Testis Tumors Research Articles

Decoding the pathogenesis of spermatogenic failure in cryptorchidism through single-cell transcriptomic profiling

Cryptorchidism, commonly known as undescended testis, affects 1%-9% of male newborns, posing infertility and testis tumor risks. Despite its prevalence, the detailed pathophysiology underlying male infertility within cryptorchidism remains unclear. Here, we profile and analyze 46,644 single-cell transcriptomes from individual testicular cells obtained from adult males diagnosed with cryptorchidism and healthy controls. Spermatogenesis compromise in cryptorchidism links primarily to spermatogonium self-renewal and differentiation dysfunctions. We illuminate the involvement of testicular somatic cells, including immune cells, thereby unveiling the activation and degranulation of mast cells in cryptorchidism. Mast cells are identified as contributors to interstitial fibrosis via transforming growth factor β1 (TGF-β1) and cathepsin G secretion. Furthermore, significantly increased levels of secretory proteins indicate mast cell activation and testicular fibrosis in the seminal plasma of individuals with cryptorchidism compared to controls. These insights serve as valuable translational references, enriching our comprehension of testicular pathogenesis and informing more precise diagnosis and targeted therapeutic strategies for cryptorchidism.

A rare combination of double primary malignancies; mixed germ cell tumor of testis with papillary carcinoma of thyroid: a case report

Double malignancy occurring in multiple organs is relatively rare yet possible. The second primary lesion is identified either simultaneously with the primary lesion (synchronous) or after a while (metachronous). We report a case of synchronous double malignancy in a patient who had two separate carcinomas, a non-seminomatous germ cell tumor (NSGCT) and a papillary carcinoma of thyroid. These types of synchronous double malignancies can be dealt as independent carcinomas. This existence of two carcinomas at anatomically dissimilar sites with distinct histopathologies, being a rare combination, led us to report the case.

Incarcerated Intestine by Testicular Mass in Huge Scrotum: A Case Report

Large testicular tumor is not a commonly seen entity in the modern era. While treatment of large testicular tumors is via inguinal radical orchiectomy, large testicular tumors carry the dilemma of delivering these large masses via the inguinal or scrotal approach. Our case was a 90 years old man with obstruction signs and huge scrotum that shows incarcerated large bowel with huge testicular mass, that in his surgery we did Radical Orchiectomy and we replace incarcerated Large Bowel in scrotum and discharge him successfully. Giant testicular cancer is considered one of the largest testicular masses in the world. Delayed seeking medical advice and appropriate management is the major cause behind this rare presentation. Increasing the awareness regarding self-examination and eliminating the stigma is the cornerstone to markedly reduce this type of unusual presentation since any testicular size change and mass can be easily noted by the patient. Surgical exploration and adjuvant chemotherapy seems as a reasonable treatment option in the setting of bilateral intra-abdominal testis tumor in an adult patient. The study underscores the effectiveness of the intervention in promoting preventive behaviours against testicular cancer among university students, laying the groundwork for future educational initiatives. Although testicular cancer (TC) is the most common malignancy in males between the ages of 18 and 50 years, little effort has been made to increase public awareness about TC and testicular self-examinations (TSEs). Intestinal obstruction without a past surgical history of abdominal surgeries or trauma is a rare and challenging clinical situation. This case report describes the presentation, diagnosis, and management of intestinal obstruction in a patient with an uncommon aetiology of small bowel obstruction. Chronic hernia incarceration can lead to weakening and ischemia of the bowel, and minimal trauma can lead to perforation of the weakened segment. In such presentations, bowel resection and repair of the defect with a biological material is safe and feasible.

