Testis Tumors Research Articles

Statistics of malignant tumors of urinary and male urogenital organs in Russia and the countries of the former USSR

The study objective is to analyze incidence of cancer morbidity and morality in Russia and some former Soviet states. Prevalence of urinary and male urogenital organs cancer continues to grow. Morphological verification of the diagnosis varied from 58.5 % (at bladder cancer in Tajikistan) up to 93.7 % (in Russia), at a prostate cancer the maximum values are registered in Russia, Belarus and Ukraine (91–99 %); at kidney cancer in Russia, Belarus and Uzbekistan (84 %). In 2012–2017 years the increase of kidney cancer incidence in Russia (in men) made 13.8 %; at a prostate cancer, growth of the standardized rates is registered in all provided countries of the former USSR (except Kyrgyzstan). Decrease in incidence rates of bladder cancer is registered at men in Belarus, Moldova, Kazakhstan, Armenia and Kyrgyzstan. In Russia and Belarus mortality rates of kidney and a bladder cancer decreased; at a prostate mortality rate for the 5 anniversary is stable in Belarus; its insignificant increase was in Russia (for 3.4 %). The increase of penis cancer incidence in Russia was 24 %. The ratio of the maximum and minimum incidence rates among regions of Russia reached 16-fold sizes (at penis cancer) and 6-fold sizes – at testis tumours. Above, than on average in Russia (2.1 per 100 thousand, male population) testis cancer cases in Belarus (3.0 per 100 thousand). In 2012–2017 the increase of testis cancer incidence in Russia was 16.7 %.

Organ-sparing procedures in GU cancer: part 2-organ-sparing procedures in testicular and penile tumors.

Organ-sparing surgery (OSS) is recommended in selected patients with testicular tumors and penile cancer (PC). The functional and psychological impacts of organ excision for these genital tumors are profound. In this review, we summarize the indications, techniques and outcomes of OSS for these two tumors. PubMed® was searched for relevant articles up to December 2018. For Testicular sparing surgery (TSS) search, keywords used were; testicular tumors alone and in combination with "testicular sparing surgery", "partial orchiectomy" and outcomes. For penile conserving surgery (PCS), keywords used were: penile cancer alone and in combination with "penile conserving surgery", "partial penectomy" and outcomes. Because of the low quality of available evidence, a narrative rather that systematic review has been performed. Indications of TSS are tumors ≤ 2 cm in solitary testis or bilateral tumors and no rete testis invasion. Prerequisites include normal testosterone and luteinizing hormone levels and patient compliance with follow-up. Indications for PCS are distal penile lesions with clinical stage ≤ T1. Adequate penile stump (3cm) is required after surgery to maintain forward urine stream. Frozen section helps to reduce the risk of recurrence. Local recurrence after PCS is not associated with reduced survival and can be managed with another PCS in selected patients. The reported oncological and functional outcomes following TSS and PCS are adequate. In properly selected patient OSS in testicular and penile tumors has a comparable oncological outcome to total organ excision with added advantages of preserving organ function and psychological well-being.

Abstract 3092: Activation of evolutionarily young transposable elements and the host innate immune system are linked to clinical response to 5-azacitidine

Abstract The DNA methyltransferase inhibitors 5-azacitidine (AZA) and 5-aza-2-deoxycytidine (DAC) have been approved for the treatment of higher-risk myelodysplastic syndrome (MDS), chronic myelomonocytic leukemia (CMML), and acute myeloid leukemia (AML). A more comprehensive understanding of the molecular changes in patients treated with AZA is needed to help explain why only about 50% of these patients have clinical responses. We examined gene expression profiles in a total of 150 RNA samples taken before, during and after treatment with AZA, in three cohorts of patients with hematological cancers (40 patients total; 15 non-responders, 25 responders). We show that activation of the innate immune system is linked to clinical response to AZA treatment. We also measured the induced expression of transposable elements (TEs) to determine whether this was a potential trigger for the immune response. Both responders and non-responders showed robust upregulation of TEs however responders showed the statistically significant upregulation of specific classes of evolutionarily young transposable elements (TEs). These include short and long nuclear elements (SINEs and LINEs) and endogenous retroviruses (ERVs). Moreover, the upregulation of type I interferon signaling pathway genes in responders was significantly higher than non-responders, but not cancer testis antigens (CTAs) or tumor suppressor genes with the exception of CDKN2A and CDKN2B. Therefore, we suggest that induction of specific subsets of silenced evolutionarily young TEs may be a key to the success of epigenetic therapy in hematological cancer patients. Citation Format: Hitoshi Ohtani, Andreas D. Ørskov, Alexandra S. Helbo, Linn Gillberg, Minmin Liu, Wanding Zhou, Johanna Ungerstedt, Eva Hellstrom-Lindberg, Weili Sun, Gangning Liang, Peter A. Jones, Kirsten Grønbæk. Activation of evolutionarily young transposable elements and the host innate immune system are linked to clinical response to 5-azacitidine [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3092.

