Radical Orchiectomy Research Articles

MP21-15 PREDICTORS OF LOW TOTAL TESTOSTERONE (TT) LEVELS AFTER RADICAL ORCHIECTOMY (RO) FOR TESTIS CANCER (TC)

You have accessJournal of UrologyCME1 May 2022MP21-15 PREDICTORS OF LOW TOTAL TESTOSTERONE (TT) LEVELS AFTER RADICAL ORCHIECTOMY (RO) FOR TESTIS CANCER (TC) Jose M. Flores, Nicole Benfante, and John P. Mulhall Jose M. FloresJose M. Flores More articles by this author , Nicole BenfanteNicole Benfante More articles by this author , and John P. MulhallJohn P. Mulhall More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002554.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Clinical experience shows that many men experience low TT levels after RO for TC. The literature cites a prevalence of up to 20%. The aim of this study is to define prevalence and predictors of low TT in this population. METHODS: Patients who had (i) unilateral RO for TC (ii) had two, early morning TT levels post-RO (iii) which was measured using LCMS constituted the study population. Chemo/radiation therapy pre or post-RO T therapy were exclusions. Demographics, comorbidity and endocrine profile pre and post-RO were recorded. We describe the prevalence of low TT (<300 ng/dl) pre and post RO as well as changes in TT level after RO, including the proportion of men who dropped < 300 ng/dL and ≥ 100 ng/dL. We performed multivariable analysis to evaluate predictors of low TT as well of a significant drop (≥ 100 ng/dL) after RO. RESULTS: 152 men were analyzed. Mean age was 44±16 years. Mean TT level pre-RO was 403±253. 34% of these men had T levels ≤300 ng/dL. 5% had diabetes, 13% had OSA. Median time between RO and postoperative TT measurement was 2 (1-6) months. Mean TT level post-RO were 403±253 and 54±49 ng/dL. Representing a median -67 ng/dL drop in TT levels. Post-RO, 51% had low TT levels, 40% with normal TT levels pre-RO had low TT post-RO, and 41% dropped ≥100 ng/dL in TT. After multivariable assessment, only age at RO was predictive of low post-RO TT or dropping TT ≥ 100 ng/dL after RO (pre-RO age, per 10 years increase, OR 1.44, 95%CI 1.12-1.85, p value 0.005). CONCLUSIONS: In our cohort of men with TC and RO, approximately half of the men with TC had low TT levels and 40% dropped ≥ 100 ng/dL in TT levels post-surgery. Older age at the time of the RO increased the likelihood of low TT or a decrease of ≥ 100 ng/dL in TT levels post-RO. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e333 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jose M. Flores More articles by this author Nicole Benfante More articles by this author John P. Mulhall More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP46-08 COST AND UTILIZATION OF CONCURRENT VS STAGED TESTICULAR IMPLANT FOR RADICAL ORCHIECTOMY