Assessment of quantitative microflow Vascular Index in testicular cancer

PurposeUltrasound (US) is the primary imaging modality when a testicular tumor is suspected. Superb microvascular imaging (SMI) is a novel, highly sensitive Doppler technique that allows quantification of flow signals by determination of the Vascular Index (VI).The aim of the present study is to investigate the diagnostic significance of the SMI-derived VI in normal testicular tissue and testicular cancer. MethodsThis retrospective analysis included patients who underwent testicular US in our department from 2018 to 2022. Inclusion criteria were: i) sufficient image quality of the stored images, ii) US with standardized SMI-default setting (colour gain of 44 ± 5), iii) patient age ≥ 18 years, and iv) normal testicular findings or testicular tumor with histopathological workup. US examinations were performed as part of clinical routine using a high-end ultrasound system (Aplio i800/i900, Canon Medical Systems Corporation, Tochigi, Japan). Statistical analysis included Chi-square test and Mann-Whitney U tests and receiver operating characteristic (ROC) curve analysis. ResultsA total of 62 patients (31 each with normal findings and testicular tumors) were included. The VI differed statistically significantly (p < 0.001) between normal testis (median 2.5 %) and testicular tumors (median 17.4 %). Like vascular patterns (p < 0.001), the VI (p = 0.030) was shown to distinguish seminomas (median 14.8 %), non-seminomas (median 17.6 %) and lymphomas (median 34.5 %). ConclusionsIn conclusion, our study has shown the VI to be a quantitative tool that can add information for differentiating testicular tumor entities. While further confirmation in larger study populations is desirable, our results suggest that the VI may be a useful quantitative parameter.

Encysted spermatic cord hydrocele: A case series

Introduction and importanceEncysted spermatic cord hydrocele is a rare anomaly characterized by obstruction of processus vaginalis closure. Clinically, it presents as a swelling in the inguinal region extending to the upper scrotum and does not communicate with the peritoneal cavity. It is often mistaken for indirect inguinal hernias, inguinal lymphadenopathy, undescended testis, and primary tumors of the cord in infants and children, making the diagnosis challenging. Case presentationWe report the cases of five male patients aged nine months to 12 years who presented with painless swelling on the right side of the scrotal region. Physical examination revealed firm masses in the right inguinal region with positive transillumination, negative cough impulse tests, and irreducibility. Inguinal and scrotal ultrasonography showed an anechoic cystic lesion with thin walls, without any signs suggestive of a hernia. Patients were diagnosed with encysted spermatic cord hydrocele and advised to undergo cyst excision. The postoperative periods were uneventful, and expected recovery was observed at one-week and one-month follow-ups. Clinical discussionEncysted spermatic cord hydroceles are rare causes of painless inguinal swelling. The medical history and clinical findings can be used to establish a diagnosis, which can be confirmed using ultrasonography. Management depends on differentiating between spermatic cord hydrocele and scrotal hydrocele and involves considering the type. Treatment options range from conservative measures to surgery, particularly for non-communicating hydroceles that persist beyond 12–18 months or enlarge in size. ConclusionEncysted hydrocele of the cord is rare and is often mistaken for indirect inguinal hernias in infants and children. This similarity makes the diagnosis challenging and necessitates vigilance from clinicians. Surgical intervention results in optimal outcomes, especially in cases where the hydrocele persists beyond 12–18 months or with size progression.

