Intratesticular Tumor Research Articles

Intratesticular Mullerian Serous Borderline Tumor With Microinvasion: A Rare Tumor and Review of the Literature.

Ovarian-type (ie, Mullerian) epithelial tumors occurring in the testicular and paratesticular regions are exceptionally rare, with only a handful reported worldwide. Serous tumors are the most frequently encountered subtype among these rare tumors. The pathogenesis of these tumors within the testicular and paratesticular regions remains a subject of intrigue and debate, with various hypotheses attempting to explain their presence in the paratestis region, where most tumors occur. However, our understanding of the pathogenesis of intratesticular tumors is limited. To date, 11 known examples of intratesticular serous Mullerian tumors have been reported globally. In this report, we present an extraordinary tumor, an intratesticular Mullerian serous borderline tumor with foci of microinvasion, in a 38-year-old male patient. This tumor exhibits histological features similar to their ovarian counterparts and is confirmed through an immunohistochemical panel. Our report underscores the extreme rarity of these tumors, emphasizes the importance of heightened awareness among clinicians and pathologists, and provides valuable insights into their complex development and histogenesis. This contribution aims to enhance diagnostic precision and optimize therapeutic strategies for similar tumors.

Imaging of pediatric testicular tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper.

Primary intratesticular tumors are uncommon in children, but incidence and risk of malignancy both sharply increase during adolescence. Ultrasound is the mainstay for imaging the primary lesion, and cross-sectional modalities are often required for evaluation of regional or distant disease. However, variations to this approach are dictated by additional clinical and imaging nuances. This paper offers consensus recommendations for imaging of pediatric patients with a known or suspected primary testicular malignancy at diagnosis and during follow-up.

Clinical Study of Testicular Leiomyosarcoma: Our Experience

Introduction: Leiomyosarcoma is malignant soft tissue tumor of mesenchymal origin arising from undifferentiated smooth muscle cells. Thera are two types of Leiomyosarcoma of scrotum namely para-testicular and intra-testicular. The Intra testicular tumor is relatively rare. Blood vessels or contractile cells of the seminiferous tubules is believed to be the origin of this rare tumor which is of mesenchymal origin. Objective: Prospective clinical evaluation of testicular leiomyosarcoma with retroperitoneal mass and metastasis to para-aortic and retro-caval lymph nodes. Material & Methods: All 21 consecutive patients who were diagnosed as testicular mass on evaluation from August 2018 to July 2021 were included in study after fulfillment of eligibility criteria. Prior to surgery all patients were evaluated. All patients operated with standard method of radical high inguinal orchidectomy, followed by chemo or radio therapy as and when required on further evaluation and histopathology checked. Patients demographic, clinical-pathological, testicular tumor parameters and tumor markers with perioperative data, metastatic parameters recorded prospectively and analysed. Outcome measures were demographic data, tumor response, perioperative data, complications and follow-up at 12 months. Results: In our study out of 21 patients, 13 patients (61.9%) were found to be in stage 1,4 patients (19%) were in stage 2 and another 4 patients (19%) were in stage 3 according to IGCCCG. Only 5 patients (23.8%) were found with retroperitoneal paraarotic and paracaval Lymphadenopathy. Metastasis to liver, lung, brain and major visceral organs were present in 4 of our patients (19.8%). Conclusion: As less cases have been reported so far, clinical and biological behavior of this tumor difficult to predict. Based on the literature review, the treatment of choice for an intratesticular leiomyosarcoma is a radical orchidectomy and clinico-radiological surveillance in cases at stage I. As there are no available data regarding the management of stage II or Stage III disease post radical orchidectomy.