You have accessJournal of UrologyCME1 May 2022MP46-08 COST AND UTILIZATION OF CONCURRENT VS STAGED TESTICULAR IMPLANT FOR RADICAL ORCHIECTOMY Arman Walia, Joshua Horns, Niraj Paudel, Aditya Bagrodia, Jim Hotaling, and Tung-Chin Hsieh Arman WaliaArman Walia More articles by this author , Joshua HornsJoshua Horns More articles by this author , Niraj PaudelNiraj Paudel More articles by this author , Aditya BagrodiaAditya Bagrodia More articles by this author , Jim HotalingJim Hotaling More articles by this author , and Tung-Chin HsiehTung-Chin Hsieh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002612.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: American Urological Association guidelines recommend testicular prosthesis discussion prior to orchiectomy. Utilization may be low. We investigated outcomes and care utilization between concurrent implant (CI) and staged implant (SI) insertion after radical orchiectomy. METHODS: The MarketScan Commercial claims database (2008-2017) was queried for men >18-years-old who underwent radical orchiectomy for testicular tumor, stratified as orchiectomy with no implant, CI, or SI (any time post-orchiectomy). 90-day outcomes included rate of reoperation, readmission, emergency department (ED) presentation, and outpatient visits. Regression models provided rate ratio comparison. RESULTS: 8803 (8564 no implant, 190 CI, 49 SI) patients were identified with no difference in age, Charlson comorbidity index, benefit plan, additional cancer treatment, or metastasis. Median perioperative cost at orchiectomy (+/- implant) for no implant, CI, and SI were $5682 (3648-8554), $7823 (5403-10973), and $5380 (4130-10521), respectively (p<0.001). Median perioperative cost for SI at implantation was $8180 (4920-14591) for a total cost (orchiectomy + implant) of $13560 (5380 + 8180). Total postoperative costs stratified by additional cancer treatment (chemotherapy, radiation, retroperitoneal surgery) are in Table 1. 90-day care utilization is in Table 2. CI patients were more likely to have follow-up (OR 2.48, p=0.006) with more visits (OR 1.54, p=0.030) compared to the SI group post-implantation, but had similar follow-up (OR 1.93, p=0.065) and less visits (OR 1.29, p=0.025) compared to the SI patients’ post-orchiectomy period. No difference in cost or rate of ED visits, readmission, or reoperation was identified.Overall explant rates were 4.7% (9) for CI and 14.3% (7) for SI (p=0.04) with a median time to explant of 166 (135-210) and 40 (9.5-141.5) days, respectively (p=0.06). Median cost of removal was $2060 (IQR 967-2880). CONCLUSIONS: CI placement has less total perioperative cost, lower explant rate, and similar postoperative utilization compared to SI. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e775 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Arman Walia More articles by this author Joshua Horns More articles by this author Niraj Paudel More articles by this author Aditya Bagrodia More articles by this author Jim Hotaling More articles by this author Tung-Chin Hsieh More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP39-08 IMPACT OF SARS-COV-2 PANDEMIC ON THE DIAGNOSIS AND SURGICAL INTERVENTION OF COMMON UROLOGICAL CONDITIONS: RESULTS FROM A MULTI-INSTITUTIONAL DATABASE FROM THE UNITED STATES

You have accessJournal of UrologyCME1 May 2022MP39-08 IMPACT OF SARS-COV-2 PANDEMIC ON THE DIAGNOSIS AND SURGICAL INTERVENTION OF COMMON UROLOGICAL CONDITIONS: RESULTS FROM A MULTI-INSTITUTIONAL DATABASE FROM THE UNITED STATES Maxwell Towe, Sirpi Nackeeran, Mohammad Hout, Abhishek Bhat, Ranjith Ramasamy, and Hemendra Shah Maxwell ToweMaxwell Towe More articles by this author , Sirpi NackeeranSirpi Nackeeran More articles by this author , Mohammad HoutMohammad Hout More articles by this author , Abhishek BhatAbhishek Bhat More articles by this author , Ranjith RamasamyRanjith Ramasamy More articles by this author , and Hemendra ShahHemendra Shah More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002599.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The SARS-CoV-2 (COVID) pandemic threatened access to healthcare, raising concerns that patients were going underdiagnosed and undertreated. The aim of our study was to understand the impact of the COVID pandemic on diagnosis and surgical management of common urological conditions. METHODS: Using a large multi-center electronic health record network (TRINETx) consisting of 46 healthcare organizations, we conducted an epidemiological study investigating the number of patients newly diagnosed with common urological conditions and those undergoing urologic surgeries at yearly intervals from March 1st, 2016 to March 1st, 2021. Relevant international classification of diseases (ICD) codes used to identify urologic conditions are elaborated on in Table 1. Current procedural terminology (CPT) codes used to identify surgeries are detailed in Figure 1. We then determined the percentage of newly diagnosed patients who underwent surgery for each specific year. RESULTS: We saw a decrease in number of all urologic surgeries being performed during the initial year of the pandemic (Figure 1). From March 2020-2021, there was a >20% decrease in surgical case load for benign prostatic hyperplasia procedures (−29.5%), prostate biopsies (−30.1%), incontinence procedures (−33.6%), and vasectomies (−22.8%), compared to the preceding year. Radical cystectomies and orchiectomies saw the lowest decrease, −5.9% and −8.6%, respectively. A similar trend was seen in the number of individuals newly diagnosed with urologic conditions and percentage of patients undergoing surgical intervention. The lowest drops were seen with ureteral stent placements (−5.0%) and prostate biopsies (−3.1%). CONCLUSIONS: The number of people receiving urologic diagnoses and surgical case load for urologic procedures significantly reduced during the first year of the COVID pandemic. Providers should be aware of this healthcare disparity, and greater efforts made to identify these “missed” patients moving forward. Source of Funding: Research was supported by Acerus Pharmaceuticals in the form of an educational grant used to access the TriNetX database. Acerus Pharmaceuticals was not involved in the planning, design, writing or any other aspect of this project.This work was also supported by National Institutes of Health Grant R01 DK130991 and Clinician Scientist Development Grant from the American Cancer Society to Ranjith Ramasamy © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e667 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Maxwell Towe More articles by this author Sirpi Nackeeran More articles by this author Mohammad Hout More articles by this author Abhishek Bhat More articles by this author Ranjith Ramasamy More articles by this author Hemendra Shah More articles by this author Expand All Advertisement PDF DownloadLoading ...