Expression of cellular apoptosis susceptibility (CAS) in the human testis and testicular germ cell tumors

Testicular germ cell tumors are the most frequent malignancies found in men between 15 and 44years old. Although cellular apoptosis susceptibility (CAS) was demonstrated to be upregulated in breast cancer and colon cancer, the expression of CAS in the human testis and testicular germ cell tumors remained elusive. In the present study, CAS-positive signals were detected in the normal testicular tissues, cancer adjacent normal testicular tissues, seminoma, yolk sac tumor, and teratoma. Interestingly, the expression level of CAS in testicular germ cell tumors (TGCTs) (but not seminoma) was significantly lower than that of human testicular tissues and cancer adjacent normal testicular tissues, suggesting that decreased CAS contributed to the progression of TGCTs. Notably, the expression of CAS in seminoma was significantly higher than that of in the non-seminomas, consistent with the results from TCGA database. Furthermore, the localization of CAS is mainly restricted in the nucleus in the lesions of normal human testicular tissue and cancer adjacent normal testicular tissue. Although the expression of CAS was not significantly different between normal testicular tissue and seminoma, CAS was more enriched in cytoplasm in seminoma compared to the normal, cancer adjacent tissue and other types of TGCTs. The current results demonstrated reduced expression of CAS in the human testicular germ cell tumors and the CAS translocation from the nuclear to cytoplasm in seminoma, thereby supporting a possible role in normal testis function and in the development of seminoma.

Genomic Features of Metastatic Testicular Sex Cord Stromal Tumors

BackgroundMetastatic testicular sex cord stromal tumors of the testis (MSCSTs) comprise an extremely uncommon form of genitourinary malignancy. ObjectiveTo perform comprehensive genomic profiling (CGP) to enable the search for potential therapy targets. Design, setting, and participantsTen patients with testicular Leydig cell tumors (LCTs), six with Sertoli cell tumors (SCTs), and three with undifferentiated sex cord stromal tumors (USCSTs) and a comparison group of 366 patients with ovarian sex cord stromal tumors (SCSTs) underwent hybrid-capture–based CGP to evaluate all classes of genomic alterations (GAs). The tumor mutational burden (TMB) was determined on 1.1 Mbp of sequenced DNA, and microsatellite instability (MSI) was determined on 114 loci. InterventionCGP on tumor samples. Outcome measurements and statistical analysisDescriptive analyses and differences between histological subgroups were reported. Results and limitationsIn these patients, all of whom had metastatic disease at the time of sequencing, the primary testis tumor was sequenced in six (32%) patients and a metastatic site in 13 (68%) patients. The overall frequencies of GAs were similar in LCTs, SCTs, and USCSTs, ranging from 3.0 to 3.5 GAs/tumor. The most frequent untargetable GAs included CTNNB1 and CDKN2A/B, both ranging from 20% to 33% of cases. Targetable GAs were uncommon in all MSCST subgroups, but several tumors showed potential for cell-cycle inhibitors (CDK4 in LCTs), mTOR inhibitors (RICTOR, NF2, and PTEN in all three tumor types), hedgehog inhibitors (PTCH1 in LCTs), and poly(ADP-ribose) polymerase inhibitors (BAP1 in SCTs). No MSI-high status was identified. The TMB was also low in all MSCST groups, and tumors featuring a TMB of ≥10 mutations/Mb were not identified. GA findings from ovarian SCSTs largely recapitulated those from MSCSTs. A lack of clinical outcome correlation is a limitation of the present analyses. ConclusionsRare cases of testicular MSCSTs have GAs linked to potential targeted therapy benefits on CGP. In contrast, the lack of MSI-high status and an overall low TMB indicate a likely lack of benefit for immunotherapies. Patient summaryGenomic profiling can guide clinical research and disclose therapeutic opportunities for patients with rare testicular cancers for which standard therapies are lacking.