Capillary Hemangioma of the Testis: A Case Report and Literature Review

Abstract Introduction/Objective Testicular capillary hemangioma is a rare benign vascular tumor and typically occurs in patients younger than 20 years. Study suggests that the mean age of these patients is usually 25.1 ± 22.7 years. We report a case of a 63-year-old man who underwent an uncomplicated radical orchiectomy for scrotal irritation and testicular fullness. Methods/Case Report Clinically he was found to have a large testicular mass. Ultrasound showed cystocele and an intratesticular tumor. Increased LDH was also found. Gross examination showed a single large cystic cavity containing yellow-colored fluid and a well-circumscribed tan-brown nodule measuring 2.5 × 1.8 × 1.0 cm within the testicular parenchyma. There was no extension into the tunica albuginea. Microscopic examination showed groups of capillaries of varying sizes in a lobular arrangement with bland spindle-like endothelial cells lining these capillary structures. The circumscribed vascular lesion was well-demarcated from the testicular parenchyma by a fibrous 0.1-cm pseudocapsule. The benign nature of this lesion was suggested by the lack of any mitotic activity, anaplasia, or dysplasia. Immunohistochemical staining was strongly positive for endothelial markers (CD31 and CD 34), and negative for mesothelial (WT1) and lymphatic markers (D2-40), excluding an adenomatoid tumor. Based on these characteristic morphological and immunohistochemical findings, the diagnosis of testicular capillary hemangioma was made. After 6 months of follow-up, the patient was well without any clinical evidence of recurrence. Results (if a Case Study enter NA) NA Conclusion While rarity of testicular capillary hemangioma impedes significant changes in how we approach adult testicular masses, the possibility of a benign tumor should always be in mind to consider. This is especially pertinent when patients fall outside the typical age range for germ-cell tumors, and for patients with a solitary testicular mass.

Primary intratesticular rhabdomyosarcoma\xa0in children: a case report and review of the\xa0literature

BackgroundThe importance of this paper is to help to emphasize the importance of chemotherapy for children with pure intratesticular rhabdomyosarcoma after radical inguinal orchiectomy is done as first treatment of rhabdomyosarcoma. The information provided in this paper about the follow-up outcomes of the patient described in this paper, it highlights that, recurrence and even metastasis of intratesticular rhabdomyosarcoma in children are more likely to occur if surgery it not combined with chemotherapy.Case presentationHerein, we present a 6-year old African male child with a 3 months history of a painless right intratesticular tumour. The tumour was poorly vascularized and was in continuity with the spermatic cord. Pelvic computer tomography (CT) scan showed a heterogeneous mass with well-defined margins without microcalcification and multiple bilateral inguinal enlarged lymph nodes were noticed without pelvic lymphadenopathy. The tumour measured 3.8 × 2.8 × 3.9 cm. The tumour marker panel showed: lactate dehydrogenase of (472 UI/l), alpha-fetoprotein (1.43 UI/ml) and human chorionic gonadotrophin beta (2.9 mUI/ml). Microscopically, the tumour was composed of small to medium size undifferentiated cells. These were oval to spindle, hyperchromatic cells to stromal myxoid degeneration were noted. Tunica albuginea and rete testis both were infiltrated by tumour. The tumour showed high mitotic count which measured 50 mitoses per 10 High Power Field (HPF). The diagnosis of rhabdomyosarcoma (RMS) was confirmed by immunohistochemistry (IHC) testing using myoD antibody which showed strong and diffuse intranuclear staining of the tumour cells. Currently, he is on cyclophosphamide and vincristine chemotherapy regime and his condition has improved much.ConclusionsThe experience obtained from the index case is crucial for the management of patients with intratesticular rhabdomyosarcoma which should always make sure that radical inguinal orchiectomy is covered by chemotherapy and/or radiotherapy. This will potentially lower the possibilities of recurrence and/or metastasis of the tumour, hence improving the prognosis of the patients. We report the clinical, radiological, and laboratory characteristics as well as the outcome of the patient.

Testis-sparing surgery for testicular masses: current perspectives.

Males who present with a palpable testis nodule are likely to have malignant germ cell tumor in >90% of cases. Therefore radical orchiectomy remains the standard of care for intratesticular tumors. However, due to the recent developments of high-frequency probes in ultrasonography, the incidence of detecting a small non-palpable testis tumor is higher and higher. These lesions are thought to be benign in more than 60-80% of cases, thus a radical orchiectomy should be considered an overtreatment. In addition to that, radical orchiectomy might cause infertility, psychological issues and endocrine disorders, hence an organ-sparing procedure in such cases should be pursued. Only fourteen reliable retrospective studies met the inclusion criteria. No prospective randomized trials have appeared in Medline database. This review of the current literature has confirmed the safety and efficacy of testicular-sparing surgery in selected patients: 1) monorchid patients; 2) bilateral testis masses; 3) normal patients with a small, non-palpable masses detected with US, as long as the dimension of the lesion is up to 3 cm and not greater that 30% of the total volume of the organ. According to the literature, testis sparing surgery is a safe and feasible procedure for patients presenting a benign small testis mass. The enthusiasm found in the literature should however be tempered as the small number of patients reported in the studies coupled with the absence of a prospective trial represent important limits that need to be overtaken. Therefore more robust and well-designed studies are needed.

