Typical Seminoma Research Articles

Preoperative level of sex hormones as a predictor (prognostic factor) of the morphological characteristics of testicular malignancies

Introduction. Testicular cancer (TC) mostly affect young men of reproductive age. Several studies have shown correlation between the level of sex hormones in testicular cancer and serum tumor markers. However, currently, the relationship between hormone levels before orchidectomy and the clinical and pathomorphological characteristics of the tumor has not been sufficiently studied. Aim of the study: to analyze the relationship between hormone levels and the clinical stage and histological characteristics of the tumor in patients with testicular cancer and to develop prognostic models. Material and Methods. This prospective single-center study included 66 patients with testicular cancer. Localized, locally advanced and metastatic testicular cancer was diagnosed in 55 (83.3 %), 9 (13.6 %) and 2 (3.0 %) patients, respectively. A preoperative assessment of hormones such as total and free testosterone (T), estradiol (E2)), gonadotropic hormones (LH, FLH, Prolactin) and b-HCG was carried out. Patients were divided into 2 groups depending on the histological structure of the tumor: seminoma (n=31) and non-seminoma (n=35). The following parameters were assessed: tumor size, lymphovascular invasion and rete testis invasion. Results. In non-seminoma tumors, the values of sex hormones and beta-hCG were higher, but the values of gonadotropic hormones were lower compared with typical seminomas (p<0.05). High concentrations of b-HCG were observed predominantly in pT3 compared to pT1 stages (p=0.018). Correlation analysis revealed a connection between total (ρ=0.351; p=0.004) and free T (ρ=0.342; p=0.008), E2 (ρ=0.292; p=0.022), b-HCG (ρ=0.244; p= 0.048), LH (ρ=-0.287; p=0.039), FSH (ρ=-0.264; p=0.04) and the size of the primary tumor. The presence of rete testis invasion was accompanied by a low LH value and a high b-HCG value compared to patients without this prognostic parameter (p=0.015, p<0.001, respectively). Prognostic models were developed to determine the probability of histological structure and the presence of rete testis invasion (p<0.001) with high sensitivity (82.1 % and 76.5 %) and specificity (76.9 % and 100 %). Conclusion. The findings suggest that non-seminoma tumors are associated with changes in the pituitary-gonadal (HPG) axis. The high values of sex hormones and low values of gonadotropic hormones before orchidectomy are associated with a large size of the primary tumor. Additionally, a low LH value and a high b-HCG value are predictors of rete testis invasion. High b-HCG levels are associated with more aggressive tumor biology and poor prognosis.

SPERMATOCYTIC SEMINOMA-A RARE CASE REPORT

A rare yet distinct testicular germ cell tumor is spermatocytic seminoma which represent less than 1% of testicular cancers. It was first recognized by Masson et.al in 1946. It is between 25 and 40 times less frequent than the typical seminoma. An older presentation age and a decreased propensity to metastasis are the clinical characteristics that set out spermatocytic seminoma from classical seminoma. Spermatocytic seminoma never arises in any location other than the testis that is unrelated to other varieties of germ cell cancers, in contrast to the typical seminoma, which develops in the extragonadal sites as a primary tumor (where it is known as a germinoma) and typically occurs with other forms of germ cell tumor. It has a better prognosis.. The preferred treatment is orchidectomy. Radiotherapy is not required to be given after it.