Testicular Epidermoid Cyst: A Rare Case Report.

Introduction an importanceTesticular epidermoid cysts (TECs) are rare benign testicular neoplasms. Recently, testicular epidermoid cysts (TECs) are listed as teratoma of prepubertal type, however it is still difficult to differentiate the epidermoid cyst from malign testicular tumor. Therefore, we would like to report testicular epidermoid cyst at our institution.Case presentationA 67-year-old man from Indonesia, presented with chronical painless mass of testis since one year ago. On physical examination obtained normal penile structure with descended testicles, palpable intrascrotal mass with size of 10 × 7 × 5 cm, firm consistency, immobile, without any tenderness, and no lymphadenophaty in groin. Scrotal USG showed intratesticular mass, homogenous parenchym, showed no vascularization during Doppler examination. Histopathological examination revealed the specimen of right scrotum with size of 12.5 cm × 8.5 cm × 6.1 cm with red-brownish colored, during lamellation, obtained encapsulated mass with size of 12.2 cm × 7.9 cm × 6 cm, hollowed space filled with porridge-like texture with capsule thickness of 0.1–0.3 cm.Clinical discussionEpidermoid cysts are benign lesions occurring on the skin usually, however, it rarely occurs in intratesticular area. Most of the cases (60%) presented with the typical onion-ring phenomenon. Histopathological findings commonly revealed typical well-defined cyst lined by a fibrous membrane. No skin appendages are found in the cyst's lumen and no germ cell neoplasm (GCN) is present in the adjacent testicular parenchyma.ConclusionAll testicular masses are considered malignant until proven otherwise. It is necessary to do accurate diagnosis for the prevention of unnecessary radical orchiectomy.

MP34-01 IS TESTIS SPARING SURGERY A SAFE APPROACH IN PATIENTS WITH SMALL TESTICULAR LESIONS REFERRING TO A FERTILITY CENTER? A RETROSPECTIVE ANALYSIS REPORTING LONG-TERM ONCOLOGICAL OUTCOMES AND FACTORS ASSOCIATED WITH MALIGNANCY

MP34-01 IS TESTIS SPARING SURGERY A SAFE APPROACH IN PATIENTS WITH SMALL TESTICULAR LESIONS REFERRING TO A FERTILITY CENTER? A RETROSPECTIVE ANALYSIS REPORTING LONG-TERM ONCOLOGICAL OUTCOMES AND FACTORS ASSOCIATED WITH MALIGNANCY

The role of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in determining the prognosis of patients with testicular cancer

