Testicular Malignancy Research Articles

Scrotal abscess with xanthogranulomatous epididymo-orchitis: a case report of rare diagnostic entity

Xanthogranulomatous epididymo-orchitis is an extremely rare diagnostic entity presenting as ascrotal mass with or without pain. Rarely, it can affect prostate, epididymis, and testicle. It canmimic a testicular malignancy both clinically as well as radiologically, hence, careful pathologicalexamination and biomarker study are essential to rule out malignancy. We report a case of 50 yearsold male with increasing right testicular swelling with a discharging pus. Skin over scrotum wasgangrenous. Right orchidectomy was performed. Histopathological diagnosis revealed features ofxanthogranulomatous epididymo-orchitis with no evidence of malignancy. IHC markers for tumorwere negative.

THYMIC CANCER WITH ADRENAL METASTASIS: A RARE PRESENTATION

SESSION TITLE: Medical Student/Resident Disorders of the Mediastinum Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Thymic tumors are rare invasive neoplasms and account for 0.2% to 1.5% of all neoplasms. Among them, thymic carcinomas are the most aggressive variant that represents approximately0.06% of all malignancies. Lung involvement is very common whereas extra-thoracic metastasis is rare. We describe a case of thymic cancer with adrenal metastasis which is a very rare presentation. This case highlights the various presentations of such a rare tumor which can often be missed due to the paucity of knowledge of this malignancy due to low incidence. CASE PRESENTATION: A 40-year-old male arrived at the hospital with a chief complaint of dull aching chest pain and back pain for one month. He also endorsed weight loss, night sweats, and weakness. He denied smoking, travel, or remote history of TB. Initial vitals, physical examination, and labs were unremarkable. He had a chest Xray which showed an 8 cm lobulated anterior mediastinal mass. Chest tomography (CT) showed large anterior mediastinal mass 7 x13 cm, enlarged mediastinal lymph nodes, and bilateral adrenal masses. At this time our differentials included lymphoma, thymic cancer, metastatic testicular cancer, germ cell tumor, or infectious etiology. Scrotal ultrasound was not suggestive of testicular malignancy. Lactate Dehydrogenase was elevated at 800 concerning for germ cell tumor. Core needle biopsy of the mediastinal mass was suggestive of high-grade thymic carcinoma. An adrenal biopsy was positive for poorly differentiated thymic cancer. The diagnosis of metastatic thymic cancer was established. Oncology was consulted and chemotherapy with cisplatin, doxorubicin, and cyclophosphamide was initiated. Despite chemotherapy, his symptoms worsened and a repeat CT scan at 6 months showed enlargement of the primary tumor to 10x10 cm with infiltration of the sternum and anterior chest wall, enlargement of the bilateral adrenal metastasis, invasion into the right hepatic lobe, kidneys and retroperitoneal carcinomatosis. Due to the advanced nature and poor prognosis of the disease, the patient refused further chemotherapy and decided palliative care. DISCUSSION: Thymic epithelial tumors have an indolent clinical course and are often associated with vague symptoms. Paraneoplastic syndromes associated with thymic cancer include Myasthenia gravis and rarely pure red cell aplasia or hypogammaglobulinemia. Gold standard treatment for thymic neoplasms at any stage is surgical resection. In advanced cases, cisplatin-based chemotherapy is recommended. Pembrolizumab is an accepted option for refractory cancer. Every patient is given post-operative radiotherapy to reduce the chance of recurrence. CONCLUSIONS: 1) Though thymic cancers are uncommon, it must always be included in the differentials for a patient presenting with a mediastinal mass. 2) The prognosis of thymic carcinoma is generally poor and tumor stage is the most important prognostic indicator. Reference #1: Sharma, S. and L. Dawson, A Rare Tumor with a Very Rare Initial Presentation: Thymic Carcinoma as Bone Marrow Metastasis. Case Reports in Pathology, 2017. 2017: p. 6497376. Reference #2: Nishino M, Ashiku SK, Kocher ON, Thurer RL, Boiselle PM, Hatabu H. The thymus: a comprehensive review. RadioGraphics. 2006;26:335–348. Reference #3: A. Marx, J. K. C. Chan, J.-M. Coindre et al., "The 2015 World Health Organization Classification of tumors of the thymus: continuity and changes,” Journal of Thoracic Oncology, vol. 10, no. 10, pp. 1383–1395, 2015. DISCLOSURES: No relevant relationships by Alisha Grewal, source=Web Response No relevant relationships by Ricardo Herrera, source=Web Response No relevant relationships by Jonathan Munoz, source=Web Response No relevant relationships by Tarreq Noori, source=Web Response No relevant relationships by kinnari SHAH, source=Web Response

