Primary Retroperitoneal Lymph Node Dissection for Clinical Stage II A/B Seminomas: A Systematic Review and Meta-Analysis

ABSTRACT Introduction Chemotherapy and radiation therapy are considered standard treatments for stage II seminoma patients; however, these therapies are associated with long-term toxicities. Recently, retroperitoneal lymph node dissection has emerged as an alternative strategy, and the first three phase II trials were published in 2023 with promising results. The present study conducted a systematic review and meta-analysis to evaluate this surgery as an alternative treatment for stage IIA/B seminoma patients. Purpose Seminomas are the most common testicular tumors, often affecting young adult males. Standard treatments for stage II seminomas include chemotherapy and radiation therapy, but these therapies are associated with long-term toxicities. Thus, identifying alternative strategies is paramount. Herein, we conducted a systematic review and meta-analysis to appraise the efficacy and safety of retroperitoneal lymph node dissection (RPLND) for treating this condition. Methods We systematically searched the PubMed, Embase, and Cochrane databases for studies evaluating RPLND as a primary treatment for stage II A/B seminomas. Using a random-effects model, single proportion and means and pooled 2-year recurrence-free survival rates with hazard rates and 95% CI were calculated. Results Seven studies were included, comprising 331 males with stage II seminomas. In the pooled analysis, the recurrence rate was 17.69% (95% CI 12.31-24.75), and the 2-year RFS rate was 81% (95% CI 0.77-0.86). The complication rate was 9.16% (95% CI 6.16-13.42), the Clavien-Dindo > 2 complication rate was 8.83% (95% CI 5.76-13.31), and the retrograde ejaculation rate was 7.01% (95% CI 3.54-13.40). The median operative time was 174.68 min (95% CI 122.17-249.76 min), median blood loss was 105.91 mL (95% CI 46.89-239.22 mL), and patients with no evidence of lymph node involvement ranged from 0-16%. Conclusions Primary RPLNDs for treating stage IIA/B seminomas have favorable RFS rates, with low complication and recurrence rates. These findings provide evidence that this surgery is a viable alternative therapy for these patients.

Contrast-enhanced ultrasound as a valuable imaging modality for characterizing testicular lesions / 亚洲男科学杂志(英文版)

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.

Escala del modelo de creencias de salud en español para el cáncer y la autoexploración testicular / Spanish-language version of the health belief model scale for testicular cancer and testicular self-examination / Escala em espanhol do modelo de crenças em saúde para câncer e autoexame testicular

RESUMEN El objetivo de este estudio fue adaptar y validar la escala del modelo de creencias de salud para el cáncer y autoexploración testicular (AT) en estudiantes universitarios en México y determinar las variables sociodemográficas, clínicas y del modelo de creencias que influyen en efectuar la AT. Se realizó el proceso de traducción y retraducción de la cual se obtuvieron 72 ítems, que fueron revisados por expertos y se eligieron 39 ítems, los cuales fueron aplicados en un grupo de 30 estudiantes para revisar la comprensión y el tiempo de aplicación; por último, esta versión se aplicó en 803 estudiantes de una universidad pública. Se obtuvo una escala de 38 ítems divididos en 6 factores congruentes con el modelo de creencias de salud: susceptibilidad (α = 0,77), seriedad (α = 0,82), beneficios (α = 0,80), barreras (α = 0,83), autoeficacia (α = 0,88) y motivación para la salud (α = 0,71) que explican el 44% de la varianza y presentan una consistencia interna de adecuada a buena. La variable que más influye en la realización de la autoexploración testicular fue la autoeficacia. La versión en español de la escala del modelo de creencias de salud para el cáncer y la autoexploración testicular obtuvo evidencias de validez y confiabilidad en esta muestra de estudiantes universitarios.