SOME PATHOMORPHOLOGICAL FEATURES OF GERM CELL TUMORS OF TESTICLE

Objective: This study aims at identifying the main individual clinical and morphological features of germ cell testicular tumours through a detailed pathomorphological analysis of biopsy and postoperative material.
 Materials and Methods: The study involved the examination and analysis of archival biopsy and post- operative material of testicular cancer cases in Poltava and the Poltava region between 2018 and 2022. The samples were obtained from the Poltava Regional Pathology Bureau. Histological preparations were made using standard methods, stained with haematoxylin and eosin, and subjected to microscopic examination.
 Results: A total of 22 cases of testicular cancer were registered in the Poltava Regional Pathology Bureau between 2018 and 2022. The average age of men diagnosed with these tumours was 43.6±14.9 years. The study identified different types of germ cell testicular tumours, including typical seminoma, spermatocytic seminoma, embryonal cancer, and mixed germinative tumours (combinations of spermatocytic seminoma, embryonal cancer, and teratoma; combinations of typical seminoma and embryonal cancer; combinations of embryonal cancer and teratoma). Microscopic examination revealed histological features specific to each of these tumour types.
 Conclusions: Among germ cell tumours of the testicles in the Poltava region over the past 5 years, typical seminoma was the most frequently detected type, an average age of patients with the diagnosis is 50 years. The youngest patient diagnosed with testicular cancer was 21 years old, who had embryonal cancer. Germ cell testicular tumours have a heterogeneous structure, posing challenges in making pathomorphological di- agnoses. However, detailed microscopic examination enables the verification of the histological type of the tumour and identification of individual features of germinogenic neoplasias.

Impact of chemotherapy on anxiety, depression, and suicidality amongst testicular cancer survivors.

418 Background: Chemotherapy for testicular cancer (TC) is highly effective yet associated with significant consequences on long-term health-related quality of life. We evaluate the impact of chemotherapy on anxiety, depression, and suicidality amongst TC survivors. Methods: We conducted a retrospective cohort study of US veterans diagnosed with TC in the Veterans Health Affairs database from 1990-2016. Patients with non-primary germ cell tumor histologies were excluded. Baseline disease characteristics and treatment received were ascertained from the VA Central Cancer Registry. Anxiety or depression was a composite endpoint comprised of diagnosis codes for anxiety, depression, or administration of medications used to treat these diagnoses. Incident suicidality was defined as a diagnosis code for suicidal ideation. Time to event was defined as time from diagnosis to event or censor at the time of last follow-up. Rates of outcomes were reported through cumulative incidences. Associations with outcomes and receipt of chemotherapy were assessed through multivariable Cox regression models. Results: In total, 1684 patients (1174 seminoma, 510 nonseminoma) were included in the cohort. Median age at diagnosis in the cohort was 40 years old. Median follow up time was 7.67 years for surviving patients. 1506 (89.4%) patients were white, 114 (6.8%) were African American, and 64 (3.8%) were another or unknown race. There were 1066 (63.3%) stage I patients, 191 (11.3%) stage II, 198 (11.8%) stage III, and 229 (13.6%) unknown stage patients. 579 (34.4%) patients received chemotherapy. At the time of diagnosis, 104 (6.2%) patients already experienced anxiety or depression. At 10 years, cumulative incidence of the diagnosis of anxiety or depression as 44.1% in the entire cohort. At 10 years, cumulative incidence of the diagnosis of suicidality was 5.5%. On multivariable Cox regression, factors associated with a higher risk of anxiety or depression were older age at diagnosis (Hazard Ratio (HR): 1.11 per standard deviation increase, p=0.01), being unemployed (HR: 1.25, p=0.01), and receipt of chemotherapy (HR: 1.43, p<0.001). Race, stage, alcohol or tobacco use and seminoma type were nonsignificant. Factors associated with increased risks of suicidality were being unemployed (HR: 2.00, p=0.01) and not being married (HR: 2.50, p=0.001). Stage, age, race, alcohol and tobacco use, seminoma type, and receipt of chemotherapy were not significantly associated with suicidality. Conclusions: Psychosocial morbidity is high among TC survivors. Despite being effective and necessary for maintaining excellent oncologic outcomes, chemotherapy appears to increase the rates of psychosocial morbidity. Socioeconomic risk factors, including employment and marriage, may also impact psychosocial health. Clinicians should be proactive in identifying support systems for TC survivors.