Development of a 3D-printed testicular cancer model for testicular examination education.

Testicular cancer is the most commonly diagnosed malignancy in young males. Testicular examination is a non-invasive and inexpensive means of detecting testicular cancer at an early stage. In this project, a set of 3D-printed models was developed to facilitate teaching testicular examination and improving understanding of testicular malignancies among patients and medical learners. Five scrotum models were designed: a control model with healthy testes, and four models containing a healthy testicle and a testicle with an endophytic mass of varying size. The anatomy, texture, and composition of the 3D-printed models were refined using an iterative process between the design team and urologists. The completed models were assessed by six urologists, two urology nurse practitioners, and 32 medical learners. Participants were asked to inspect and palpate each model, and to provide feedback using a five-point Likert scale. Clinicians reported that the models enabled accurate simulation of a testicular examination involving both healthy and pathologic testes (χ̄=4.3±1.0). They agreed that the models would be useful teaching tools for both medical learners (χ̄=4.8±0.5) and patients (χ̄=4.8±0.7). Following an educational session with the models, medical learners reported improvements in confidence and skill in performing a testicular examination. 3D-printed models can effectively simulate palpation of both healthy and pathologic testes. The developed models have the potential to be a useful adjunct in teaching testicular examination and in demonstrating abnormal findings that require further investigation.

Subinguinal orchiectomy-A minimally invasive approach to open surgery.

ObjectivesTo determine the rate of morbidity and assess the oncological outcomes for the subinguinal orchidectomy technique.BackgroundRadical inguinal orchiectomy is the definitive management for a testicular mass suspicious for malignancy. The standard approach involves the division of the spermatic cord at the internal inguinal ring. In addition to the morbidity of a significant incision through skin and fascia, a known complication is damage to the nerves within the canal leading to local hypoesthesia or persistent inguinal and scrotal neuralgia. The subinguinal orchiectomy technique avoids opening the inguinal canal by excising the spermatic cord at the external inguinal ring.MethodsPatient data from three urologists who routinely perform subinguinal orchiectomies for suspected testicular malignancy was collected. A retrospective analysis between March 2011 and March 2019 was undertaken evaluating demographic, clinical, and histological data points. Descriptive analysis of oncological and surgical outcomes of subinguinal orchiectomy for testicular mass was performed. Descriptive analysis of oncological and surgical outcomes of subinguinal orchiectomy for testicular mass was performed.ResultsAbout 42 orchiectomies performed via the subinguinal approach were identified. The median age was 38 years (range 22‐72) and mean follow‐up time was 18.4 months (range 0.59‐61). Of the 38 patients with testicular cancer, histopathology showed 26 with pT1, 9 with pT2, and 3 with pT3 disease. Three patients had involvement of the cord, with one patient having a positive surgical margin secondary to venous invasion. No patients experienced neuropathic complications, hernia, or wound break down.ConclusionThese data suggest that subinguinal orchiectomy provides acceptable oncological outcomes, comparable to a traditional technique, and may decrease the risk of neuropathic injury and incisional/inguinal hernia. Further investigation with a larger, prospective series is required.

Recent malignant testicular tumor trend in Japan, a country with an aging population: a large-scale study of 2012-2015 hospital-based cancer registry data.