Terato-Neuroendocrine Tumour of Testis: Review and Update

Neuro-endocrine tumours commonly emanate from intestinal and respiratory epithelium. Neuro-endocrine tumours could also on rare occasions afflict various organs of the human body. Neuro-endocrine tumour afflicting the testis is an uncommon tumour which does account for far less than one percent (&lt;1%) of all tumours of testis. To the knowledge of the author, less than 100 cases of primary neuro-endocrine tumour of the testis had been reported so far in the global literature. The reported cases of neuro-endocrine tumour of testis have ranged between 10 years and 83 years of age and the reported incidence rate had been noted to be higher within the fifth and sixth decade of life. Majority of patients who are afflicted by neuro-endocrine tumour of testis do tend to manifest with unilateral painless testicular mass. Sixteen percent (16%) of patients who are afflicted by neuro-endocrine tumour of testis do manifest with symptoms of neuroendocrine tumour syndrome. Eleven percent (11%) of primary neuroendocrine tumours of testis tend to be diagnosed initially with a contemporaneously-associated metastasis. Neuro-endocrine tumours of the testis occur as a primary testicular neuroendocrine tumour, or they may be metastatic neuroendocrine tumour to the testis with the primary tumour originating from elsewhere in the body especially from the gastrointestinal or cardiorespiratory tract system. Primary neuro-endocrine tumour of testis, could be further sub-divided into: (a) primary pure neuroendocrine tumour of testis; and (b) neuro-endocrine tumour of testis contemporaneously associated with teratoma or dermoid/epidermoid cysts. Once a neuro-endocrine tumour of testis is diagnosed, it is pivotal that clinicians should exclude a metastatic neuroendocrine tumour to the testis with the primary tumour originating from elsewhere within the human body. It has been iterated that the presence of teratomas elements within the neuro-endocrine tumour of testis does sufficiently rule out the primary site outside the testis. In order to accurately diagnose the neuro-endocrine tumour of the testis, it has been advised that it is pertinent to submit the tumour mass entirely and to look for any additional lineage of differentiation. Twenty five percent of primary neuro-endocrine tumours of testis are associated with teratoma. Histogenesis of pure neuroendocrine tumour of the testis is yet to be clarified. Two postulates had been propounded in relation to the mode origin of neuroendocrine tumour of testis including: (1) Emanation from a teratoma which is the germ cell origin postulate; (2) Emanating from argentaffin cells that are located within crypts of Lieberkühn .A study related to three pure testicular neuroendocrine tumours of testis had indicated that pure neuroendocrine tumour of testis might have different genetic background other than germ cell tumour.[11] Histopathology examination of specimens of neuro-endocrine tumour of testis has tended to demonstrate tumour cells that tend to be typified by the presence of nests of small round cells with uniform nuclei forming small acini and rosettes or sheets. The cells tend to contain eosinophilic granules within the cytoplasm and granular chromatin within the nuclei. The tumour cells do exhibit positive staining for neuroendocrine markers like chromogranin and synaptophysin as illustrated in detail in the article. Radical orchidectomy is the most adopted option of treatment; nevertheless, necessitation for the undertaking of provision of adjuvant treatment depending upon histological grading has not been clarified. Because of the possibility of development of local recurrence and or distant metastases after a long time, it is pivotal for all clinicians to carefully follow-up their patients over a long-period of time with clinical, laboratory testing and radiology-imaging testing follow-ups in order to establish early diagnosis of any local recurrence or distant metastasis to be able provide further treatment of curative intent early. There is also the possibility that neuro-endocrine tumours of testis had so far been under-reported due to mis diagnosis of the tumour upon pathology examination of the testicular tumour or the correct set of monoclonal and polyclonal antibodies had not been utilized in the immunohistochemistry study assessment of the tumours. It would be advised that all clinicians and pathologists globally should have a high index of suspicion for a neuro-endocrine tumour of testis in order to establish prompt diagnosis of the tumour and to provide appropriate assessment, treatment and follow-up of all their patients.

"The Remodelled Wen Cystic Trophoblastic Tumour Testis"

"The Remodelled Wen Cystic Trophoblastic Tumour Testis"

Seepage and Swelling-Neuroendocrine Tumour Testis

Neuroendocrine tumour of testis configures a well differentiated neuroendocrine tumour or a low grade, epithelial neoplasm demonstrating neuroendocrine differentiation. Testicular neuroendocrine tumour may concur with pre-pubertal teratoma or exceptionally articulate as a post-pubertal subtype. Tumour cells manifest with a near diploid genotype. Tumour cells appear devoid of is chromosome 12p or numerical aberrations confined to X chromosome. Cytological examination exhibits isolated singular cells or sheets of neoplastic cells permeated with granular cytoplasm, uniform, spherical nuclei and evenly distributed, fine nuclear chromatin. Morphologically, tumefaction exhibits cellular nests, glands with intra-luminal mucin, solid sheets, insular, acinar or trabecular pattern of tumour evolution. Monomorphic neoplastic cells are pervaded with abundant, granular, eosinophilic cytoplasm, regular spherical nuclei and fine or salt and pepper nuclear chromatin, encompassed within a delicate, fibrous or hyalinised stroma.