Diagnosis of acute myelomonocytic leukemia in a patient with extramedullary testicular lesion

A complex clinical case of acute myelomonocytic leukemia with extramedullary lesion of the testis is presented. patient yu., born in 1968, applied to the National Medical Research Centre for Oncology (Rostov-on-don) after an injury to the inguinal region. ultrasound was performed: in the right testicle in the middle third, a mass of 30 × 23 × 16 mm was revealed. A biopsy was performed: the morphological picture is characteristic of a typical seminoma. Orchofuniculectomy was performed on the right. Histopathological conclusion: the morphological picture is more characteristic of a typical seminoma, but does not allow excluding lymphoma. In order to differentiate between a germ cell tumor and a lymphoproliferative disease, an immunohistochemical study of the tumor tissue, a morphological and immunophenotypic study of the bone marrow were performed. According to the immunohistochemical data, the morphological picture and immunophenotype of tumor cells are characteristic of extranodal NK/T-cell lymphoma of the testis with Cd4 co-expression. However, according to the myelogram data, 20 % of morphologically heterogeneous blast cells were found: with round or bean-shaped nuclei, delicate mesh structure of chromatin, 1–2 nucleoli and a monocytoid form of nuclei with indistinct nucleoli. The cytoplasm of varying basophilia degrees, vacuolized, with delicate azurophilic granularity. The content of the monocytoid population was increased (19 %), represented mainly by promonocytes, which corresponds to acute myelomonocytic leukemia. According to flow cytometry, the immunophenotype of blast cells corresponds to acute myeloid leukemia with Cd56 co-expression. In connection with the new data obtained, the histological preparation was revised again with the expansion of the immunohistochemical study. Result: morphological picture and immunophenotype of tumor cells are characteristic of acute myelomonocytic leukemia with extramedullary lesions of the right testicular tissue. final diagnosis: acute myelomonocytic leukemia with extramedullary lesion of the right testicle, with Cd56 co-expression. The presented clinical case showed the need to use a wide range of diagnostic techniques to determine the nature of the disease. The results of morphological and cytometric studies of the bone marrow were decisive in establishing the diagnosis of M4 acute myeloid leukemia with extramedullary lesions of the right testicle in this patient.

CRYPTORCHIDISM IN DOGS

Cryptorchidism is a disease that is manifested by the retardation of the testicles with the associated anatomical structures inside the abdomen or inguinal canal. In dogs, the appearance of cryptorchidism is of unclear etiology, but it is believed to have a genetic basis. The "gold standard" in the diagnosis of this disease is ultrasound diagnostics with a sensitivity of 95-100%. The study was conducted on 10 dogs. The clinical examination of dogs suspected to suffer from cryptorchidism was initially carried out using adspection and palpation methods, after which an ultrasound examination was performed to identify and localize residual testicles. All dogs underwent surgical removal of both residual and physiologically descended testicles. A pathohistological analysis was performed on the removed residual testicles. Bilateral cryptorchidism was found in 2 out of 10 dogs (20%), while unilateral cryptorchidism was found in 8 out of 10 dogs (80%). Right unilateral cryptorchidism was found in 5 out of 8 dogs (62.5%), while left unilateral cryptorchidism was found in 3 out of 8 dogs (37.5%). The predictive value of the comparison of ultrasound identification and localization of residual testicles with their surgical identification and localization in this study was 100%. The results of the pathohistological analysis showed the presence of tumorous changes in the type of seminoma on one testicle in one dog (unilateral inguinal cryptorchidism), while the diagnosis of testicular atrophy was made in the remaining 9 dogs with morphologically changed testicles.

A CASE OF BILATERAL SYNCHRONOUS TESTICULAR TUMORS, WHICH WAS DIFFICULT TO DIFFERENTIATE FROM MALIGNANT LYMPHOMA

We report a case of bilateral synchronous testicular tumors, which was difficult to differentiate from malignant lymphoma. A 56-year-old man with a left scrotal mass was referred to our hospital. Ultrasonography revealed a uniformly hypoechoic mass in bilateral testes. Magnetic resonance imaging also revealed a homogeneously low-intensity lesion in the bilateral testes on T2-weighted images. Abdominal and chest computed tomography showed no lymphadenopathy or metastasis. The image findings at that time suggested a malignant lymphoma, and consequently, we performed a right radical orchiectomy. Histopathological examination revealed typical seminoma in the right testis; following this observation, left radical orchiectomy was performed, and the patient was diagnosed with synchronous bilateral testicular germ cell tumors. No recurrence or metastasis has been detected postoperatively. We recommend that the diagnosis of bilateral testicular tumors be made on the basis of patients' age, tumor marker level, and image findings.