Japan's national database of hospital-based cancer registries is estimated to cover ~67% of all new cancer cases. Using this database, we analyzed the characteristics of the recently diagnosed testicular malignancy. We obtained data for 6510 adult testicular malignancy patients diagnosed in 2012-2015. The distributions of patient ages, histological diagnoses and testicular germ cell tumor hospital care volumes were determined. The most common histology was seminoma (60.3% of all testicular malignancies), followed by non-seminoma (24.1%) and diffuse large B-cell lymphoma (13.1%). The median and mean ages of the testicular germ cell tumor patients were high at 38 and 39.8years, respectively. The age distribution peaked at 30-40years, followed by 40-50years. Approximately 18% of testicular germ cell tumor patients were ≥50years. The ages of the diffuse large B-cell lymphoma patients peaked at 70-80years (mean 67.7years). When the analysis was limited to the testicular germ cell tumor patients who received first-course cancer treatment at the participating hospitals, the number of high-volume hospitals with ≥20 testicular germ cell tumor care volume was limited to 61 (10.0% of the 605 hospitals that treated ≥1 testicular germ cell tumor patient). However, when the patients who changed hospitals during treatment or relapsed after treatment completion were analyzed together, the number of high-volume hospitals increased to 104 (17.0% of 612 hospitals). The testicular germ cell tumor patients' mean age was nearly 40years. The proportions of older testicular germ cell tumor patients and diffuse large B-cell lymphoma patients were higher than previously thought. The reasons for this trend are unknown, but it is important to address the trend identified herein in a country with a super-aging population.

Scrotal Epidermoid Cyst Presenting as Extra-Testicular Scrotal Mass: A Diagnostic Dilemma

We hereby report a scrotal epidermoid cyst presenting as a scrotal mass which a rare entity in the absence of trauma. 36years old male presents with a complaint of left sided testicular swelling and discomfort. The workup included clinical examination, alpha-fetoprotein (αFP) and beta-human chorionic gonadotropin (β-hCG) analyses and scrotal ultrasound. Clinically confused as testicular malignancy. Complete surgical excision of the cyst was performed. Histopathology confirmed epidermoid cyst with no evidence of malignancy.

Testicular Adrenal Rest Tumour (TART) or Testicular Malignancy: A Clinical Dilemma.

Testicular adrenal rest tumour (TART) is a known entity in patients with congenital adrenal hyperplasia. An adult patient presenting with testicular enlargement raises a concern for malignancy and this creates a diagnostic dilemma between non-malignant conditions such as TART versus testicular malignancy. We describe a case where the patient underwent orchiectomy due to clinical concern for malignancy but, retrospectively, this outcome could have been prevented by medical treatment. This case emphasises the need to learn from errors. There is a need to increase awareness of the condition among medical professionals to reduce the chances of unnecessary surgical intervention.LEARNING POINTSTo recognize testicular adrenal rest tumour (TART) as cause of testicular enlargement in adult patients with congenital adrenal hyperplasia.To differentiate TART from other types of testicular malignancy.Consider medical treatment with exogenous glucocorticoid and mineralocorticoid replacement to prevent unnecessary surgical intervention.

SUN-523 Thyroid Storm: A Rare Presentation of HCG Producing Metastatic Choriocarcinoma