ABSTRACT The objective of this study was to adapt and validate the health belief model scale for testicular cancer and testicular self-examination (TSE) in university students in Mexico and to determine the sociodemographic, clinical, and health belief model variables that influence TSE performance. Translation and back translation were conducted, and 72 items were obtained and reviewed by experts, following which 39 items were selected and applied to a group of 30 students to assess comprehension and application time. Finally, this version was applied to 803 students at a public university. A scale consisting of 38 items was obtained, and the items were divided across six factors consistent with the health belief model: susceptibility (α = 0.77), seriousness (α = 0.82), benefits (α = 0.80), barriers (α = 0.83), self-efficacy (α = 0.88), and health motivation (α = 0.71). These factors explain 44% of the variance and show an internal consistency ranging from acceptable to good. The variable that most strongly influenced the performance of testicular self-examination was self-efficacy. The Spanish-language version of the health belief model scale for testicular cancer and testicular self-examination yielded evidence of validity and reliability in this sample of university students.

RESUMO O objetivo deste estudo foi adaptar e validar a escala do modelo de crenças em saúde para o câncer e o autoexame testicular (AT) em estudantes universitários no México e determinar as variáveis sociodemográficas, clínicas e do modelo de crenças que influenciam a realização do AT. Realizou-se o processo de tradução e retrotradução, do qual foram obtidos 72 itens que foram revisados por especialistas. Posteriormente, foram escolhidos 39 itens que foram aplicados em um grupo de 30 estudantes para verificação da compreensão e do tempo de aplicação. Por último, esta versão foi aplicada a 803 alunos de uma universidade pública. Obteve-se uma escala de 38 itens, divididos em 6 fatores consistentes com o modelo de crenças em saúde: suscetibilidade (α = 0,77), seriedade (α = 0,82), benefícios (α = 0,80), barreiras (α = 0,83), autoeficácia (α = 0,88) e motivação para a saúde (α = 0,71), que explicam 44% da variância e apresentam consistência interna de adequada a boa. A variável que mais influenciou a realização do autoexame testicular foi a autoeficácia. A versão em espanhol da escala do modelo de crenças em saúde para câncer e autoexame testicular obteve evidências de validade e confiabilidade nesta amostra de estudantes universitários.

Lipogranuloma Esclerosante Escrotal Primario. Reporte de caso y revisión de la literatura / Primary Scrotal Sclerosing Lipogranuloma. Case report and literature review

RESUMEN El lipogranuloma esclerosante es una condición extraña y benigna que puede afectar cualquier órgano, especialmente los genitales externos masculinos. Se suele presentar como masas subcutáneas en escroto, periné y pene. Aunque la mayoría de los casos son secundarios a aplicación de cuerpos extraños como parafina, vaselina o silicona con propósitos estéticos para aumentar el tamaño del pene, también puede deberse a degeneración lipídica endógena, secundaria a trauma, infecciones o reacciones alérgicas. No existe consenso en cuanto a su manejo ni datos sobre su prevalencia al ser una entidad poco reportada; se ha descrito el manejo con ciclos cortos de corticoides sistémicos, y cirugía en los casos recidivantes. El objetivo de este trabajo es reportar el caso de un paciente que acudió con induración y eritema en pene y escroto, quien negaba la aplicación de sustancias exógenas y que fue llevado a biopsia de la lesión, con diagnóstico de lipogranuloma esclerosante. MÉD.UIS.2021;34(2): 97-102.

ABSTRACT Sclerosing lipogranuloma is a noncommon and benign disease that could affect any system in the body, especially the male external genitalia. It is usually presented as a subcutaneous mass in scrotum, perineum and penis. Although, most cases are secondary to the injection of foreign bodies such as paraffin, petrolatum or silicone for cosmetic purposes to increase penis size, it could also be due to endogenous lipid degeneration, secondary to trauma, infections or allergic reactions. There is no unanimity regarding its management or data on its prevalence as it is a poorly reported entity. Management with short cycles of systemic corticosteroids and surgery in relapsing cases have been described. The purpose of this article is to present a case of a patient with induration and erythema in penis and scrotum, who denied the application of exogenous substances and has a reported biopsy of the lesion with diagnosis of sclerosing lipogranuloma. MÉD.UIS.2021;34(2): 97-102.