Diffuse type testicular seminoma in a stallion.

A 7-year-old stallion with progressive left testicular enlargement was presented. Grossly, the excised testicle measured 25 × 15 × 12 cm and weighed 3.7 kg. It was multinodular with a gray-white surface; however, the right testis was normal. Histologically, the neoplastic cells were disseminated diffusely in the tumoral stroma with a minimal fibrovascular stroma. Neoplastic cells were round to polygonal with abundant eosinophilic cytoplasm and large round to oval vesicular or hyperchromatic nucleous with a single prominent nucleolus. Immunohistochemically, the neoplastic cells were positive nuclear immunostaining for C-KIT and negative for OCT3/4. According to gross, histopathological, and immunohistochemical characteristics, the diffuse type of seminoma was diagnosed. Nine months later, the follow-up observation of the case showed that the tumor had no recurrence and metastasis.

Asociación entre tumor de células germinales y maliginidades hematológicas

Germ cell tumors represent 2% of human malignancies being more common in men between 15 and 35 years. About 2 to 5% occur extragonadal. Garnik reported the association between hematological malignancies and GCT in 1983, since then several cases have been reported; the majority are presented with non-seminomatous GCTs and hematologic neoplasms of a megakaryocytic nature. They have a poor prognosis and resistance to treatment, most die during the initial management of the diagnosis and there are no optimal protocols for their management. We report a case of hairy cell leukemia (PCL) treated with rituximab with a classical seminoma type GCT managed with platinum protocol (PEB), etoposide and bleomycin, achieving an adequate clinical response. Abbreviations: GCT, germ cell tumor: PCL, hairy cell leukemia.

Comparative immunohistochemical and histopathological evaluation of diffuse seminoma in a dog

A three year old male pomeraniandog was presented with history of testicular swelling. The dog manifested asymmetry and altered consistency of the testes. Palpation revealed a soft lesion in the right testis. The left testis was completely atrophied. Ultrasonography demonstrated a tumour in the testis, which depicted non-homogenous regions indicating haemorrhagic or necrotic lesions. Radiogram demonstrated that secondary growths were observed in mesenteric lymphnodes. On microscope examination a diffuse seminoma type was detected, which had a tendency to infiltrate blood vessels. Immunohistochemically Ki-67 proliferation antigen, a pronounced nuclear reaction was detected in neoplastic cells. Strong positive reaction in more than 80% of the cells pointed to a high proliferative potential of the tumour and manifested positive correlation with an unfavourable course of the disease.

Abstract 3561: Whole transcriptome analysis of testicular germ cell tumors

Abstract Next generation sequencing of the whole transcriptome enables high resolution measurement of gene expression activity in different tissue and cell types. This methodology provides an in depth study of known transcripts and depending on the data analysis, allows identification of additional transcript types such as transcript variants, fusion transcripts, and small and long ncRNAs. In this study we performed RNA-Seq using the Ion Torrent sequencing platform to compare the expression profile of testicular germ cell tumors (seminoma type, n=3) and normal testis (n=3). Using Partek Flow and Star or TopHat aligners, we aligned the reads to the human genome and mapped sequences to the RefSeq database. We identified a large number of genes that were up and down regulated with high degree of significance p<0.01, >2X FC). These included genes related to testicular tissue type, stem cell pleuripotency (NANOG; POU5F1) and proliferation (KRAS, CCND2). In addition, a number of differentially expressed noncoding RNAs were identified (SNORD12B, XIST). The method was validated on a small set of genes (>20) using qPCR (TaqMan Assays). We used the Open Array platform to quantitatively screen a larger number of differentially expressed genes (224) across a number of different testicular germ cell tumor types (non-seminoma). Citation Format: Lovorka Degoricija, Kathy Y. Lee, Sunali Patel, Shirley Chu, Ad J.M. Gillis, Martin Rijlaarsdam, Lambert C.J. Dorssers, Leendert Looijenga. Whole transcriptome analysis of testicular germ cell tumors. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 3561. doi:10.1158/1538-7445.AM2014-3561