Rudimentary and Incipient-Yolk Sac Tumour- Testis

Yolk sac tumour of testis configures as a germ cell neoplasm comprised of cellular articulations or structures simulating embryonic or foetal yolk sac, allantois and extra-embryonal mesenchyme. Testicular yolk sac tumour is pre-eminently comprised of prepubertal subtype which is non-concordant to germ cell neoplasia in situ, emerges as a ‘pure’ neoplasm and demonstrates multiple gains within chromosome 1q, 20q or 22 and losses within chromosomes 1p, 4 or 6q. Postpubertal subtype is concurrent to germ cell neoplasia in situ (GCNIS), preponderantly configures as a component of ‘mixed tumour’ and occurs due to testicular dysgenesis syndrome, subfertility or as single nucleotide polymorphism (SNP) variants within KITLG, SPRY4 or DMRT1 genes and expounds gain of isochromosome 12p. Upon microscopy, neoplasm may configure distinctive configurations as microcystic or reticular pattern, macrocystic pattern, myxomatous pattern, sarcomatoid or spindle shaped cellular pattern, solid pattern, glandular or alveolar pattern, endodermal sinus or perivascular pattern, hepatoid pattern, papillary pattern, parietal pattern or poly-vesicular vitelline pattern. Yolk sac tumour appears immune reactive to alpha fetoprotein (AFP), glypican 3, SALL4, pancytokeratin, villin or CK7. Neoplastic cells appear immune non-reactive to OCT3/4, CD30, CD117, placental alkaline phosphatase (PLAP), podoplanin (D2-40), inhibin, GATA3 or p63. Testicular yolk sac tumour requires segregation from neoplasms as teratoma, seminoma, embryonal carcinoma, rete testis with hyaline globules and microcystic leydig cell tumour. Tumefaction preponderantly depicts elevated levels of serum alpha fetoprotein (AFP). Testicular yolk sac tumour may be optimally subjected to surgical manoeuvers as orchiectomy.

Evaluation of Relapse Risk Factors and Treatment Outcomes in Stage 1 Germ Cell Testicular Tumors

Aim: This study aims to evaluate risk factors for relapse in stage 1 germ cell tumors (GCTs) and compare relapse and survival outcomes between treated and untreated patients.&#x0D; Method: The study encompasses patients diagnosed with GCTs aged 18 and above, treated and monitored at our oncology clinic between 2012 and 2022. After excluding cases with secondary malignancies, 54 patients with confirmed histopathological stage 1 testicular tumors were analyzed. Patient data, treatment received, and follow-up information were recorded, and statistical analyses were performed using IBM SPSS Statistics version 22.0.&#x0D; Results: In the seminoma subgroup, relapse was observed in 3 out of 24 (12.5%) patients. Although there was no statistically significant difference in terms of relapse between the groups with and without risk factors such as rete testis involvement and tumor diameter, it was observed that relapse occurred at a higher frequency in both risk groups. Among non-seminomatous tumors, 5 out of 30 (16.7%) patients experienced relapse. Although a notable numerical difference in lymphovascular invasion —a defined risk factor—was observed, statistical significance was lacking. A significant difference in relapse was observed between patients receiving adjuvant treatment and those who did not.&#x0D; Conclusion: For both seminoma and non-seminomatous tumors at stage 1, surveillance is recommended for patients lacking identified risk factors. Nevertheless, patients with established risk factors warrant personalized consideration, weighing factors such as age, comorbidities, and preferences to guide treatment decisions.

Unclassified Sex Cord/Gonadal Stromal Testis Tumour with a “Pure “Spindle Cell Component: Pathological Features And Review of The Literature

Background: About 2-5% of adult testicular tumors are classified as sex cord/stromal tumors, which are an uncommon group of tumors of the testis. Occasionally, a small percentage of Sex Cord/stromal Testis Tumors (SCST) that are primarily composed of spindle cells seem to be unclassifiable. There are about six cases reported where spindle cells predominate, four of which are consisting purely of spindle cells. At the morphologic level, a striking resemblance to a fibroma has raised the notion of a possible fibrothecoma, but this is not supported by the immunohistochemistry, and the features are consistent with an unclassified sex cord/stromal tumor with a “pure” spindle cell component. Description: A 45-year-old man with a firm mass in the lower pole of the left testis for 3 years. The patient had no comorbidities and no features of endocrinopathies. All blood tests were normal. The ultrasound showed a solitary hypoechoic mass with increased blood flow by Doppler scan. A well-circumscribed tumor measuring 30mmx 15mm with no discernible capsule was identified macroscopically. Microscopy showed a well-circumscribed spindle cell lesion with no necrosis, cytological atypia, or mitoses. The tumor cells appeared spindled with eosinophilic cytoplasm, vesicular nuclei, and occasional nucleoli. No nuclear grooves were noted in the tumour cells. No vascular invasion was present. Actin, calretinin, CD99, S100, and inhibin were positively immunoreactive. Conclusion: The findings were consistent with an Unclassified pure spindle SCST, a rare tumor with a benign course that must be distinguished from several spindle cell neoplasms. There are no biochemical markers for the diagnosis of this tumor, thus requiring meticulous clinical examination, especially if it is small in size. We report a case of “pure spindle cell sex cord stromal tumour of the testis in a 45 years old man in which the histomorphological as well as the immunohistochemical features are consistent with the diagnosis of unclassified sex cord/stromal testis tumor with “pure” spindle cell component.