Appropriateness for testis-sparing surgery based on the testicular tumor size in a pediatric and adolescent population

In children, most small testicular tumors are benign, and testicular-sparing surgery (TSS) is a viable treatment option. The objective of this study is to assess for correlation between the tumor size and final pathologic diagnoses appropriate for TSS for pediatric and adolescent patients with an intratesticular mass and negative serum tumor markers (STMs). A retrospective review of 24 patients (aged 0-18 years) who underwent radical or partial orchiectomy between 2003 and 2015. Patients with unifocal, unilateral intratesticular tumors and negative STMs were included. Tumors with benign and non-germ cell histology were considered appropriate for TSS, and active germ cell tumor elements on final histology were categorized as inappropriate for TSS. Baseline characteristics, tumor size, and frozen section results were evaluated for association, for the entire cohort and then for a subset of pubertal and postpubertal patients (defined as ≥10 years old). Patients with testicular tumor pathology inappropriate for TSS were significantly older (median age 17.1 years, P=0.03). A 2-cm size cutoff did not accurately predict pathology for the entire cohort, or for just pubertal and postpubertal patients (P=0.132, P=0.154, respectively). Frozen section and final pathology demonstrated good agreement (κ=0.826, P<0.001) as did pre-operative and final pathologic size measurement (κ=0.703, P<0.001). Frozen section analysis did not miss a TSS inappropriate pathology. The present data refute the finding in adults that a 2-cm cutoff accurately predicts pathology in pediatric patients with an intratesticular mass and normal STMs. These data suggest that TSS should still be offered, regardless of the tumor size alone, but frozen section appears to more accurately predict pathology than the tumor size, and its use should, thus, be emphasized. There are several limitations of this study to mention. First, this is a retrospective review of a small cohort of patients with a rare clinical scenario, which necessitated the combination of pediatric and adolescent patients. The study did not evaluate oncologic outcomes. In children with an intratesticular tumor and normal STMs, a tumor size cutoff of 2cm does not appear to accurately predict the final pathology. However, the data presented support the continued use intra-operative frozen section analysis in both children and adolescents undergoing TSS.

Adenomatoid tumor of the testis mimicking malignant testicular cancer on multiparametric ultrasound

BackgroundAdenomatoid tumor is one of the most common histological subtypes of paratesticular cancer arising from the epididymis. In very rare cases, these tumors appear as intratesticular lesions originating in the tunica albuginea, representing a diagnostic challenge.Case presentationWe present a case of a 51-year-old man with a small (0.9 cm) hyperechoic lesion of the left testicle mimicking testicular cancer on multiparametric ultrasound. The lesion was localized in the peripheral zone, confirming vascularization and increased stiffness on contrast-enhanced ultrasound and real-time elastography. Preoperative tumor markers and hormone levels were within normal ranges. Staging computed tomography was negative. Organ-sparing surgery with tumor enucleation and frozen section analysis was performed, confirming testicular adenomatoid tumor.ConclusionCurrently, no typical ultrasound features can definitively distinguish intratesticular adenomatoid tumors from malignant testicular masses. Thus, a surgical approach is almost always considered in such a case for both diagnostic and therapeutic purposes.

Qualitative and quantitative contrast-enhanced ultrasonography for the characterisation of non-palpable testicular tumours

To assess the diagnostic performance of conventional ultrasound (US) and contrast-enhanced ultrasonography (CEUS) in the differential diagnosis of non-palpable intratesticular tumours. The local ethics review board approved the protocol, and all of the patients provided written informed consent. Between December 2011 and February 2014, men with non-palpable testicular tumours and normal tumour markers who were referred for surgery were included. The tumours were analysed by conventional US, including B-mode and colour Doppler US (CDUS) as well as by CEUS. Morphological aspects and qualitative and quantitative CEUS criteria, based on visual enhancement and time-intensity curves, were assessed for each lesion. Forty patients were ultimately included. Based on histopathological results, the tumours were classified into three groups: benign tumours (n=16), malignant tumours (n=15), and burned-out tumours (n=9). In B-mode, the morphological aspects were significantly different between benign and malignant tumours (p-values from 0.0002 to 0.008). Qualitative and quantitative analyses of the CEUS images revealed that burned-out tumours exhibited significantly less enhancement than malignant and benign tumours: in burned-out tumours, time-intensity curves were flat, whereas in both benign and malignant tumours the curves had a bell-shaped pattern. All intensity parameters were lower for burned-out tumours compared to benign and malignant tumours (p-value from 0.0001 to 0.026). Both benign and malignant tumours enhanced strongly, however, and no significant difference between the two was noted (p-value from 0.0721 to 0.0953). Unlike conventional US, which enable benign lesions to be differentiated from malignant or burned-out tumours, CEUS failed to enabled differentiation between benign lesions and malignant vascularised testicular tumours. CEUS appears to have the potential, however, to differentiate burned-out tumours from vascularised testicular tumours.