Seminoma Presenting as a Polypoid Bladder Mass: A Case Report / Mesanede Polipoid Kitle Olarak Seminom Olgusunun Sunulması: Bir Olgu Sunumu

We report a case of extragonadal seminoma presenting as a polypoid mass in the urinary bladder. The patient presented with two months history of hematuria. e valuation by Ct scan and cystoscopic examination revealed a polypoid mass in the base of the bladder. Biopsy of the mass revealed a classical type of seminoma. The diagnosis of seminoma was supported by strong immunostaining of the tumor cells for C-Kit and placental alkaline phosphatase. Thorough physical examination and radiologic imaging of other organ systems failed to reveal any other tumor. Both testes were found to be normal on examination and on ultrasound imaging. Patient responded well to chemotherapy. This case is unique because to the best of our knowledge there are no previously reported cases in the literature with seminoma presenting as a bladder mass.

Metastatic Seminoma Presenting as Enlarging Retroperitoneal Mass in a Patient with Neurofibromatosis I

Neurofibromatosis type 1 (NF1) is a rare genetic disorder where patients develop neurofibromas and have characteristic skin and eye findings. These patients have increased risks for certain types of cancers, especially of neural origin. Testicular cancer is a relatively common type of cancer for younger men, and is considered a very treatable malignancy if identified early. This report describes a patient with NF1 who had an initial chief complaint of back pain. A retroperitoneal mass was identified, but initial pathology report was epithelioid granulomas without necrosis, and was non-diagnostic. After the patient developed deep vein thrombosis as complication of the mass, a repeat biopsy would provide the diagnosis of typical seminoma. A second review by independent pathologists of the primary biopsy sample was also unable to appropriately diagnose the seminoma. This report illustrates how a clear pathological diagnosis can drastically alter the approach to the disease and change the prognosis in a patient with an already rare disorder.

Seminoma presenting as a polypoid bladder mass: a case report

We report a case of extragonadal seminoma presenting as a polypoid mass in the urinary bladder. The patient presented with two months history of hematuria. Evaluation by CT scan and cystoscopic examination revealed a polypoid mass in the base of the bladder. Biopsy of the mass revealed a classical type of seminoma. The diagnosis of seminoma was supported by strong immunostaining of the tumor cells for C-Kit and placental alkaline phosphatase. Thorough physical examination and radiologic imaging of other organ systems failed to reveal any other tumor. Both testes were found to be normal on examination and on ultrasound imaging. Patient responded well to chemotherapy. This case is unique because to the best of our knowledge there are no previously reported cases in the literature with seminoma presenting as a bladder mass.

Sodium/iodide symporter is expressed in the majority of seminomas and embryonal testicular carcinomas