Adjuvant carboplatin for clinical stage I testicular seminoma in New Zealand centers: Retrospective analysis of efficacy and long-term adverse effects.

e16041 Background: Adjuvant carboplatin reduces relapse risk in clinical stage I (CS1) testicular seminoma, though there is a paucity of long-term safety data. While some studies report that two cycles is more effective than one, there is no randomised trial evidence or consensus on the optimal number of cycles. European guidelines recommend a risk-based approach to consider adjuvant carboplatin in those with either rete testis involvement (RTI) or tumour size > 4cm, and surveillance for other patients. We report long-term outcomes of 2 cycles of adjuvant carboplatin dosed at area under the curve (AUC) of 7 as standard management of CS1 seminoma since 2000. Methods: We performed a retrospective analysis on treatment and outcomes of patients with CS1 seminoma who received adjuvant carboplatin from 2000 to 2016 at the Waikato, Lakes and Bay of Plenty District Health Boards. We also collected information on mortality, causes of death and subsequent malignant neoplasms (SMN). Results: Of 160 patients, median age 39 (range 20-73) years, 154 received 2 cycles of carboplatin: 148 dosed at AUC7 and six at AUC6; another six patients had one cycle of carboplatin AUC7, curtailed due to toxicity in 3 patients. Two relapses occurred: one at 10 months (in hindsight stage 2a at diagnosis) and one at 22 months (died of pulmonary embolism 2 months after achieving complete response with BEP chemotherapy). Neither RTI (present in 21.3%) nor tumour size > 4cm (in 43.1%) were predictive of relapse. No patients died of seminoma. At median follow up of 109 (range 17-209) months, relapse-free survival was 98.7%, overall survival was 97.5% and disease-specific survival was 100%. A SMN occurred in 11 patients (6.9%) at median 96 months and caused 4 deaths (melanoma, myeloma, small cell lung cancer and glioblastoma); 4 patients (2.6%) had a contralateral testicular germ cell tumour (at median 69 months). One patient had persistent grade 1 thrombocytopenia at 46 months. Conclusions: This data adds to the body of evidence that two cycles of carboplatin AUC7 is safe, effective adjuvant treatment for CS1 seminoma. It did not have significant long-term adverse effects in our population.

First case of mature teratoma and yolk sac testis tumor associated to inherited MEN-1 syndrome: a case report

First case of mature teratoma and yolk sac testis tumor associated to inherited MEN-1 syndrome: a case report

A Huge Intraabdominal Lump in a Male Patient of 32 Year with Congenital Absence of Left Testis - A Case Report

Undescended testis is a common risk factor for the testicular neoplasm. The risk of malignancy in an undescended testis is highest when the testis lies in the abdomen. It usually presents with a painless intraabdominal lump. Seminoma is the most common adult germ cell tumour of testis whereas Yolk sac tumour in seen in the pediatric age group. Pure yolk sac testicular tumor in an adult is extremely uncommon. Here we present a case where an adult male presented to us with a painless left sided intraabdominal lump with undescended testis on the same side was previously diagnosed as metastatic adenocarcinoma of unknown primary. In a private hospital he received three cycles of chemotherapy; but the lump did not reduce in size and he was reffered to our care for better management. The lump was excised and histopathological report revealed yolk sac tumour of left testis which is a rare presentation in adult.
 J Shaheed Suhrawardy Med Coll, December 2018, Vol.10(2); 115-117

Testis-sparing surgery for testicular masses: current perspectives.

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

Genomic features of metastatic testicular sex cord stromal tumors.

