). There was no significant discrepancy in apoptosis (p&gt;0.05) in KP1 group compared with N1 group, as well as in KP2 group compared with N2 groups. The number of necrosis, viability of germinal epithelial cells in the CT and PT level in KP1 group in compared with N1 group, as well as in KP2 group in compared with N2 group were significantly different (p&lt;0.05). Conclusion: Nifedipine administration prior to testicular detorsion can maintain cell viability and decrease the amount of necrotic germinal epithelial cells in the CT and prevent the decrease in PT levels after unilateral TT.

Primary testicular diffuse large B-cell lymphoma: a single center experience

Objective To review the experience of the clinical diagnosis and treatment of primary testicular diffuse large B-cell lymphoma. Methods A review was made who were treated in the Tumor Hospital of Zhengzhou University from January 2011 to November 2018. The average age of the patients was 58 years old, with 4 cases in left side and 8 cases in right side. All patients were admitted to hospital with painless testicle mass. Solid mass of testis were detected by ultrasound with no abnormality in tumor markers. All patients underwent orchiectomy and followed by chemotherapy. Results Twelve primary testicular lymphoma (PTL) were identified by pathology, with 8 cases in phase I, 2 cases in phase II, 1 case in phase III , and 1 case in phase IV. The mean follow-up was 31 months. Inguinal orchiectomy was recommended as a diagnositc and initial therapy. All patients underwent R-CHOP/CHOP chemotherapy consisting of cyclophosphamide, doxorubicin, vincristine and prednisone with or without rituximab, including 6 cases with R-CHOP and 6 cases with CHOP. Nine of 12 patients underwent intrathecal prophylatic chemotherapy and 6 of 12 patients underwent contralateral testicle radiotherapy. Relapse occured in 2 patient with CHOP in central nervous system and died of the disease. One case with CHOP relapsed in abdominal cavity. No contralateral testicle relapse was observed. Conclusions PTL is a rare extranodal lymphoma. Painless testicle tumor in men over 50 years old should suspect of this disease. Inguinal orchiectomy is an important part of the treatment, which combines systemic chemotherapy and prophylactic modalities such as radiotherapy of contralateral testis and/or central nervous system (CNS) prophylaxis. Key words: Lymphoma, B cell; Testis; Treatment; Prognosis

Progress of primary testicular lymphoma

Primary testicular lymphoma (PTL) is a rare extranodal non-Hodgkin lymphoma (NHL), accounting for 1%-2% of NHL. The most common pathological type is diffuse large B-cell lymphoma, while some rare pathologic subtypes are mantle cell lymphoma, NK/T cell lymphomas, and other T cell lymphomas. The typical clinical manifestations are unilateral and painless testicular swelling with several weeks to months. Due to relapse in central nervous system (CNS) or contralateral testicle, PTL has a very poor prognosis. Thus, it is necessary for the combination therapy (orchiectomy + chemotherapy with anthracycline-containing regimen + testicle and involved field radiotherapy + CNS prophylaxis). This review discusses some controversial issues including the prognostic markers of PTL, the choice of rituximab immunotherapy, the therapeutic value of radiotherapy, and the best strategy for preventing the relapse of CNS. Key words: Testicular neoplasms; Orchiectomy; Antineoplastic combined chemotherapy protocols