Non-palpable incidentally found testicular tumors: Differentiation between benign, malignant, and burned-out tumors using dynamic contrast-enhanced MRI

PurposeTo evaluate qualitative, semi-quantitative, and quantitative parameters obtained by dynamic contrast-enhanced (DCE)-MRI for the characterization of histologically proven, non-palpable, incidentally found intratesticular tumors. Materials and methodsFrom 2006 to 2014, we included men with non-palpable, incidentally found testicular tumors on ultrasound, normal tumoral marker levels,referred for surgery. DCE-MRI data were analyzed retrospectively and independently by two radiologists blinded to the histological diagnosis. The visual enhancement patterns, time-signal intensity curves, shape of the curves (type 0–3), maximal relative enhancement (Peak), initial enhancement slope (IS), time to peak (TTP), as well as transfer constants Ktrans and Kep were compared between the tumors. The interobserver correlation was evaluated. Receiver Operating Characteristic (ROC) curves and areas under the curve (AUC) were extracted. ResultsThirty-one patients (mean age of 37.3 years) were included. Tumor mean size was 1.2±0.77 cm (min=0.3cm, max=2.8cm). Regarding the histology results, three groups were defined: Twelve stromal “benign tumors” (BT) exhibited more type 2 and type 3 curves than 12 “malignant tumors” (MT) and 7 “burned-out tumors” (BOT) (p<0.0001). BT had a higher peak (96 vs. 54 and 17%), shorter TTP (215 vs. 412 and 692 sec), higher IS (73 vs. 12 and 2 arbitrary units), higher Ktrans (255 vs. 88 and 14min−1*1000) and higher Kep (554 vs. 159 and 48min−1*1000) than MT and BOT, respectively (p<0.0001, p=0.0003, p<0.0001, p<0.0001 and p<0.0001, respectively). The agreement coefficient values and the AUC extracted after gathering MT with BOT varied from 0.83 to 0.96 and from 0.868 to 0.978, respectively. ConclusionDCE-MRI may assist in differentiating between benign intratesticular stromal tumors,malignant and burned-out tumors.

P-01-063 Intraoperative injection of (99mm)Tc- nanocolloid for localization of nonpalpable intratesticular tumours in organ-sparing surgery

P-01-063 Intraoperative injection of (99mm)Tc- nanocolloid for localization of nonpalpable intratesticular tumours in organ-sparing surgery

Intraoperative injection of 99mmTc-nanocolloid for localization of nonpalpable intratesticular tumors in organ-sparing surgery

ObjectiveRadical orchidectomy is the standard treatment for malignant testis tumors. Radical orchidectomy results in androgen deprivation, infertility and impaired psychological well-being, especially in synchronous bilateral tumors, metachronous contralateral tumors or tumor in a solitary testis. According to the European Association of Urology Guidelines, if pre-operative testosterone level is normal and the tumor volume is less than 30% of the testicular volume, organ preserving surgery can be performed. For nonpalpable tumors, organ-sparing surgery needs a precise intraoperative localization with high-frequency ultrasound, especially for nonpalpable tumors. Material and methodsWe report two cases of nonpalpable intratesticular tumors successfully localized using 99mmTc nanocolloid injected with intraoperative US and detected with a γ-ray detection probe. ConclusionsThis method is easily reproducible and safe for the patient. This technique could guarantee complete excision of the tumor, especially if the mass is poorly delimited.

Testicular capillary hemangioma: Case report

Testicular capillary hemangioma: Case report

Inyección intraoperatoria de nanocoloide con tecnecio-99 metaestable para la localización de tumores intratesticulares no palpables en orquiectomías parciales

ObjectiveRadical orchidectomy is the standard treatment for malignant testis tumours. Radical orchidectomy results in androgen deprivation, infertility and impaired psychological well-being, especially in synchronous bilateral tumours, metachronous contralateral tumours or tumour in a solitary testis. According to the European Association of Urology Guidelines, if pre-operative testosterone level is normal and the tumour volume is less than 30% of the testicular volume, organ preserving surgery can be performed. For nonpalpable tumours, organ-sparing surgery needs a precise intraoperative localization with high-frequency ultrasound, especially for nonpalpable tumours. Matherial and methodsWe report two cases of nonpalpable intratesticular tumours successfully localised using 99mmTc nanocolloid injected with intraoperative US and detected with a γ-ray detection probe. ConclusionsThis method is easily reproducible and safe for the patient. This technique could guarantee complete excision of the tumour, especially if the mass is poorly delimited