532 Background: Metastatic testicular sex cord stromal tumors of the testis (MSCST) comprise an extremely uncommon form of genitourinary malignancy. In a comparative genomic study, we performed comprehensive genomic profiling (CGP) to characterize the genomic alterations (GA) in MSCST and to enable the search for potential therapy targets. Methods: The MSCST were classified as metastatic Leydig Cell Tumors (LCT), Sertoli Cell Tumors (SCT) and Undifferentiated (USCST). In this study, 10 cases of LCT, 6 cases of SCT and 3 cases of USCST underwent hybrid-capture based CGP to evaluate all classes of genomic alterations. Tumor mutational burden (TMB) was determined on 1.1 Mbp of sequenced DNA and microsatellite instability (MSI) was determined on 114 loci. Results: All patients had clinically advanced recurrent and/or metastatic disease. The primary testis tumor was used for sequencing in 6 MSCST (32%) and a metastatic site in 9 (68%) of the MSCST. In 10 (91%) of 11 MSCST positively stained by IHC for inhibin expression. The overall frequencies of GA were similar in all LCT, SCT and UTST ranging from 3.0 to 3.5 GA/tumor. The most frequent untargetable GA found in all MSCST cases included CTNNB1 and CDKN2A/B, both ranging from 20-33% of cases. Targetable GA were uncommon in all MSCST sub-groups but several tumors featured potential for cell cycle inhibitors ( CDK4 in LCT), MTOR inhibitors ( RICTOR, NF2 and PTEN in all 3 tumor types), hedgehog inhibitors ( PTCH1 in LCT) and PARP inhibitors ( BAP1 in SCT). No MSI-High status was identified in any MSCST. The TMB was also low in all MSCST groups. Conclusions: Although the 3 subgroups of testicular MSCST feature defining histopathologic features, these tumors have similar genomic signatures on CGP. The low levels of GA per tumor, infrequent tumor aneuploidy, absence of MSI-High status and low TMB all indicate that testicular MSCST are genetically stable. However, rare cases of testicular MSCST reveal GA linked to potential targeted therapy benefits on CGP linked to dysregulation of multiple biologic pathways. In contrast, the lack of MSI-High status and overall low TMB in testicular MSCST indicates a likely lack of benefit for immunotherapies for these rare forms of malignancy.

Post-chemotherapy robot-assisted retroperitoneal lymph node dissection in non-seminomatous germ cell tumor of testis: Feasibility and outcomes of initial cases.

To report our initial experience and short-term results in post-chemotherapy robot-assisted retroperitoneal lymph node dissection (RA-RPLND) for advanced testicular cancer. We analyzed prospectively collected data of 5 patients who underwent post-chemotherapy RA-RPLND between August 2017 and May 2018. All patients had a diagnosis of non-seminomatous germ cell tumor (NSGCT) of testis and received three or four cycles of BEP chemotherapy for their clinical stage IIC disease before the surgery. Perioperative parameters (operation time, estimated blood loss and intraoperative complications) and postoperative findings (change in hematocrit, duration of hospitalization and postoperative complications) were noted. Pathological outcomes and postoperative radiological imaging in the 3rd month were investigated. RA-RPLND was completed successfully in all patients, and none of them required conversion to open surgery or early intervention. The median operation time was 309 minutes (range, 275-360), and median estimated blood loss was 180 mL (range, 150-210). One patient required postoperative transfusion of 1U red blood cells. The histologic examination of the specimens revealed necrosis in 3, and mature teratoma in 2 patients. The median hospitalization time after surgery was 2 days. During a median follow-up of 10 months (range 7-12), there were no retroperitoneal recurrences or distant metastasis in radiological imaging. No major complication (Clavien ≥3) or death occurred. The only minor complication was transfusion of red blood cells in one patient (Clavien 2) and the overall complication rate was 20 percent. Post-chemotherapy RA-RPLND appears to be a feasible and oncologically safe procedure with acceptable operative morbidity. However, this technique should be applied in centers highly experienced in robotic surgery, considering that RPLND is a surgery with fatal complications.

Incidence of malignant tumours (1996-2012) in young Italian soldiers sent on mission abroad. Preliminary analysis of the data of the Parliamentary Enquiring Commission on depleted uranium and vaccines (CUC)