'Testicular masquerade': a case report of testicular malignancy with persistent Müllerian duct syndrome and transverse testicular ectopia.

Persistent Müllerian duct syndrome (PMDS) is a rare sexual development disorder. It is even more rarely associated with transverse testicular ectopia (TTE), a rare form of testicular ectopia, in which both testes descend through a single inguinal canal and are present in the same hemiscrotum. PMDS with TTE is associated with 18%-33% malignant transformation. Here we report the case of a 48-year-old man who presented with a large right inguinoscrotal swelling and on evaluation was found to have a large right testicular mass with complete right inguinal hernia, undescended left testis and a central abdominal mass. On evaluation with contrast-enhanced computed tomography abdomen and pelvis and image-guided biopsy he was diagnosed with mixed germ cell tumour of the right testis (predominantly a seminoma) with a retroperitoneal nodal mass and absent left testis, for which he received chemotherapy. Post-chemotherapy he underwent surgery and was diagnosed intraoperatively with PMDS along with TTE and testicular malignancy arising from the ectopic left testis. Postoperative recovery and follow-up were uneventful. Most cases of PMDS are diagnosed early in life. They present clinically with unilateral or bilateral undescended testis with inguinal hernia. In adults, PMDS is usually associated with male infertility. However, TTE is associated with an increased risk of testicular tumours if undiagnosed until adulthood. In adults PMDS with TTE is usually an intraoperative finding and is commonly associated with malignancy in the ectopic/undescended testis.

Leydig Cell Tumour of Testis and Scrotal Contents: A Review and Update

Leydig Cell Tumour of Testis and Scrotal Contents: A Review and Update

Biallelic MAD2L1BP (p31comet) mutation is associated with mosaic aneuploidy and juvenile granulosa cell tumors.

MAD2L1BP-encoded p31comet mediates Trip13-dependent disassembly of Mad2- and Rev7-containing complexes and, through this antagonism, promotes timely spindle assembly checkpoint (SAC) silencing, faithful chromosome segregation, insulin signaling, and homology-directed repair (HDR) of DNA double-strand breaks. We identified a homozygous MAD2L1BP nonsense variant, R253*, in 2 siblings with microcephaly, epileptic encephalopathy, and juvenile granulosa cell tumors of ovary and testis. Patient-derived cells exhibited high-grade mosaic variegated aneuploidy, slowed-down proliferation, and instability of truncated p31comet mRNA and protein. Corresponding recombinant p31comet was defective in Trip13, Mad2, and Rev7 binding and unable to support SAC silencing or HDR. Furthermore, C-terminal truncation abrogated an identified interaction of p31comet with tp53. Another homozygous truncation, R227*, detected in an early-deceased patient with low-level aneuploidy, severe epileptic encephalopathy, and frequent blood glucose elevations, likely corresponds to complete loss of function, as in Mad2l1bp-/- mice. Thus, human mutations of p31comet are linked to aneuploidy and tumor predisposition.

The long non-coding RNA transcript, LOC100130460 (CAND1.11) gene, encodes a novel protein highly expressed in cancer cells and tumor human testis tissues.

Testis-specific genes encoding for long non-coding RNA (lncRNA) have been detected in several cancers; many produce proteins with restricted or aberrant expression patterns in normal or cancer tissues. To characterize new lncRNA involved in normal and/or pathological differentiation of testicular cells. Using bioinformatics analysis, we found that lncRNA LOC100130460 (CAND1.11) is expressed in normal and tumor testis; its expression was assessed in several human cell lines by qRT-PCR. CAND1.11 protein, produced by a single nucleotide mutation, was studied by western blot and immunofluorescence analysis on normal, classic seminoma, and Leydig cell tumor testicular tissues. CAND1.11 gene is primate-specific; its expression was low in SH-SY5Y cells and increased when differentiated with retinoic acid treatment. CAND1.11 expression in PC3 cells was higher than in PNT2 cells. CAND1.11 protein is present in the human testis and overexpressed in testicular cancer tissues. This report is one of the few providing evidence that a lncRNA produces a protein expressed in normal human tissues and overexpressed in several testicular cancers, suggesting its involvement in regulating cell proliferation and differentiation. Although further studies are needed to validate the results, our data indicate that CAND1.11 could be a potential new prognostic biomarker to use in proliferation and cancer.

