Risk of second primary cancers after testicular cancer in East and West Germany： a focus on contralateral testicular cancers

Testicular cancer survival rates improved dramatically after cisplatin-based therapy was introduced in the 1970s. However, chemotherapy and radiation therapy are potentially carcinogenic. The purpose of this study was to estimate the risk of developing second primary cancers including the risk associated with primary histologic type （seminoma and non-seminoma） among testicular cancer survivors in Germany. We identified 16 990 and 1401 cases of testicular cancer in population-based cancer registries of East Germany （1961-1989 and 1996-2008） and Saarland （a federal state in West Germany; 1970-2008）, respectively. We estimated the risk of a second primary cancer using standardized incidence ratios （SIRs） with 95% confidence intervals （95% Cls）. To determine trends, we plotted model-based estimated annual SIRs. In East Germany, a total of 301 second primary cancers of any location were observed between 1961 and 1989 （SIR： 1.9; 95% Ch 1.7-2.1）, and 159 cancers （any location） were observed between 1996 and 2008 （SIR： 1.7; 95% Ch 1.4-2.0）. The SIRs for contralateral testicular cancer were increased in the registries with a range from 6.0 in Saarland to 13.9 in East Germany. The SIR for seminoma, in particular, was higher in East Germany compared to the other registries. We observed constant trends in the model-based SIRs for contralateral testicular cancers. The majority of reported SIRs of other cancer sites including histology-specific risks showed low precisions of estimated effects, likely due to small sample sizes. Testicular cancer patients are at increased risk especially for cancers of the contralateral testis and should receive intensive follow-ups.

Undescended epididymo-testicular metastasis from prostatic carcinoma

Dear Sir, Metastasis of prostatic carcinoma to testis is un- common in the clinical situation, and the involvement of the epididymis is even rarer. Heidrich et al. [1] found only 80 cases of testicular involvement in prostate cancer in published reports. In 1993, Wiebe et al. [2] found only 14 previous cases of epididymal metastasis from prostatic carcinoma in published work. The simulta- neous involvement of testis and epididymis was reported by Suhler and Blanchard in 1980 [3]. To our knowledge, this was the first documented case of a prostatic carcinoma metastasizing to undescended testis and epididymis.

Influence of Combined Therapeutic Potential of Meso 2, 3-dimercaptosuccinic Acid and Calcium Disodium Edetate on Lead-induced Testicular Alterations in Rats

The therapeutic efficacy of a combinaion of meso 2,3-dimeroaptosuccinic acid (DMSA) and calcium disodium EDTA in protecting testicular disorders in chronic lead intoxication was investigated. The results indicate that two five-days courses of the combined therapy produced a more effective recovery in the lead induced biochemical and histopahological disorders compared to conventional single 5 days therapy. No adverse effect of the chelators, when administered individually or in combination, was noticed in the testes of control (without lead exposure) animals.

Benign intratesticular schwannoma:a rare finding

Schwannoma is a peripheral nerve tumour, occasionally located in the genitourinary tract. We described an extremely rare case of intratesticular neurinoma in a 79-year-old patient. （Asian JAndrol 2006 Jan; 8： 101-103）

Diffusion-weighted MR imaging of normal and abnorma scrotum： preliminary results

Magnetic resonance （MR） imaging of the scrotum represents an important supplemental diagnostic tool in the evaluation of scrotal diseases. Diffusion-weighted （DW） MR imaging is a developing technique, proved to improve tissue characterization. We evaluated the feasibility and diagnostic performance of DW MR imaging in the detection and characterization of scrotal lesions. We retrospectively evaluated 31 scrotal lesions （23 intratesticular and 8 extratesticular） in 26 men. All MR examinations were performed on a 1.5-T unit, using a pelvic-phased array coil. DW sequences were obtained using a single shot, multislice spin echo planar diffusion pulse sequence and a b factor of 0 and 900 s mm-2. The DW MR characteristics and the apparent diffusion coefficient （ADC） values of normal scrotal contents and scrotal diseases were evaluated. Comparison between the ADC values of normal scrotum, benign lesions and scrotal malignancies was performed. The accuracy of conventional sequences, DW images alone and DW imaging combined with conventional images in differentiating benign from malignant scmtal lesions was calculated. The ADC values of testicular malignancies were different from those of normal testis and benign intratesticular lesions, and the ADC values of benign extratesticular lesions from those of normal epididymis （P〈0.05）. The overall accuracy of conventional imaging, DW imaging alone and DW MR combined with conventional sequences in the characterization of intratesticular lesions was 91%, 87% and 100%, respectively. Our findings suggest that DW MR imaging and ADC values may provide valuable information in the diagnosis and characterization of scrotal diseases.