since 2000s, epidemiological studies conducted by the Italian Ministry of Defence on Italian soldiers sent on a mission abroad showed excess mortality and/or incidence for Hodgkin lymphomas and also a significant reduction of all tumours and of all diseases. this analysis aim to evaluate tumour incidence and overall mortality among Italian soldiers sent on a mission abroad (period 1996-2012; 3,663 cases). This investigation is preliminary to a more complete retrospective study on the cohort of soldiers affected by tumour (No. 6,104 cases) diagnosed in the period 1973-2017 and registered by the Epidemiological Defence Observatory (OED). cohort data were acquired by the Uranium Commission of the Chamber of Deputies (CUC, 2016-2018). For statistical and epidemiological reasons, mainly dictated by the number, completeness, and quality of information concerning patients (or deceased) and the study population. The survey was temporarily limited to male military aged between 20 and 59 during the period 1996-2012 (No. 3,663; 60% of the total). Military from the four Italian defence forces - Air force, Carabinieri, Army, and Navy - were, respectively, divided into two groups: those involved in at least one mission abroad ("missionaries"; No. 874; 24%) and all the others ("non-missionaries"; No. 2,789; 76%). Using the method of indirect rate standardization, the age-standardized incidence ratio comparing missionaries and non-missionaries (SIRm) and comparing missionaries and the general population considered as an external reference (SIR) were calculated, with respective 90% confidence intervals (95%CI). Similarly, the overall mortality risk among missionaries was investigated. considering the population of the non-missionaries, the analysis of tumour incidence (TM) by military forces identified excesses in the missionaries of the Air Force (SIRm: 126.7; 90% CI 107.9-147.9), Carabinieri (SIRm: 152.8; 90%CI 134.0-173.7), and the Army (SIRm: 116.2; 90%CI 108.1-125.6). Taking into account missionaries, there was an excess of risk for specific neoplasia: for hemolymphopoietic system in Carabinieri (SIRm: 150.1; 90%CI 106.0 - 207.1) and in the Army (SIRm: 109.0; 90%CI 93.9-125.9); for Hodgkin lymphoma in Air force (SIRm: 187.7; 90%CI 88.1-352.5), Carabinieri (SIRm: 187.3; 90%CI 87.9-351.8), and the Army (SIRm; 104.5; 90%CI 81.2-132.6); for leukaemia in the Army (SIRm: 142.4; 90%CI 107.5-185.4). Significant risk excesses were also observed in missionaries for stomach, testis, kidney, bladder, and thyroid tumours. On the other hand, for missionaries in the Navy, a statistically significant risk reduction for all tumours emerged (SIRm: 61.1; IC90% 51.0-72.6). Missionaries showed a higher mortality for all causes. this preliminary study confirms the need for an in-depth survey on the health status of Italian soldiers. In particular, the risk for diseases, even non-neoplastic and after 2012, should be investigated in the military over the age of 60, who has a greater risk of incidence and mortality, not only for tumour. All potential disease determinants, both environmental and personal, should also be studied.

A Multicenter Retrospective Review of Pediatric Leydig Cell Tumor of the Testis.

Leydig cell tumors (LCTs) are rare tumors arising from testosterone-producing Leydig cells. Although LCTs are usually benign, malignancy has been reported in 10% of cases in adults, and local recurrence or metachronous tumors of the contralateral testis have been described. Radical orchiectomy is the current standard of care. We report on 12 children with LCT at 3 institutions between 2000 and 2016. Presenting symptoms included precocious puberty, palpable testicular mass, and scrotal swelling. Radical orchiectomy was performed in 9 patients. Three patients were treated with enucleation. All patients were alive at last follow-up without evidence of local recurrence or metastasis.

Perspectives of usak university faculty of medicine and dentistry students to biochemistry course

Aim: In this study, we aimed to share our experiences about patients with miscellaneous non-specific malign stromal tumors of testis. We report the demographic and clinical characteristics and the long-term results in patients with non-specific malign stromal tumors of testis.Material and Methods: 234 patients with testicular cancer between June 1994 and January 2019 have been evaluated retrospectively. Eleven patients (Dedifferentiated liposarcoma, Diffuse large B-cell lymphoma, Embryonal rhabdomyosarcoma, Adenocarcinoma of the epididymis, Ewing’s sarcoma of the testis, Testicular leiomyosarcoma, Well-differentiated liposarcoma, Paratesticular high grade sarcoma and Paratesticular malignant mesothelioma) whose data were reached, are taken into the study. Patients’ age, scrotal localization of symptoms, clinical examination findings, serum tumor marker levels, pathology results and follow-up period were recorded. Results:The mean age at diagnosis was 43.7 years (range, 18 to 79). 54.5% of the lesions were localized to the right hemiscrotal area and of 45.4% to the left hemiscrotal area. None of patients had a history of unilateral undescended testis in medical history or testicular cancer in familial history. Serum tumor markers were normal in all patients. The mean scrotal mass lesion at diagnosis was 59.9 mm3 (range, 33 to 138 mm3). 3 or 4 cyles of chemotherapy protocols were administered in necessary cases. Mean follow-up period was 80.6 months (range, 12 to 297 months). Tumor recurrence was occured in only two patients (Dedifferentiated liposarcoma and Adenocarcinoma of the epididymis) during the follow-up.Conclusion: Miscellaneous non-specific malign stromal tumors of the testis should be kept in mind especially in middle age group patients presented with malign scrotal lesions. Surgical treatment should be aggressive and additional specific treatment according to pathology result should be planned without delay. Follow-up protocols are recommended to be tumor specific.