Testicular angioleiomyoma presenting with haematospermia

Testicular angioleiomyoma presenting with haematospermia

Myoid gonadal stromal tumor: a distinct testicular tumor with peritubular myoid cell differentiation

We report a distinct, primary testicular tumor with peritubular myoid cell differentiation. A 25-year-old man developed a well-circumscribed testicular tumor composed of cytologically bland spindled cells, which were strongly and diffusely positive for desmin, smooth muscle actin, muscle-specific actin, and smooth muscle myosin. In addition, S-100 was diffusely positive, and cytokeratin (CK5/6 and AE1/3) was focally positive. Calretinin, inhibin, and CD34 were all negative. This pattern of immunoreactivity was very similar to the normal adjacent peritubular myoid cells. Follow-up after radical orchiectomy showed benign behavior. We found reports of 6 similar intratesticular tumors demonstrating peritubular myoid cell-like differentiation and having favorable outcome. We believe that the myoid gonadal stromal tumor is a rare, yet distinct, testicular tumor separate from leiomyoma and deserves recognition.

A rare neoplasm of the testis: capillary hemangioma

Intratesticular vascular neoplasms are extremely rare tumors and mostly seen in children or young adults. We reported a case of capillary hemangioma of the testis to attract attention to testicular hemangioma and also to prevent invasive surgery of the testis. The patient was an 18-year-old boy with a testicular mass. Scrotal sonography revealed a varicocele in the left testis and a simple cyst in the left epididymis. There was a solid hypoechoic neoplastic area 75 mm in diameter in the right testis. The laboratory findings including tumor markers and serum levels of alpha-fetoprotein and beta-human chorionic gonadotrophin were normal. The patient underwent right orchiectomy and the pathology diagnosis was capillary hemangioma. Testicular neoplasms derived from connective tissue, blood vessels and musculature are uncommon and intratesticular tumors of vascular origin are extremely rare. There are only 21 cases reported in the literature. The pathologists and the surgeon have to be aware of this entity as the prognosis of the neoplasm determines the method of surgery. Capillary hemangioma of the testis can be similar to malignant testicular tumors on clinical presentation, as well as on ultrasonography and magnetic resonance imaging. Although it is impossible to differentiate a hemangioma from a seminoma before the operation, intraoperative frozen study may be helpful in the differential diagnosis. Frozen section must be performed if the neoplasm has significant vascular proliferation identified by Doppler sonography. Because of the benign nature of this lesion, conservative surgical treatment by means of tumor enucleation with preservation of the testis is possible if intraoperative frozen section examination can be performed.

Epidermoid cyst: a rare intratesticular tumor in children

An 18-year-old boy presented with a palpable left testicular mass. Sonography demonstrated a circumscribed left intratesticular mass with concentric layers of alternating increased and decreased echogenicity (Fig. 1). There was no blood flow within the lesion with color Doppler interrogation (Fig. 2). Sonographic findings suggested a testicular epidermoid cyst, a diagnosis that was pathologically confirmed following surgical enucleation. Epidermoid cysts are rare benign tumors with no malignant potential that compose 1–2% of intratesticular masses in children [1]. Histopathologically, these lesions are lined by stratified squamous epithelium and filled with

Primary Intratesticular Spindle Cell Tumors: Interdigitating Dendritic Cell Tumor and Inflammatory Myofibroblastic Tumor

Spindle cell neoplasms arising in the testis are uncommon; most cases belong to the category of gonadal stromal tumors, and the presence of distinctive clinical and pathological features usually lead to a definitive diagnosis. In some instances, however, the diagnosis of these tumors can be challenging and special techniques are needed. The present study reports 2 unusual cases of primary intratesticular tumors showing a striking morphology, characterized by spindle to stellate cells in a lymphoid background. The diagnosis of interdigitating dendritic cell tumor and inflammatory myofibroblastic tumor was established in the 2 cases, and their probable origin in cells of the accessory immune system is discussed. Although both tumors share similar histological features, their immunohistochemical profiles were decisive for a definitive diagnosis.

Leiomyoma of the testis: A rare testicular mass

We report the sonographic appearance of a testicular leiomyoma, which is a rare smooth muscle tumor of the testis. The patient presented with a painless testicular mass that was confirmed as an intratesticular tumor on sonographic examination. Histopathologic examination revealed a testicular leiomyoma.