Maternal cigarette smoking during pregnancy and reproductive health in children： a review of epidemiological studies

Maternal cigarette smoking may affect the intrauterine hormonal environment during pregnancy and this early fetal exposure may have detrimental effects on the future trajectory of reproductive health. In this review, we discuss the epidemiological literature on the association between prenatal exposure to maternal cigarette smoking and several aspects of reproductive health. The literature points towards an increased risk of the urogenital malformation cryptorchidism, but a potential protective effect on the risk of hypospadias in sons following prenatal cigarette smoking exposure. Studies on sexual maturation find a tendency towards accelerated pubertal development in exposed boys and girls. In adult life, prenatally exposed men have impaired semen quality compared with unexposed individuals, but an influence on fecundability, that is, the biological ability to reproduce, is less evident. We found no evidence to support an association between prenatal cigarette smoking exposure and testicular cancer. Among adult daughters, research is sparse and inconsistent, but exposure to cigarette smoking in utero may decrease fecundability. In conclusion, prenatal exposure to cigarette smoking may cause some long-term adverse effects on the reproductive health.

Successful treatment of a high-risk nonseminomatous germ cell tumor using etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine: A case report

BACKGROUND Choriocarcinoma is an infrequent entity and the most aggressive subtype of germcell tumors.Because of early metastatic spread and rapid disease progression,choriocarcinoma patients display poor prognosis.Although etoposide,methotrexate,actinomycin D,cyclophosphamide,and vincristine(EMA-CO)regimen is widely used to treat gestational trophoblastic tumors in females,its role in treating male choriocarcinoma is seldom reported.CASE SUMMARY A 32-year-old man was diagnosed with burned-out primary germ cell tumors(GCT)with retroperitoneum,liver and lung metastases.Biopsy of the liver revealed pure choriocarcinoma.The patient received bleomycin,etoposide,and cisplatin chemotherapy.After two cycles of treatment,response evaluation revealed the mixed response.EMA-CO regimen was used in the second-line therapy.After eight cycles,the patient showed a potentially resectable state and thus,all residual masses were surgically removed.The patient was completely cured,and 10 years later,he is leading a healthy life without complications.CONCLUSION This paper is the first case of high-risk nonseminomatous GCT in a male patient to be successfully treated with the EMA-CO regimen.The EMA-CO regimen can be used actively in patients with high-risk nonseminomatous GCT.

Robot-assisted retroperitoneal lymphadenectomy:The state of art

Objective:To perform a narrative review about the role of robot-assisted retroperitoneal lymphadenectomy(R-RPLND)in the management of testicular cancer.Methods:A PubMed search for all relevant publications regarding the R-RPLND series up until August 2019 was performed.The largest series were identified,and weighted means calculated for outcomes using the number of patients included in each study as the weighting factor.Results:Fifty-six articles of R-RPLND were identified and eight series with more than 10 patients in each were included.The weighted mean age was 31.12 years;primary and post chemotherapy R-RPLND were performed in 50.59%and 49.41%of patients.The clinical stage was I,II and III in 47.20%,39.57%and 13.23%of patients.A modified R-RPLND template was used in 78.02%of patients,while 21.98%underwent bilateral full template.The weighted mean node yield,operative time and estimated blood loss were,respectively,22.15 nodes,277.35 min and 131.94 mL.The weighted mean length of hospital stay was 2 days and antegrade ejaculation was preserved in 92.12%of patients.Major post-operative complications(Clavien III or IV)occurred in 5.34%.Positive pathological nodes were detected in 24.54%,while the recurrence free survival was 95.77%with a follow-up of 21.81 months.Conclusion:R-RPLND has proven to be a reproducible and safe approach in experienced centers;short-term oncologic outcomes are similar to the open approach with less morbidity and shorter convalescence related to its minimal invasiveness.However,longer follow-up and new trials comparing head-to-head both techniques are expected.

Primary testicular lymphoma:Clinical characteristics and oncological outcomes

Background:Primary testicular lymphoma(PTL)is a rare testicular malignancy,despite being considered the most common testicular tumorin patients olderthan 60 years.Primary testicularlymphoma represents only 1%-9%oftesticular neoplasms.Few studies have been published regarding its clinical features and management.This study aimed to analyze the clinical characteristics and outcomes of PTL.Materials and methods:Orchiectomy specimens of 15 patients with PTL diagnosed during 2000-2020 at our institution were retrospectively studied.We collected information on demographic data,clinical features,management aspects,and outcomes of PTL treatment.Kaplan-Meier survival curves and Cox regression analyses were used to study survival.Results:The median patient age was 69 years(interquartile range,61-72 years).The most prevalent clinical presentation was testicular swelling(80%),and only 13.33%of the patients presented with systemic symptoms.Centralnervous system involvement was detected in 6 patients(40%).Of the 15 patients,5(33.33%)had stage IE and 10(66.67%)had stage IVE lymphoma.Diffuse large B-cell lymphoma was the most common histological subtype.Twelve patients(80%)received chemotherapy.During follow-up,4 patients(26.67%)relapsed.The recurrence ratein the contralateraltesticle was 13.33%.The median cancer-specific survivalwas 21.58 months(95%confidence interval,0-43.95 months).Univariate Cox regression analysis showed that central nervous system involvement and International Prognostic Index score were significantly associated with shorter cancer-specific survival.Conclusions:Primary testicularlymphoma has a high relapse rate and poor prognosis.Management strategies typicallyinclude radical orchiectomy and systemic chemotherapy.Central nervous system involvement and International Prognostic Index scores were associated with lymphoma-specific survival.