Background: The beta subunit of human Chorionic Gonadotropin (hCG) and TSH are very similar and hCG is known to weakly bind the TSH receptor. hCG induced hyperthyroidism has been previously reported as a rare paraneoplastic syndrome in non-seminomatous germ-cell tumors and usually presents with subclinical thyrotoxicosis. We present a noteworthy case of thyroid storm in a patient with hCG producing testicular Choriocarcinoma. Clinical case: A 19-year-old Hispanic man presented to an outside emergency department (ED) with one day of abdominal pain, nausea, recurrent emesis and subjective fever. He had presented to the same ED 9 days prior with similar symptoms which prompted contrasted CT Abdomen/Pelvis demonstrating hepatic masses and a large right testicular mass, suspicious for primary testicular malignancy. On return evaluation, he was noted to have tachycardia with HR 165, mild scleral icterus, tenderness to palpation of right upper quadrant, abdominal pain and a right scrotal mass (5x5 cm). CBC revealed; WBC 12.0 k/uL (n: 4-10.8), AST: 428 u/L (n: 3-34); ALT: 176 u/L (n: 15-41); total bilirubin: 6.3 mg/dL (n: 0.2-1.3), TSH <0.005 uIU/mL (n: 0.4-4.0) and FT4 5.02 ng/dL (n: 0.7-1.4). Clinical scenario was consistent with thyrotoxicosis concerning for thyroid storm (Burch-Wartofsky Point Scale: 50) requiring intensive care for which he was transferred to our institution. Thyroid US revealed increased thyroid vascularity without nodularity. Laboratory workup revealed negative TG Ab, Anti-TPO Ab, TRAb, and TSIG. Conversely, TBG was elevated at 31.2 mcg/ml (n: 13-30). Initial hCG level was obtained as 6,074. After re-testing with dilution was specifically requested, initial hCG was corrected to 6,760,713. Oncologic workup confirmed diagnosis of hCG producing testicular choriocarcinoma with liver and lung metastases. On admission, he was started on oral methimazole and propranolol as well as intravenous steroids which led to marked symptomatic improvement and normalization of FT4 to 1.37 allowing for discontinuation of antithyroid medication on 7th day of hospitalization. He completed 1 cycle of cisplatin/etoposide and experienced marked reduction of his hCG level to 951,460 which correlated with improvement of his TFTs and resolution of his hyperthyroid symptoms.Conclusion:A low threshold of suspicion should be maintained for the possibility of hyperthyroidism in patients with suspected testicular choriocarcinoma, particularly in the context of recent iodinated contrast imaging. If the clinical picture does not support a primary etiology of hyperthyroidism and hCG is not concordantly elevated, re-assessment of hCG by dilution should be considered as hCG assay is also subject to prozone (hook) effect. Hyperthyroidism should be actively managed and closely monitored as response to treatment can be rapid.

PD25-07 ASSESSING TRENDS IN SPERM CRYOPRESERVATION AT A TERTIARY REFERRAL CENTRE OVER 25-YEARS

You have accessJournal of UrologyInfertility: Epidemiology & Evaluation II (PD25)1 Apr 2020PD25-07 ASSESSING TRENDS IN SPERM CRYOPRESERVATION AT A TERTIARY REFERRAL CENTRE OVER 25-YEARS Tharu Tharakan, Miles Smith*, Thomas Stroud, Ee Teng Goh, Monica Figueiredo, Lia Joannou, Chey Dearing, Lona Vyas, Channa Jayasena, Jonathan Ramsay, and Suks Minhas Tharu TharakanTharu Tharakan More articles by this author , Miles Smith*Miles Smith* More articles by this author , Thomas StroudThomas Stroud More articles by this author , Ee Teng GohEe Teng Goh More articles by this author , Monica FigueiredoMonica Figueiredo More articles by this author , Lia JoannouLia Joannou More articles by this author , Chey DearingChey Dearing More articles by this author , Lona VyasLona Vyas More articles by this author , Channa JayasenaChanna Jayasena More articles by this author , Jonathan RamsayJonathan Ramsay More articles by this author , and Suks MinhasSuks Minhas More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000882.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Cancer survival rates are improving. This has resulted in an increased focus on male survivorship programmes, including fertility preservation. Whilst the gonadotoxic effects of cancer therapy are widely recognised, there is a paucity of data regarding trends in sperm cryopreservation. In particular, there remains a lack of knowledge regarding the types of cancers for which preservation is undertaken and whether there has been an increase in the utility of services. METHODS: An analysis of all oncological sperm cryopreservation at a UK tertiary centre between 1992-2016. Primary measures concerned trends in referrals over this period; in particular, the number of patients, the malignant indication for cryopreservation and patient age. Pre-freeze semen parameters were also assessed over time and used to calculate Total Motile Count (TMC). RESULTS: 3433 oncological patients cryopreserved sperm during the 25-year period. Referrals increased from each year group to the next, with an overall rise of 112%; from 415 (1992-1996) to 878 (2012-2016). Testicular malignancies remained the most prevalent indication for sperm cryopreservation throughout, although the relative contribution of each cancer type changed over time (p<0.001). Most notable was the rise in the proportion of patients with prostate cancer, from 0.5% of patients (1992-1996) to 5.6% (2012-2016). The median age of patients freezing sperm increased over the study period (p<0.001), from 29 years (1992-1996) to 32 years (2012-2016). Overall, 5.5% of men (n=190) were aged 50 or over at the time of their cryopreservation; with 39% of these individuals (n=74) banking sperm between 2012-2016. In all, 339 teenage cancer patients (aged 13-19) cryopreserved. Whilst there was an absolute increase in the number of teenage patients seen over the 25 years, the proportion they accounted for in each year group slightly reduced; from 9.2% (1992-1996) to 8.9% (2012-2016). Median TMC values did not change significantly across the timeframe, either overall or for individual cancer types. CONCLUSIONS: This study represents the largest single-centre evaluation of oncological sperm cryopreservation. We report a number of important trends over a 25-year period; the number of patients electing to bank sperm before oncological therapy is increasing, whilst the types of cancer encountered are changing. Furthermore, there has been a rise in the number of patients cryopreserving sperm at both extremes of age. These findings are encouraging and indicate an increased awareness of fertility preservation amongst men of all ages and cancer types. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e540-e541 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tharu Tharakan More articles by this author Miles Smith* More articles by this author Thomas Stroud More articles by this author Ee Teng Goh More articles by this author Monica Figueiredo More articles by this author Lia Joannou More articles by this author Chey Dearing More articles by this author Lona Vyas More articles by this author Channa Jayasena More articles by this author Jonathan Ramsay More articles by this author Suks Minhas More articles by this author Expand All Advertisement PDF downloadLoading ...