A Rare Presentation of ph Chromosome: idic der (22q11) in Blast Crisis Chronic Myeloid Leukemia

The ider(22)t(9;22)(q34;q11) is a rare secondary karyotypic abnormality of Ph chromosome positive chronic myeloid leukemia associated with disease progression, poor clinical outcome and short survival in most of the previously reported cases. The present case of CML with idic der(22)t(9;22)(q34;q11) or idic der Ph with hybrid transcript ratio of BCR-ABL being 97% showed a complex karyotype: 48,XY,+8,t(9;22)(q34;q11)i dic(22)(q11),+idic der(22)t(9;22)(q34;q11). On treatment with Imatinib the initial transcript ratio was reduced to 12.125%, 0.932% but later increased to 93%. The patient developed extra medullary myeloid cell tumor of testis after a year of treatment followed by the detection of T3151 mutation. Cytogenetics provides an evidence for progression of disease at an earlier phase than other markers in this case.

Non-specific malign stromal tumors of testis

Aim: In this study, we aimed to share our experiences about patients with miscellaneous non-specific malign stromal tumors of testis. We report the demographic and clinical characteristics and the long-term results in patients with non-specific malign stromal tumors of testis. Material and Methods: 234 patients with testicular cancer between June 1994 and January 2019 have been evaluated retrospectively. Eleven patients (Dedifferentiated liposarcoma, Diffuse large B-cell lymphoma, Embryonal rhabdomyosarcoma, Adenocarcinoma of the epididymis, Ewing’s sarcoma of the testis, Testicular leiomyosarcoma, Well-differentiated liposarcoma, Paratesticular high grade sarcoma and Paratesticular malignant mesothelioma) whose data were reached, are taken into the study. Patients’ age, scrotal localization of symptoms, clinical examination findings, serum tumor marker levels, pathology results and follow-up period were recorded. Results:The mean age at diagnosis was 43.7 years (range, 18 to 79). 54.5% of the lesions were localized to the right hemiscrotal area and of 45.4% to the left hemiscrotal area. None of patients had a history of unilateral undescended testis in medical history or testicular cancer in familial history. Serum tumor markers were normal in all patients. The mean scrotal mass lesion at diagnosis was 59.9 mm3 (range, 33 to 138 mm3). 3 or 4 cyles of chemotherapy protocols were administered in necessary cases. Mean follow-up period was 80.6 months (range, 12 to 297 months). Tumor recurrence was occured in only two patients (Dedifferentiated liposarcoma and Adenocarcinoma of the epididymis) during the follow-up. Conclusion: Miscellaneous non-specific malign stromal tumors of the testis should be kept in mind especially in middle age group patients presented with malign scrotal lesions. Surgical treatment should be aggressive and additional specific treatment according to pathology result should be planned without delay. Follow-up protocols are recommended to be tumor specific.

SCROTAL PATHOLOGIES;

Objectives: To assess common presenting complaints & the role of Grey Scale and Doppler ultrasound in evaluation ofscrotal pathologies. Design: Cross sectional study, Setting: Khyber X rays, Khyber Medical Centre, Peshawar. Period: July 2011 toDecember 2011. Material and Methods: Data from patients presenting for evaluation of scrotal pathologies was analyzed for presentingcomplaints and ultrasound findings according to objectives of the study. Results: In total 210 cases were included in the study. The agewise categorization included pediatric population (14.3%) adult population (80.9%) and geriatric population (4.3%). Pain was the mostcommon presenting feature in all age. Other major presenting complaints included swelling, absent testis, history of trauma, lower urinarytract symptoms (LUTS), and infertility. Hydrocele was the most common finding overall. Other major ultrasound finding includedvaricocele, epididymo-orchitis, spermatocele, atrophic testis, undescended testis tumors and complications of trauma. Conclusions:Scrotal pathologies are among the frequently encountered problems in our region. Ultrasound is a sensitive and useful tool for evaluationof scrotal pathologies.