Contrast-enhanced ultrasound as a valuable imaging modality for characterizing testicular lesions

Contrast-enhanced ultrasound(CEUS)is a new form of ultrasound(US)that can dynamically display microvessels in a highly sensitive manner.The purpose of this study was to investigate the efficacy of CEUS for characterizing testicular lesions in comparison with conventional US.Forty-seven patients with testicular lesions were enrolled.The histopathology results revealed that 31 cases were neoplastic(11 cases of seminomas,8 nonseminomatous germ cell tumors,8 lymphomas,2 Leydig cell tumors,and 2 nonspecific tumors),and 16 cases were nonneoplastic(8 cases of infarctions,3 epidermoid cysts,and 5 inflammation).The indicators of shallow lobulated morphology and cystic-solid echogenicity on conventional US were suggestive of germ cell tumors.More indicators on CEUS were found to be useful for characterizing testicular lesions.All the neoplastic lesions showed hyperenhancement on CEUS.Moreover,germ cell tumors presented with heterogeneous enhancement(73.7%,14/19),a twisted blood vessel pattern,rapid wash-in and wash-out,and peripheral rim hyperenhancement signs.Lymphoma was characterized by nonbranching linear vessel patterns(87.5%,7/8),rapid wash-in and slow wash-out.In nonneoplastic lesions,infarction and epidermoid cysts showed no enhancement,and abscesses were observed with marginal irregular enhancement.The sensitivity,specificity,and accuracy of CEUS for differentiating between neoplastic and nonneoplastic lesions were 100%,93.8%,and 97.9%,respectively,and these values were higher than those for conventional US(90.3%,62.5%,and 80.9%,respectively).CEUS can sensitively reflect the microvascular perfusion in testicular lesions and offers high accuracy for characterizing them.

Predictors of sperm recovery after cryopreservation n testicular cancer

Our objective was to identify predictors of improved postthaw semen quality in men with testicular cancer banking sperm for fertility preservation. We reviewed 173 individual semen samples provided by 67 men with testicular germ cell tumor （TGCT） who cryopreserved sperm before gonadotoxic treatment between 1994 and 2010 at our tertiary university medical center. Our main outcomes measures were independent predictors for the greater postthaw total motile count （TMC） in men with TGCT. Men with NSGCT were more likely to be younger （P 〈 0.01） and had high cancer stage （Ⅱ or Ⅲ, P 〈 0.01） compared with men with seminoma. In our multiple regression model, NSGCT histology, use of density gradient purification, and fresh TMC 〉 median fresh TMC each had increased odds of a postthaw TMC greater than median postthaw TMC. Interestingly, age, advanced cancer stage （11 or III）, rapid freezing protocol, and motility enhancer did not show increased odds of improved postthaw TMC in our models. In conclusion, men with TGCT or poor fresh TMC should consider preserving additional vials （at least 15 vials） before oncologic treatment. Density gradient purification should be routinely used to optimize postthaw TMC in men with TGCT. Larger, randomized studies evaluating cancer stage and various cryopreservation techniques are needed to assist in counseling men with TGCT regarding fertility preservation and optimizing cryosurvival.

Paratesticular fibrous pseudotumor： a report of five cases and literature review

Paratesticular fibrous pseudotumor is a rare benign tumor that originates from intrascrotal tissue, such as tunica vaginalis, epididymis, or spermatic cord. Five cases of fibrous pseudotumor in our hospital were reviewed retrospectively, and the clinical manifestations were analyzed. Three cases of unilateral nodules, comprising one case located in the tunica vaginalis and two cases located in the epididymis, underwent local excision of the unilateral nodule. Two cases of diffuse incrassation in the tuniea vaginalis underwent right radical orchiectomy. Postoperative pathological examination showed that all were fibrous pseudotumors. An average follow-up of 26 months showed uneventful results without recurrence for all patients. Fibrous pseudotumor is not a neoplasm but a reactive fibrous inflammatory hyperplasia. Definitive diagnosis requires pathological examination. Radical orchiectomy should be avoided when possible, and local excision should be performed because of the lack of obvious evidence of potential malignancy.