Embryonal Rhabdomyosarcoma of the Testis

Rhabdomyosarcoma (RMS), arising from mesenchymal cells, is the most common soft tissue tumour in children and accounts for up to half of all sarcomas. We present a case of a 15 year old male presented with gradually increasing right sided scrotal swelling for last one year. The patient was later diagnosed as right testicular malignancy with metastasis in abdominal lymph nodes and lungs. Inguinal orchidectomy was performed and final histopathological diagnosis was embryonal rhabdomyosarcoma of right testis.&#x0D; Journal of Surgical Sciences (2019) Vol. 23(2): 98-99

The lack of HSD17B3 in male mice results in disturbed Leydig cell maturation and endocrine imbalance akin to humans with HSD17B3 deficiency.

Hydroxysteroid (17β) dehydrogenase type 3 (HSD17B3) deficiency causes a disorder of sex development in humans, where affected males are born with female-appearing external genitalia, but are virilized during puberty. The hormonal disturbances observed in the Hsd17b3 knockout mice (HSD17B3KO), generated in the present study, mimic those found in patients with HSD17B3 mutations. Identical to affected humans, serum T in the adult HSD17B3KO mice was within the normal range, while a striking increase was detected in serum A-dione concentration. This resulted in a marked reduction of the serum T/A-dione ratio, a diagnostic hallmark for the patients with HSD17B3 deficiency. However, unlike humans, male HSD17B3KO mice were born with normally virilized phenotype, but presenting with delayed puberty. In contrast to the current belief, data from HSD17B3KO mice show that the circulating T largely originates from the testes, indicating a strong compensatory mechanism in the absence of HSD17B3. The lack of testicular malignancies in HSD17B3KO mice supports the view that testis tumors in human patients are due to associated cryptorchidism. The HSD17B3KO mice presented also with impaired Leydig cell maturation and signs of undermasculinization in adulthood. The identical hormonal disturbances between HSD17B3 deficient knockout mice and human patients make the current mouse model valuable for understanding the mechanism of the patient phenotypes, as well as endocrinopathies and compensatory steroidogenic mechanisms in HSD17B3 deficiency.