Background: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), as systemic inflammatory response markers, have been shown to play a role in prognostic factors for patients with malignancies in recent years. However, their application as the prognostic factors of testicular cancer remains unknown. This study aims to evaluate the prognostic role of testicular malignancies using preoperative hematological parameters, NLR and PLR, and their pre-diagnostic role in the staging of testicular cancer. Methods: This was a cross-sectional retrospective study of thirty-nine patients who underwent radical orchiectomy due to testicular cancer at the Department of Urology Haji Adam Malik General Hospital between January 2014 and December 2018. For each patient, clinical features including age, sex, clinical stage, chemotherapy, radiology report, pre-treatment neutrophil count, lymphocyte count, platelet count, NLR, PLR, and postoperative histopathological report were collected. Then we analyzed the association between NLR, PLR and the testicular cancer metastasis incidence. Result: The mean age of the patients was 27.56 ± 17.47 years. Seventeen patients had seminoma (42.5%), 16 others were yolk sac type of cancer (40.0%), and the rest six patients were teratoma (3 patients), lymphoma (2 patients), and embryonal carcinoma (1 patient). More than half (66.48%) of the patients received chemotherapy after radical orchiectomy, with 48.70% in clinical stage III. PLR was associated with testicular cancer metastases (p=0.024), while NLR was not (p=0.729). Conclusion: High pre-treatment PLR levels are associated with the occurrence of metastasis in testicular cancer patients. Hematological parameters will become critical in the preoperative evaluation of such testicular cancer cases. The potential prognostic significance of NLR and PLR in testicular cancer should be tested with further studies.

Clomid after failed Onco-microsurgical testicular sperm extraction: A case for delaying contralateral surgical sperm retrieval

Background &amp; Objectives: Onco-microsurgical testicular sperm extraction (Onco-microTESE) allows the microsurgical extraction of testicular sperm from the unaffected regions of the tumour-bearing testis at the time of radical orchidectomy. We report the case of a 36-year-old hypogonadotropic male with a testicular tumour and non-obstructive azoospermia. Method: A left radical orchidectomy was performed with simultaneous onco-microTESE. Although some sperm were found during the procedure, these were unsuitable for cryopreservation due to abnormal morphology. Given his low testosterone level (4.1 nmol/L), contralateral surgical sperm retrieval at the same sitting was not performed. Histology of the affected testicle demonstrated a classical seminoma and ‘Sertoli cell only’ appearance. He was subsequently started on clomiphene citrate. Results: After 9 months of clomiphene citrate, repeat semen analysis showed a total of 2.8 million sperm (1 million/mL), with 80% motility. Four vials of semen were cryopreserved, and this ejaculated sperm was used for in vitro-fertilisation (IVF) with intracytoplasmic sperm injection (ICSI). All six harvested eggs were fertilised. By day 5, there were two top grade blastocysts available, one of which was transferred and another frozen. After 9 months, the couple welcomed the birth of a healthy male infant. Conclusion: To our knowledge, this case is the first to demonstrate the benefit of clomiphene citrate in a patient with testis cancer resulting in a reversal of azoospermia and a subsequent live birth with assisted conception. Level of evidence: Not applicable

Satisfaction with testicular prosthesis: a Portuguese questionnaire-based study in testicular cancer survivors

Radical orchiectomy in testicular cancer patients can have a negative impact on body image and self-esteem. Reconstructive surgery with testicular prosthesis might mitigate this burden. We conducted a questionnaire-based study aiming to evaluate our patients’ satisfaction with testicular prosthesis. Overall satisfaction was rated as excellent or good in 97.7%. The main complaints were related to the prosthesis’ inappropriate texture (45.5%), size (18.1%) or position (15.9%). Among men interviewed, 59% considered that having a normal looking scrotum was either extremely important or important for their self-esteem. The majority (88.2%) stated they would make the same decision again, and nearly all patients would recommend it to other men with testicular cancer. We believe testicular implants should always be offered, leaving the final decision to the patient.

Unclassified testicular sex cord-stromal tumors in children

We report a case of 12-year-old boy diagnosed with an unclassified sex cord stromal testicular tumor after a mild testicular trauma and the unclear ultrasound finding of a testicular mass. Physical examination was significant for a mass in the right testis. Scrotal magnetic resonance revealed an 8 millimeters nodular lesion suggestive of a Leydig cell tumor. Tumor markers were negative. The patient underwent a right radical orchiectomy plus implantation of a testicular prosthesis. Tumor cells expressed inhibin, WT 1, CD 56, CD99, vimentin and actin. Pathological diagnosis was unclassified sex cord stromal tumor confined to the testis. Metastatic workup by CT was negative. Unclassified sex cord-stromal tumors are infrequent and show an indeterminate differentiation of tumor cells that cannot be characterized with light microscopy towards Leydig, Sertoli, granulosa or theca cells. Immunohistochemistry helps in the differential diagnosis.Due to the risk of malignancy, local recurrence and uncertain biological behavior, radical orchiectomy is recommended, and a metastatic workup should be performed. Keywords: children; orchiectomy; sex cord-stromal tumor; scrotal ultrasound; testicular tumor