CIC fusion-positive sarcoma of the spermatic cord

In addition to germ cell tumors and tumors of the sex cord stroma, the WHO classification of testis and paratesticular tumors also contains malignant soft tissue tumors. Among them, liposarcomas of the spermatic cord are the most common entities. Other mesenchymal tumors with smooth muscle, skeletal muscle, fibroblastic/myofibroblastic, or nerve sheath differentiation are rare. Ewing sarcoma is composed of uniform small round cells and typically characterized by translocations of the EWSR1 gene. In rare cases, Ewing sarcoma-like tumors lack an EWSR1 gene fusion. Some of these tumors harbor a specific CIC translocation. However, Ewing-like sarcoma has up to now never been described in the testis or spermatic cord. The present case describes the first EWSR1-negative, undifferentiated round cell sarcoma with CIC translocation of the spermatic cord. Potential differential diagnoses are discussed.

Testicular tumours discovered during infertility workup are predominantly benign and could initially be managed by sparing surgery.

To evaluate the pathological features and recurrence of incidental testis tumours treated by partial orchiectomy in a population of infertile men. We retrospectively pooled, from four andrology referral centres, 32 patients diagnosed with testis mass during regular infertility workup. Patients included had an impaired sperm analysis and testis sparing surgery was performed to prevent secondary azoospermia or androgen therapy. Mean age was 36 (IQR, 32 to 37). The mean largest tumoral diameter was 8.5 mm (IQR, 5 to 10). A total of 25% (8 of 32) of patients had a malignant tumour (seminoma, 7 of 32, 22%; teratoma, 1 of 32, 3%) and 75% (24 of 32) had a benign lesion (Leydig cell tumour, 23 of 32, 72%; scar tissue, 1 of 32, 3%). Malignant tumours were then managed by total orchiectomy (six of eight) or by radiotherapy (two of eight). With a mean follow up of 26 months (IQR, 8 to 32), one patient (3%) had an homolateral recurrence, which was a Leydig cell tumour. Not a single patient developed metastasis. Seventy-five per cent of the tumours discovered during infertility management were of a benign pathology. A conservative approach could be proposed initially to avoid unnecessary orchiectomies. Orchiectomy and radiotherapy could be discussed as salvage therapies for malignant lesions.

MIXED GERM CELL TERATOMATOUS TUMOUR OF TESTIS IN ADULTS: DIAGNOSTIC CHALLENGES FOR A HISTOPATHOLOGIST (case report)

Background. Testicular tumours account for approximately 1-2 % of the total cancer cases in the male population globally and show higher incidence in the younger male age group of up to 15 years. The majority (~98 %) of testicular tumours are observed to be of the germ-cell origin which can either be of seminomatous type or non-seminomatous type. The non-seminomatous germ cell neoplasm may be pure or of mixed subtype. Objective was to emphasize the rare case of mixed germ cell teratomatous tumour of testis in adult man.Methods. A mixed germ cell teratomatous tumour of testis comprising of yolk sac tumour and embryonal carcinoma in an adult Indian male is reported in the research.Results. A 45 year-old Indian male presented with enlargement of right testis which was found to be an encapsulated right testicular tumour on exploratory surgery which was followed by radical orchiectomy. Serum AFP and β-hCG levels were elevated to 380 ng/ml and 590 mg/ml respectively. Histopathology revealed a mixed germ cell teratomatous tumour of testis comprising of yolk sac tumour and embryonal carcinoma.Conclusions. In adults teratomas occur usually as a component of mixed germ cell tumours. However in the present case teratomatous embryoid yolk sac germ cell tumour of testis was observed in an Indian adult male. The prognosis of embryoid germ cell tumours of testis is generally poor. The possibility of this condition should always be considered in all cases that present with a testicular lump.