Discrimination between benign and malignant testicular lesions using volumetric apparent diffusion coefficient histogram analysis

PurposeThis study aimed to evaluate the role of volumetric apparent diffusion coefficient (ADC) histogram analysis in discriminating between benign and malignant testicular masses. MethodsIn this retrospective study, fifty-nine patients with 61 pathologically confirmed testicular masses were consecutively enrolled, including 18 benign lesions and 43 malignant lesions. All patients conducted preoperative magnetic resonance imaging (MRI) with diffusion-weighted imaging. Eighteen volumetric histogram parameters were extracted from the ADC map of each lesion. Comparisons were conducted by an independent t-test or Mann-Whitney U test, where appropriate. The classification performance of the parameters that showed significant differences between benign and malignant testicular disease were evaluated via receiver operating characteristic (ROC) curve analysis. ResultsAmong the 18 histogram parameters we extracted, the energy, total energy, and range of ADC of testicular malignancies were all significantly increased compared with those of benignities. The minimum ADC and 10th percentile ADC of testicular malignancies were both significantly reduced compared with those of benignities. The minimum ADC value achieved the highest diagnostic performance in distinguishing between testicular benignities and malignancies, with an area under the ROC curve (AUC) of 0.822, sensitivity of 81.40 %, and specificity of 77.78 %. ConclusionsVolumetric ADC histogram analysis might be a useful tool to preoperatively discriminate between benign and malignant testicular masses.

Prognosis of Patients With Testicular Carcinoma Is Dependent on Metastatic Site.

Background: Existing data on the association of metastatic sites and prognosis of patients with metastatic testicular malignancy are limited. In this study, the association of survival outcome and the prognostic value of different metastatic sites in patients with metastatic testicular cancer was investigated.Methods: A dataset from the Surveillance, Epidemiology and End Results (SEER) survey was selected for a retrospective metastatic testicular cancer cohort study. Patients with different metastatic sites were divided into corresponding groups for further analysis. Kaplan-Meier analysis with log-rank test was implemented for comparison of the survival distribution of cases. Multivariate Cox regression models were then applied to analyze the association of distant metastases with survival for all selected patients and subgroup based on different histological type with a single metastatic site.Results: A total of 1,661 patients treated for metastatic testicular malignant tumors between 2010 to 2016 were enrolled in this cohort study. Upon initial diagnosis, 61.9, 15.2, 6.7, 6.4, and 36.2% of patients were found to have lung, liver, bone, brain, and distant lymph nodes metastatic sites, respectively. Patients with lung, liver, or bone metastases showed more undesirable prognosis for overall survival (OS) and cancer-specific survival (CSS), in contrast with those with distant lymph node metastases (all P < 0.05). In comparison with patients with more than one metastatic site, those with a single metastasis had extended OS and CSS (both P < 0.001). In patients with a single metastatic site, Kaplan-Meier analysis and multivariate Cox regression demonstrated the association of bone and liver with the worst two groups of OS and CSS. Multivariate Cox models based on histological type showed different prognostic values of metastases in patients with seminoma or non-seminomatous germ cell tumors.Conclusion: There is much heterogeneity in the oncological outcome of site-specific metastatic patients. Metastatic profiles and the prognostic value of metastases are dependent on the histological type in TC patients. Distant lymph nodes and lung metastases indicate favorable prognostic factors, while bone and liver metastases indicate negative survival outcomes in TC.

Metastatic Mixed Germ Cell Tumor Presented With Hemoptysis- A Case Report

A 35 year’s old male presented with right testicular swelling for last six month. He developed hemoptysis and mild dyspnea for 2 weeks. Ultrasonography revealed testicular malignancy with multiple heterogenecity. CT scan of the abdomen did not reveal any lymph node metastasis. His X-ray chest showed extensive pulmonary metastasis. All three tumor markers were raised. Histology was suggestive of mixed germ cell tumor with a rare combination of Seminoma and Choriocarcinoma. Because of this rare combination of 2 varieties of testicular germ cell tumor and advanced systemic metastasis we presented this case.