A clinical case of a mixed testicular tumour with cryptorchidism in a dog of the Yorkshire Terrier breed

Histological examination of testicular tumours in cryptorchid males allows determining the nature of neoplasia, prognosis of long-term consequences in the form of metastases, and defining the optimal method of treatment of the animal, which determines the relevance of research in this area. The aim of the work is to determine the pathohistological structure of neoplasia of the left, cryptorchid, and morphology of the contralateral testes in a Yorkshire Terrier male with unilateral cryptorchidism. General clinical, ultrasonographic, radiological and histological methods were used in the examination of the animal. The article presents data on a mixed tumour of the intraperitoneal left testis of a 6-year-old Yorkshire Terrier, which is an atypical clinical case. It was found that the characteristic ultrasonographic features of the cryptorchid left testis tumour were numerous isoechoic foci of different diameters (from 4 to 26 mm), hyperechoic septa, and tuberous contours with a hyperechoic capsule. At laparotomy, the altered testis had an uneven surface saturated with blood vessels. The section showed milky-white neoplastic areas separated by fibrous bands that did not correspond to the normal structure of the organ. Histological examination of the parenchyma revealed areas of similar rounded cells in the form of a group of shapeless masses separated by a fibrous barrier. Neoplastic tubules had a developed fibrovascular stroma with an eosinophilic necrotic area. The protein membrane also had numerous fibrous formations. The layers of multifaceted cells were located perpendicular to the basal lamina, often with central necrosis, and the testicular mass contained multifocal haemorrhages. Such signs are characteristic of the lesion of Sertoli cells and interstitial Leydig cells, which indicated a mixed type of tumour of the left extraperitoneal testis of the Yorkshire Terrier. The contralateral right testis was unchanged and corresponded to the natural morphological and histological structure. The prostate was normal on macroscopic and histological examination, which has not been previously reported. Six-month follow-up of the dog showed no signs of metastatic process. The practical significance of the work is to obtain new scientific knowledge about the development of mixed tumours of the testis in cryptorchid males and the prospects for the treatment of diseased animals

Strong apoptotic response of testis tumor cells following cisplatin treatment

Most solid metastatic cancers are resistant to chemotherapy. However, metastatic testicular germ cell tumors (TGCT) are cured in over 80% of patients using cisplatin-based combination therapy. Published data suggest that TGCTs are sensitive to cisplatin due to limited DNA repair and presumably also to a propensity to undergo apoptosis. To further investigate this aspect, cisplatin-induced activation of apoptotic pathways was investigated in cisplatin-sensitive testis tumor cells (TTC) and compared to cisplatin-resistant bladder cancer cells. Apoptosis induction was investigated using flow cytometry, caspase activation and PARP-1 cleavage. Immunoblotting and RT-PCR were applied to investigate pro- and anti-apoptotic proteins. Transfections were performed to target p53- and Fas/FasL-mediated apoptotic signaling. Immunoblotting experiments revealed p53 to be induced in TTC, but not bladder cancer cells following cisplatin. Higher levels of pro-apoptotic Bax and Noxa were observed in TTC, anti-apoptotic Bcl-2 was solely expressed in bladder cancer cells. Cisplatin led to translocation of Bax to the mitochondrial membrane in TTC, resulting in cytochrome C release. Cisplatin increased the expression of FasR mRNA and FasL protein in all tumor cell lines. Targeting the apoptotic pathway via siRNA-mediated knockdown of p53 and FAS reduced death receptor-mediated apoptosis and increased cisplatin resistance in TTC, indicating the involvement of FAS-mediated apoptosis in the cisplatin TTC response. In conclusion, both the death receptor and the mitochondrial apoptotic pathway become strongly activated in TTC following cisplatin treatment, explaining, together with attenuated DNA repair, their unique sensitivity toward platinum-based anticancer drugs.