Testicular cancer is the most frequent cancer in young men. The large majority of patients have a good prognosis, but in a small group of tumors, the current treatments are not effective. Radioiodine is routinely used in the treatment of thyroid cancer and is currently investigated as a potential therapeutic tool even for extra-thyroid tumors able to concentrate this radioisotope. Expression of Na(+)/I(-) symporter (NIS (SLC5A5)), the glycoprotein responsible for iodide transport, has been demonstrated in normal testicular tissue. In this study, we analyzed NIS expression in a large series of testicular carcinomas. Our retrospective series included 107 patients operated for testicular tumors: 98 typical seminomas, six embryonal carcinomas, one mixed embryonal choriocarcinoma, and two Leydig cells tumors. Expression and regulation of NIS mRNA and protein levels were also investigated in human embryonal testicular carcinoma cells (NTERA) by real-time RT-PCR and western blotting respectively. Immunohistochemical analysis showed the presence of NIS in the large majority of seminomas (90/98) and embryonal carcinomas (5/7) of the testis but not in Leydig cell carcinomas. Expression of NIS protein was significantly associated with lymphovascular invasion. In NTERA cells treated with the histone deacetylase inhibitors SAHA and valproic acid, a significant increase in NIS mRNA (about 60- and 30-fold vs control, P<0.001 and P<0.01 respectively) and protein levels, resulting in enhanced ability to uptake radioiodine, was observed. Finally, NIS expression in testicular tumors with the more aggressive behavior is of interest for the potential use of targeting NIS to deliver radioiodine in malignant cells.

Testicular germ cell tumours in dogs are predominantly of spermatocytic seminoma type and are frequently associated with somatic cell tumours

Unlike seminomas in humans, seminomas in animals are not typically sub-classified as classical or spermatocytic types. To compare testicular germ cell tumours (TGCT) in dogs with those of men, archived tissues from 347 cases of canine testicular tumours were morphologically evaluated and characterized using human classification criteria. Histopathological and immunohistological analysis of PLAP, KIT, DAZ and DMRT1 expression revealed that canine seminomas closely resemble human spermatocytic seminomas. In addition, a relatively frequent concomitant presence of somatic cell tumours was noted in canine TGCT. None of the canine TGCT evaluated demonstrated the presence of carcinoma in situ cells, a standard feature of human classical seminomas, suggesting that classical seminomas either do not occur in dogs or are rare in occurrence. Canine spermatocytic seminomas may provide a useful model for this rare human neoplasm.

Concurrent xanthogranulomatous orchiepididymitis and seminoma in the same testis

Xanthogranulomatous orchiepididymitis (XGO) is a rare inflammatory and destructive disease of the testis that may simulate testicular malignancy. To the authors' knowledge only 19 cases of XGO have been previously reported. Herein is reported the case of a 52-year-old man with XGO who presented with a left testicular mass and pyogenic discharge from the scrotum. Ultrasound examination indicated heterogeneous testicular areas suggestive of neoplasia. Testicular tumor markers were normal. Orchidectomy was performed and histopathology showed XGO and a concurrent, occult typical seminoma. As far as the authors know the coincidence of these two lesions has not been documented previously. XGO may mimic testicular malignancy and may coexist with it. Pathologists should be aware of this concurrence of lesions to avoid potential misdiagnosis. Wide sampling of the orchidectomy specimens with XGO is mandatory to exclude an occult seminoma.

Seminoma With Conspicuous Signet Ring Cells: A Rare, Previously Uncharacterized Morphologic Variant

We report 2 seminomas with conspicuous numbers of signet ring cells. The tumors occurred in men, 24 and 69 years of age, who presented with testicular masses; 1 seminoma was a component of a mixed germ cell tumor and the other was pure. The signet ring cells occurred in a multifocal fashion in areas of otherwise typical seminoma and comprised approximately 70% and 10%, respectively, of the tumors. They had large, translucent to clear cytoplasmic vacuoles that compressed the nuclei to a peripheral crescent. In 1 case, the vacuoles contained numerous refractile, nonpolarizable globular deposits that were shown to be glycogen on the basis of periodic acid-Schiff stain positivity that was abolished by pretreatment with diastase; in the second case, they mostly appeared "empty" and lacked periodic acid-Schiff positivity. The signet ring cells were mucicarmine, cytokeratin (AE1/3) and alpha-fetoprotein negative, but positive for OCT3/4 and CD117, the latter 2 being expected for seminoma cells. A review of 30 randomly selected seminomas identified very rare, inconspicuous signet ring cells in 43%. The presence of prominent signet ring cells in seminoma may cause confusion as it has not been described previously in detail, and a variety of neoplasms, particularly metastasis, may be considered. The description of this phenomenon expands the known morphologic spectrum of the most common testicular neoplasm.