Bilateral congenital cryptorchidism and unilateral Leydig cell tumor in an adult presenting with gynecomastia and primary infertility: A case report

Introduction and importanceThe neoplasms of the testis are sporadic tumors among men. Furthermore, the rarest subset of these is neoplasms belonging to the stromal tumors of the sex cord. Leydig cell tumors are the most common form among the testicular stromal tumors. In our case, the underlying risk factor associated with the development of Leydig cell tumors was cryptorchidism. While mostly unilateral, cases of bilateral cryptorchidism may be present and have been rarely reported.Case presentationWe report a 36-year-old gentleman who presented to us with the inability to carry off intercourse without difficulty attaining erection on stimulation for the past two years. He had a history of left undescended testis since birth, for which he underwent left orchidopexy 20 years ago. An ultrasound of the pelvis showed an oval hypoechoic-shaped heterogeneous mass in the right mid-inguinal canal. Relevant blood investigations showed a deranged hormonal profile. He then underwent an uneventful right radical orchiectomy, histopathology of which was consistent with Leydig cell tumor.Clinical discussionLCT with a history of bilateral cryptorchidism has rarely been reported. This case highlights its clinical presentation, management, and further follow-up in such patients.ConclusionBilateral congenital cryptorchidism may be associated with Leydig cell tumor years later in life hence long-term follow-up is required for these patients. The clinical presentation of these tumors may vary among individuals. Any change in physical appearance, hormonal assay, and imaging studies should promptly be followed for possible surgical resection and close monitoring.

Robotic retroperitoneal lymphadenectomy in paratesticular rhabdomyosarcoma

Paratesticular sarcoma is an aggressive malignanttumor of mesenchymal origin. The rhabdomyosarcoma is the most common among children.Rhabdomyosarcoma treatment consists ofsurgery, chemotherapy and radiotherapy. Prognosicdepends on local recurrence and distant metastasis. We present the case of a 16-year-old male, who inApril 2016 underwent right radical orchiectomy surgery by testicular mass rapidly evolving, with pathological results indicating a paratesticular rhabdomyosarcoma. The extension study showed aprecaval adenopathy suggestive of lymph nodemetastasis, therefore it was a high-grade rhabdomyosarcoma. There was an appropriate response after chemotherapy (Protocol EpSSG RMS2005) andwe decided to perform a robotic lymphadenectomy. We performed a transperitoneal approach with 8mm trocar and 12mm optica trocar. We accessed the retroperitoneal space through a latero-colic incision. Then we performed a craniocaudal lymph node dissection until the aortic bifurcation. The surgical time was 240min with a blood loss of 200ml. There were no complications. The patient was discharged on the fourth day after surgery. Pathology showed metastasis of rhabdomyosarcoma without capsular rupture. After two months, we placed the left testicle into inguinal canal prior to radiotherapy. Robotic lymph node metastasis lymphadenectomy from paratesticular sarcomas is a feasible treatment with the advantage of minimally invasive surgery and acceptable morbidity.

First reported case of adult paratesticular myxofibrosarcoma in Indonesia: Case report and literature review.