Improved Management of the Advanced Nonseminomatous Testis Cancer

With the VAB-6 program about 90% (54/59) of patients with stage III and bulky stage II disease achieved complete remission and eighty percent remain free of disease. Patients with minimal metastatic disease can usually be treated successfully with chemotherapy alone, while patients with advanced disease frequently required combined treatment with chemotherapy and surgery in order to achieve complete remission. Most patients without a teratomatous component in the testis tumor will achieve complete remission with chemotherapy alone, whereas patients with a teratomatous componente are more likely to require the combined approach of chemotherapy and surgery to achieve disease free status. Pure seminoma was apparently the most responsive and pure choriocarcinoma the least responsive histologic type of testis tumor to the combination chemotherapy. The incidence of a residual mature teratoma in the resected specimem has increased with the improved efficacy of chemotherapy. High complete remission rates and a short duration of treatment ensure rapid return of afflicted individuals to productive life, thus, fulfilling a most importante goal of treatment.

Incidence of urological tumors in Down's syndrome: a systematic review and meta-analysis.

Some authors have estimated that the incidence of testicular germ cell tumors in individuals with trisomy 21 is more than fivefold higher than that in the general population. This systematic review aimed to estimate the incidence of urological tumors in patients with Down's syndrome. We conducted a search strategy in MEDLINE (OVID), EMBASE, LILACS, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to nowadays. We assessed the risk of bias and performed a meta-analysis. Also, the heterogeneity between trials was evaluated by the I2 test. We completed the subgroup analysis based on the type of urological tumor (testis, bladder, kidney, upper urological tract, penile, retroperitoneum). We found 350 studies by the search strategy. After carefully reviewing, full-text studies were included. 16,248 individuals with Down's syndrome were included, and 42 patients presented with urological tumors. There was a total incidence of 0.1%, 95%CI (0.06-0.19), I2 61%. The most common urological tumor reported was testicular. We found six studies describing 31 events and an overall incidence of 0.19%, 95%CI (0.11-0.33), I2: 51%. Other studies reported kidney, penile, upper urinary tract, bladder, and retroperitoneum tumors with a very low incidence, 0.02%, 0.06%, 0.03%, 0.11%and 0.07%, respectively. Regarding non-testicular urological tumors, we found incidences as low as 0.02% in kidney cancer or 0.03% in the upper-urothelial tract tumors. It is also lower than the general population. Compared to the age of onset of patients, it is also lower than the general population, perhaps related to a shorter life expectancy. As a limitation, we found a high heterogeneity and a lack of information regarding non-testicular tumors. There was a very low incidence of urological tumors in people with Down's syndrome. Testis tumor was the most frequently described in all cohorts and within a normal distribution range.

Cadmium and lead implication in testis cancer; is there a connection?

Testis cancer (TC) is the most common malignancy of young men. Current evidence from studies, alongside genetics and hormonal status, suggests a significant role of toxic metals, cadmium (Cd) and lead (Pb), in the origin and development of TC. Besides oxidative stress and endocrine disruption, interaction with bioelements is one of the critical mechanisms of Cd and Pb toxicity and malign transformation. This study aimed to investigate metal levels in blood, healthy, and tumor testis tissue and to reveal hormone, oxidative status, and bioelements levels in patients with TC. The study enrolled 52 patients with TC and 61 healthy volunteers. Toxic metals and bioelements levels were analyzed by atomic absorption spectrophotometry (AAS) while electrochemiluminescence immunoassay (ECLIA) and spectrophotometry methods were used for hormone and oxidative parameters evaluation. Significantly higher blood Cd levels were depicted in TC cohort. Furthermore, blood Cd elevation was associated with a 1.98 higher probability of TC developing. However, a metal concentration between healthy and tumor testis tissue did not differ significantly. Lower levels of estradiol and testosterone, established in a cohort of TC patients, followed the significant role of hormones in TC development. At the same time, ischemia-modified albumin (IMA) has been recognized as a parameter with very good accuracy as a potential diagnostic marker for TC. The study revealed different distribution patterns of copper (Cu) and zinc (Zn) in the three compartments of the patients, as well significant correlation between essential metals Cu/Zn and toxic metals Cd/Pb indicating metal-metal interactions as pivotal mechanisms of metals toxicity.