Pasqualini-Syndrom

Pasqualini's syndrome is an isolated, incretory functional disorder of the testes with a secondary Leydig cell insufficiency but, unlike Klinefelder's syndrome, with normal spermiogenesis and fertility. This unusual form of hypogonadism is caused by an inherent LH secretion disorder of the pituitary gland. The result of this is the secondary Leydig cell insufficiency and a corresponding peripheral androgen deficiency. In this communication we present the case of a 67-year-old man with Pasqualini's syndrome and a histologically confirmed left seminoma. In view of the current lack of data and our experience, we describe the properties of this uncommon syndrome; therapy, prognosis and possible relationship with seminoma are discussed in more detail. The 67-year-old male presented in our outpatient department with the urgent suspicion of a left testicular tumour as a painless swelling of the testis since about three months. In the case history we found a previously diagnosed hypogonadotropic hypogonadism, which is described in the literature as the so-called Pasqualini syndrome. On palpation, the left testis was about fist-size, scirrhous, mildly pressure sensitive and highly suspicious. Sonography of the testes revealed the enlarged left testis to be completely inhomogeneous with hypo- and hyperdense areas and large spatial requirements with unremarkable perfusion. On the basis of the clinically and sonographically supported diagnosis of a tumour of the left testis and inguinal exposure of the testes was performed. Intraoperative histology of a sample confirmed the diagnosis of a testicular tumour in the sense of a seminoma. A high left ablatio testis was carried out. The occurrence of testicular tumours of the seminoma type in association with Pasqualini's syndrome has not previously been described in the literature. Thus, we assume that the seminoma had occurred at this age independently of the Pasqualini syndrome. For the treatment of Pasqualini's syndrome not only hCG but also testosterone have been employed with success. The patient must continue therapy for his whole life. The results of interruption tests confirm that it is not a passing ailment but rather a persisting, endogenous disease. PRACTICAL CONCLUSIONS: Since the molecular genetics and genesis of this disease have not been clarified unambiguously, further clinical and experimental studies are necessary in order to better understand the disease. An increased risk of testicular tumours has not yet been observed on account of the small number of cases of Pasqualini's syndrome.

Concurrent development of testicular seminoma and choriocarcinoma of the superior mediastinum, presented as cervical mass: a case report and implications about pathogenesis of germ-cell tumours

BackgroundSynchronous presentation of more than one germ cell tumours of different histology in the same patient is considered to be very rare. In these cases of multiple germ cell tumours, strong theoretical and clinical data suggest an underlying common pathogenetic mechanism concerning genetic instability or abnormalities during the pluripotent embryonic differentiation and maturation of the germ cell.Case presentationA 25 year-old young man presented with an enlarging, slightly painful left cervical mass. Despite the initial disorientation of the diagnosis to a possible thyroid disorder, the patient underwent complete surgical resection of the mass revealing mediastinal choriocarcinoma. Subsequent ultrasound of the scrotum indicated the presence of a small lobular node in the upper pole of the left testicle and the patient underwent radical left inguinal orchiectomy disclosing a typical seminoma. Based on these results, the patient received 4 cycles of Bleomycin, Etoposide and Platinum chemotherapy experiencing only mild toxicity and resulting in complete ongoing clinical and biochemical remission.ConclusionThe pathogenesis of concurrent germ cell tumours in the same patient remains an area of controversy. Although the genetic instability of the pluripotent germ cell offers an adequate explanation, the possibility of metastasis from the primary, less differentiated tumour to a distant location as a more mature subtype cannot be excluded. Possible development of a metastatic site of different histology and thus biological behaviour (e.g choriocarcinoma) should be anticipated. Furthermore, urologists, pathologists and medical oncologists should be meticulous in the original pathological diagnosis in these patients, since there is a significant frequency of germ cell tumours with mixed or overlapping histological elements with diverse potential of evolution and differentiation.