Introduction and importanceMyxofibrosarcoma is one of the rarest sarcoma types, found in para-testicular regions of the elderly. Although this tumor is detectable by MRI, there has been no specific guideline for managing its recurrence.Case presentationA 49-year-old male with a painless scrotal mass was studied. The patient had no other complaint, and the laboratory results showed unremarkable testicular tumor markers. Ultrasound examination of the right hemiscrotum shows a solid mass in the scrotum and right inguinal that compressed the right hemitesticle. MRI examination of the scrotal region revealed a homogeneous solid mass, while at the lower abdomen, it showed a mass extending from the inguinal canal to the penis shaft and right testis. The patient had no signs of metastatic disease, but after high ligation orchidectomy, a rare paratesticular myxofibrosarcoma was revealed from histopathology examination.Clinical discussionBased on existing data and patient MRI imaging, total surgical excision with high ligation orchidectomy is the only curative therapeutic option for low-grade tumors. Furthermore, no recurrent mass was identified during follow-up, and adjuvant chemotherapy or radiotherapy was not administered. The patient was satisfied with the surgery and is on a 6-month routine follow-up to observe the physical symptoms.ConclusionThis is the first adult paratesticular myxofibrosarcoma case in Indonesia, and it was performed with radical orchidectomy with high ligation due to its invasiveness. However, adjuvant chemotherapy was not provided because the benefit remained inconclusive. The result showed that this approach produces excellent outcome without any relapse.

Utilization of radiation therapy and impact on outcomes in spermatic cord sarcomas in the United States.

419 Background: Spermatic cord sarcomas are a rare entity with management consisting of radical orchiectomy and the value of adjuvant radiation being unclear, as the literature consists of heterogeneous case series spanning multiple decades with limited numbers of patients. Methods: The National Cancer Data Base was queried for men who underwent orchiectomy for spermatic cord sarcomas between 2004 and 2018 with known surgical margin status. Kaplan-Meier with log-rank test and Cox proportional hazards tests were utilized for overall survival (OS) calculations. Associations were determined with bivariate regression analysis. Results: A total of 912 men were identified who met inclusion criteria. Six hundred seventeen (67.7%) had liposarcomas (LS) while 32.3% had non-lipsarcomatous (NLS) histologies. 5/10-year OS for men with LS was 85.1%/67.4% and 74.1%/58.4% for NLS, respectively (p &lt; 0.001). 238 (26.1%) men were treated with adjuvant radiation therapy with similar distributions between LS and NLS. Utilization of radiation was significantly associated with moderate-poorly differentiated histology (HR 3.228 [95%CI 2.241-4.649] p &lt; 0.001), radical orchiectomy (HR 1.477 [1.062-2.054] p = 0.020), positive surgical margins (HR 1.826 [95%CI 1.257-2.652] p = 0.002), but not histologic subtype or tumor size. There was no difference in OS for LS nor NLS with respect to the application of adjuvant radiation, but in men with moderately-poorly differentiated LS treated with adjuvant radiation, 5-year OS was 86.8% vs. 68.6% (p = 0.148). In men with well-differentiated LS, 5-year OS was 93.6% with XRT vs 89.5% (p = 0.623). Adjuvant XRT did not impact OS in men with positive surgical margins, nor did it have an impact on OS for NLS regardless of disease grade or margins. Conclusions: Adjuvant radiation therapy is utilized for approximately one quarter of men diagnosed with spermatic cord sarcomas. XRT may impact OS for men with moderately-poorly differentiated liposarcomas; further research with patient-level data is required.

Evaluation of a risk-adapted strategy in the primary surgical management of clinical stage IIA testicular cancer.