Testicular Lymphoma: A Rare Entity

Testicular malignancy in old age men should be thoroughly studied because of low rate of incidence. Incidence of testicular lymphomas have been shown to be nearly 9% among all testicular malignancies and 1-2% of all lymphomas found in human body. The most common hisopathological pattern among lymphomas is B-cell type and of these diffuse large B-cell subtype is commonest; however, less commonly, Burkitt’s lymphoma, anaplastic lymphoma or Hodgkin’s lymphoma may primarily involve the testis. Testicular lymphoma is rare whether as a primary or as a secondary origin. Diffuse Large B-Cell Lymphomas (DLBCL) is the most common histopathological type if primary in origin; however aggressive patterns like, Burkitt’s lymphoma, are more common when there is secondary involvement of testis. Stage of the lymphoma (Ann Arbor staging) determines the prognosis of the disease. Other prognostic factors include presence of B symptoms and International Prognostic Index (IPI) score, involvement of spermatic cord and other testis. Immunohistochemistry should be done after histopathological diagnosis for effective treatment of variants of testicular lymphoma. High inguinal orchiectomy along with chemotherapy with or without radiotherapy is current treatment of choice for these tumours. In this article, the case of testicular lymphoma is presented in a 61-year-old male patient, clinical presentation, investigations and surgical and chemotherapeutic management with discussion with respect to previous clinical studies. In this case report, patient presented with swelling of left scrotum for which he underwent the radiological and biochemical investigations. He was further planned for frozen section biopsy. The histopathological and immunohistochemical analysis was suggestive of DLBCL, as final diagnosis.

Persistent Müllerian Duct Syndrome: understanding the challenges

Persistent Müllerian Duct Syndrome (PMDS) is a rare autosomal recessive condition defined by the presence of Müllerian duct derived structures (uterus and fallopian tubes) in an otherwise normally masculinized phenotypical and genotypical (46XY) male. We aim to illustrate a case of PMDS we managed, with a summary of the current literature and recommendations for management. We prospectively followed up a case post diagnosis of PMDS and with six year follow up to date. The current literature on PMDS is summarised. The diagnosis of PMDS was made at laparoscopy at 6 months for investigation and management of bilateral impalpable testes. A Mullerian structure resembling uterus with bilateral fallopian tube-like extensions was seen in the pelvis along with bilateral intraabdominal testes. Gonadal biopsies confirmed normal testicular tissue. The child underwent successful bilateral two-stage Fowler Stephens orchidopexies. The Mullerian remnant was preserved in order to preserve testicular vascularity. Testes are intrascrotal and normal to palpation at follow-up and there have been no clinical symptoms or concerns with the Mullerian remnant during surveillance with ultrasound and MRI. To date, there are less than 300 cases described in the medical literature. We summarise the current evidence for the management of PMDS and reflect on challenges the condition poses; including fertility preservation in PMDS, testicular and Mullerian malignancy risk in PMDS, and optimal management and surveillance of PMDS. Current management recommendations for PMDS, a rare condition, are suggested after review of a case and summary of the current literature.

TUBERCULOSIS MIMICKING A TESTICULAR TUMOR

Genitourinary tuberculosis is a challenging clinical entity which can affect the entire male genital tract. Seventy-five- year old male presented with a testicular lump masquerading a testicular malignancy. Histological and microbiological examination of testicular biopsy specimens established the diagnosis of tuberculosis. Isolated testicular tuberculosis is rarely reported. High degree of clinical suspicion and histological sampling are paramount important in the process of diagnostic evaluation.

Intratesticular Sertoli Cell Tumor: About A Case and Literature Review

Sertoli cell tumors (SCT) are very rare testicular tumors, representing 0.4% to 1.5% of all testicular malignancies. They are subclassified as classic, large-cell calcifying, and sclerosing Sertoli cell tumors. We report a case of a Sertoli cell tumor of the testis in a 37-year-old man. His chief complaint was a testicular pain right, that he had for 4 months. Serum levels of tumor markers were within normal limits. Radical orchiectomy was performed. Histopathology showed a Sertoli cell tumor with no evidence of malignancy. Through the observation and review of the literature which we will discuss the clinical and therapeutic features of this rare entity.