414 Background: Patients with clinical stage IIA (CS IIA) testicular cancer often present a diagnostic and management dilemma. Clinical guidelines recommend primary retroperitoneal lymph node dissection (RPLND), chemotherapy, or radiotherapy with excellent recurrence- and disease-specific survival (RFS, DSS) rates. Given the favorable prognosis and young age of men with CS IIA disease, efforts should be made to limit treatment burden while maintaining favorable oncologic outcomes. Here we present a risk-adapted, multi-disciplinary model in the management of CS IIA testicular cancer. Methods: This was a retrospective study of men undergoing primary RPLND for CS IIA testicular cancer from 6/1/2015 to 2/28/2021. Each patient underwent radical orchiectomy with a histologic diagnosis of testicular cancer. Staging was performed with cross-sectional imaging and serum tumor markers. The case and management options were presented in a multi-disciplinary setting with the preference for re-imaging in 6-8 weeks and performance of RPLND so long as no involution of nodes or development of distant metastases. Node positivity at RPLND and clinical recurrence were evaluated. Pearson’s correlations and logistic regression were performed to evaluate the relationship between time from staging imaging to surgery and the outcomes of interest. Results: Nineteen men with CS IIA testicular cancer underwent primary RPLND. Median age at RPLND was 28 years. There were 7 (36.8%) men with pure seminoma, 11 (57.9%) with non-seminomatous germ tumor (NSGCT), and 1 (5.3%) with burnt-out primary on orchiectomy. Median largest node size was 1.2 cm (IQR 1.0-1.4 cm) on staging imaging. Final RPLND pathology revealed 2 benign (10.5%), 11 with pure seminoma (57.9%), and 6 with NSGCT elements (31.6%). The median number of positive lymph nodes on final pathology was 2 with median largest node size of 2.0 cm (IQR 1.25-3.00 cm). 9 patients (47.4%) upgraded to pN2. Median follow-up was 15 months. There were two clinical recurrences, yielding a median RFS of 9 months. Pearson correlation and univariate regression revealed no significant association between time from imaging to RPLND and upstaging from cN1 to pN2, recurrence, or recurrence-free survival. Conclusions: This study demonstrates a multidisciplinary approach selecting patients that are best managed with RPLND, supporting the oncologic safety of this risk-adapted model in the management of CS IIA testicular cancer. The pN0 rate of 10.5% is lower than historical rates in CS IIA disease and may be related to selecting out patients more appropriate for active surveillance. Similarly the 10% recurrence rate is lower than large surgical series. We are limited by lack of the denominator of patients that developed metastases at interval imaging that subsequently received systemic therapy.

Spindle Cell Lipoma of the Spermatic Cord: A Case Presentation and Literature Review of a Urologic Rarity and Radiologic Mimic of Malignant Liposarcoma

BackgroundSpindle cell lipomas are uncommon variants of typical lipomas, and presentation within the spermatic cord is exceedingly rare. Only three other cases have been reported in medical literature.Case PresentationWe present the fourth case of spindle cell lipoma of the spermatic cord, which in this particular case had imaging findings suggestive of a malignant liposarcoma prompting radical orchiectomy. Histological investigation later concluded that this represented a benign, spindle cell lipoma of the spermatic cord as evidence by positive CD34 staining and microscopic analysis.ConclusionAlthough this particular variant of lipoma is rare, it is the hope that these findings contribute to the continued study of this disease process and can potentially prompt further evaluation prior to radical orchiectomy to limit patient morbidity.

MATURE TESTICULAR TERATOMA IN PEDIATRIC PATIENT: A CASE REPORT

Objective: To report our experience on management of testicular teratoma in pediatric patient. Case(s) presentation: A 2-years-old boy presented with progressive mass in his left testis. The mass was found 3 months ago but became larger in a few days. The patient had no other genitourinary complaint. Vital signs were within normal limits. A hard and tender mass in the left scrotum sized 5x4x2.5 cm was palpated from the physical examination. An imaging study with Computed Tomography (CT) Scan revealed an enhancement in the left scrotum mass area. There was no ring enhancement in pelvic and paraaortic lymph nodes. The laboratory examination within normal limit. Inguinal radical orchiectomy was performed, and histopathological examination revealed a mature testicular teratoma of the left testis. Discussion: Testicular teratoma in children is usually benign. Testicular germ cell tumors generally have a good prognosis with current therapy. Post-orchiectomy management depends on the histology type, staging, and tumor markers. Conclusion: Testicular teratoma is a rare case and can cause minimal symptoms until it grows significantly. Testicular teratoma should be considered in the differential diagnosis of non-traumatic painless progressive scrotal mass. Inguinal radical orchiectomy may be considered as the primary management.

Promising Immunotherapy in Metastatic Testicular Sex Cord Stromal Tumours After First-Line Chemotherapy.