433P - Prospective outcomes of adolescent and young adult (AYA) patients received treatment from a tertiary cancer hospital in Bangladesh

BackgroundMalignancies in AYAs are increasing with increasing their death occurrences but a few data from developing countries. There are 72006601(44.2%) people under 15-39 years age group in Bangladesh. They are in vital age group not only for their own development but also for their country and for the world. This study was aimed to find out the outcome of treatment and causes of death. MethodsThe study was an observational study. All cancer patients aged 15-39 years completed treatment at medical oncology department in National Institute of Cancer Research and Hospital (NICRH) from Jan.2016 to Dec.2017(24 months). Of them 593 patients were included for the study. Their follow up were taken over phone or departmental follow up registries up to May 2019. Information was prospectively studied. ResultsTotal 593 patients were enrolled for this study, male(M) 295(49.75%), female(F)298(50.25%) and M:F=1:1.01. After follow up, found 170(28.67%) patients were untraceable whose 63(10.62%) patients had no contact number. Among the remaining 473 patients 170(35.94%) were died due to anorexia 162(95.3%), both nausea and vomiting 90(53%), pain and fever 65(38.24%), diarrhea 57(33.53%), respiratory distress 38(22.35%), cachexia 37(21.76%), bleeding and generalized swelling 18(10.60%), opportunistic infection 10(5.88%), stroke 3(1.176%), surgical complication 2(1.18%). Of the died patients male were 96, female were 74 and M:F was 1.3:1. The leading causes of death, according to specific disease, were lung cancer 11(61%), head neck cancer 12(57%), sarcoma 56(46%), GIT(gastrointestinal tract) cancer 39(40.63%) and leukemia 12(35%). Least death occurred in GCT (germ cell tumor) 1(4.34%) and lymphoma 7(9%). Alive patients were 240. Of them male were 84, female were 156 and the ratio was M:F=1:1.86. According to specific disease, the highest survival were in testicular malignancy 18(85.71%), breast cancer 88(71%), FGT (female genital tract) 26(70%), lymphoma 44(59%) and GIT malignancy42(43.75%). ConclusionsDeath occurrences were 170(35.94%) and tract out of follow up were 170(28.67%) in AYA that were dangerously alarming for developing countries as youth are majority of total population in developing countries. Legal entity responsible for the studyAbdullah Al Mamun Khan. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Scrotal Pyocele in a Neonate: Review of the Literature and the Lessons Learned

Objective - Bacterial infection of the scrotal appendages (scrotal pyocele) is a rare condition, especially in neonates. It is easy to confuse with other scrotal emergencies that require surgical intervention and orchiectomy. We present a case where pre- and intraoperative diagnosis was not clear and orchiectomy was performed; additionally, review of the literature, diagnostics, treatment options and lessons learned are discussed. Case report - A ten-day old full term neonate, born with bilateral hydroceles and glandular hypospadias, presented with a six day history of poor feeding and irritability; clinical examination revealed an enlarged, erythematous and tender right hemiscotum. Blood cultures, routine laboratory examinations and ultrasound (US) imaging was performed. Postnatal torsion with non-viable testicle, testicular malignancy and epididymo-orchitis were considered in the differential diagnosis. Upon surgical exploration, the testicle appeared non-viable due to severe inflammation and was removed. The patient was treated initially with ampicillin and gentamicin. After Streptococcus pneumoniae was cultured from specimens, treatment was continued with benzyl penicillin. Conclusion - Neonatal scrotal pyocele is an extremely rare condition. The main suggestive features are clinical presentation with signs of infection and an enlarged painful scrotum. US is the investigation of choice to differentiate from a surgical emergency. Free fluid in the scrotal cavity with septae, normal looking testicle on US and no signs of torsion at exploration are diagnostic signs. If diagnosed early, the first line of management is surgical aspiration or decompression, followed by broad-spectrum antibiotic treatment. With delay in diagnosis, the testicle may look non-viable and push surgeons for orchiectomy.