BackgroundTesticular sex cord stromal tumours (TSCSTs) are rare, with few studies focusing on the metastatic TSCST prognosis. The value of treatments, including radical orchiectomy (RO) and retroperitoneal lymph node dissection (RPLND), in preventing metastasis is controversial. Additionally, metastatic TSCSTs are resistant to chemotherapy. We aimed to assess the effectiveness and safety of immunotherapy in metastatic TSCSTs after first-line chemotherapy.MethodsWe retrospectively screened patients with testicular tumours undergoing testis surgery between January 2005 and January 2019. Patients with TSCSTs who had undergone testis-sparing surgery (TSS) or RO were identified. The malignant type was defined as metastasis confirmed by pathology. Treatment responses, progression-free survival (PFS), overall survival (OS) and safety were analysed.ResultsAmong the 494 testicular tumour patients who received TSS or RO, 11 (2.2%) patients with histologically proven TSCSTs were identified. At the last follow-up, 7 patients survived without tumours, and 4 patients developed metastasis and received first-line cisplatin-based chemotherapy, with 1 of them achieving an objective response. Their PFS times were 1.5, 2.2, 9.0, and 17.0 months, respectively. Two patients received immune checkpoint inhibitors (ICIs) after developing chemotherapy resistance and achieved a partial response up to the last follow-up; one of them experienced Grade 1 adverse events, and the other experienced Grade 2 adverse events during immunotherapy. The median OS time of the 4 patients with metastatic TSCSTs was 32 months.ConclusionsTSCSTs are rare, and most are benign with a good prognosis. ICIs represent a promising option for improving clinical outcomes in metastatic TSCSTs.

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 &amp; 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.

JUVENILE XANTHOGRANULOMAS MASS CAUSED TESTICULAR TORSION A RARE OCCASION IN PEDIATRICS: A CASE REPORT

Background: Juvenile xanthogranulomas (JXG) is a histiocytic disorder, in a child below 5 years of age. Xanthogranulomatous orchitis (XGO) is a rare disease, it is an extremely rare inflammatory non-neoplastic destructive lesion of the testis, and a few cases have been reported to date. Aim: We reported a case of JXO presenting as a solitary mass in the left testicle causing testicular torsion in an 11-month-old child without manifestations of JXG elsewhere. Case presentation: the patient presented with an acute history of pain in his left hemi scrotum. An ultrasound study showed a 10 x 13 mm round tumor with a distinct boundary between the tumor and the irregular heterogeneous testicular tissue, Doppler ultrasound images submitted changes suggestive of testicular torsion. Surgery was performed that showed a necrotic left testicle, with and tumor-like lesion attached to the cord and overlapping the body of epididymis. A left orchiectomy was performed. Histopathology reported that the architecture of the testis was lost. Two cut sections in the mass nodular collections of abundant xanthomatous foamy macrophages. Xanthogranulomas was suggested. Conclusion: Because of the aggressive nature of this disease, curative treatment is by either radical or partial orchiectomy considered the goal standard for the final management outcome.

A Rare Case of Bilateral Paratesticular Malignant Mesothelioma of Tunica Vaginalis with Bilateral Hydrocele

Paratesticular region is an indeterminate anatomical region including the spermatic cord with its contents- tunica vaginalis of the testes, epididymis and its appendices and testis. Paratesticular tumours may mimic testicular tumours and is clinically indistinguishable. Paratesticular malignant mesothelioma is an extremely rare tumour, representing only 0.3-5% of all mesotheliomas. There is not a specific clinical presentation however, it may present as a mass which is painless or as a hydrocele, having a wide age distribution. Lack of specific tumour markers presents a challenge in its diagnosis and management. Extreme diagnostic difficulty arises preoperatively in distinguishing malignant and benign tumour. Most of the cases are diagnosed intraoperatively or postoperatively when found on biopsy. Pleural and peritoneal mesotheliomas are known to occur in individuals exposed to asbestos. The case reported here is of a 32-year-old male who reported in the Out Patient Department (OPD) with the complaint of painless bilateral enlarged scrotum without history of exposure to asbestos. Bilateral orchidectomy followed by biopsy reported paratesticular malignant mesothelioma. Bilateral malignant mesothelioma of tunica vaginalis with bilateral hydrocele occurrence is rare, and it has an aggressive clinical progression, so clinical presentation and histopathology features are being presented to emphasise on the fact that it is critical for the urologists to be aware of such potentially rare entity. A mandatory high index of clinical suspicion is required, as lack of knowledge would result in an unnecessary radical orchidectomy as happened in present case.