Semen quality from patients affected by seminomatous and non-seminomatous testicular tumor

ABSTRACT Testicular cancer is considered a rare disease affecting approximately 1% to 2% of the male population. This neoplasm has a cure rate of over 95%; as a result, a major concern is the future of fertility of carriers from this disease. There are several histological subtypes of testicular tumors; however, the Testicular Germ Cell Tumors (TGCTs), comprising both seminoma and non-seminoma tumors, are considered the main subtypes of testicular neoplasms. TGCT are characterized by being a solid tumor that mostly affects young men aged between 15 and 40 years old. While TGCT subtypes may have an invasive potential, seminoma subtype does not affect other cells rather than germ cells, while non-seminomas have more invasive properties and can achieve somatic cells; thus, having a more aggressive nature. This research intends to review the literature regarding information about sperm parameters, correlating the data found in those studies to the subfertility and infertility of patients with TCGTs. Furthermore, it will also correlate the data to the non-seminoma and seminoma histological subtypes from pre- and post-cancer therapy. PubMed databases were used. Searched keywords included: seminoma AND non-seminoma; male infertility; germ cell tumor; chemotherapy AND radiotherapy. Only articles published in English were considered. Current studies demonstrate that both TGCT subtypes promote deleterious effects on semen quality resulting in decreased sperm concentration, declined sperm total motility and an increase in the morphology alterations. However, findings suggest that the non-seminoma subtype effects are more pronounced and deleterious. More studies will be necessary to clarify the behavior of seminoma and non-seminoma tumors implicating the reproductive health of male patients.

Examination of clinical data and semen analysis results of patients undergoing orchiectomy for testicular tumor

SUMMARY OBJECTIVE: Testicular tumor constitutes 1% of male neoplasms. Infertility can be determined in patients with testicular tumors before orchiectomy due to the deterioration of spermatogenesis. The aim of this study was to show the clinical, radiological, and pathological characteristics and spermiogram results of patients with testicular tumor and their relationship with each other. METHODS: The data of patients who underwent orchiectomy due to testicular tumor between 2016 and 2019 were reviewed retrospectively. These data included sociodemographic data of the patients, pretreatment spermiogram characteristics, level of serum tumor markers, characteristics of the ultrasonography, type of orchiectomy, and histopathological examination. RESULTS: This study included 53 male patients, with a mean age of 33.51±12.86 years. The mean levels of all tumor markers were above the reference levels. The mean tumor size was 34.68±23.32 mm. Multiple localizations and microlithiasis were detected in 11.3 and 13.2% of the tumors, respectively. The most common masses were hypoechoic (n=37; 69.8%) and hypervascular (n=47; 81%). Spermiogram and cryopreservation were performed in 29 (54.7%) of 53 patients preoperatively. The mean sperm concentration before orchiectomy was 24.21×106 /mL and group A sperm motility 0.79%, group B sperm motility 39.10%, group C sperm motility 9.83%, and group D sperm motility 22.69% in testicular tumors. CONCLUSION: Spermatogenesis adversely affected before the treatment due to local and systemic effects of testicular cancer. Fertility expectations can be increased in the subsequent years by semen analysis and referral to cryopreservation.

Contents of the inguinal canal: identification by different imaging methods / Conteúdos do canal inguinal: identificação pelos diferentes métodos de imagem

Abstract Although the correct diagnosis of inguinal hernias can often be made by clinical examination, there are several situations in which imaging methods represent the best option for evaluating such hernias, their content, and the possible complications. In addition, bulging of the inguinal region is not always indicative of a hernia, because other lesions, including tumors, cysts, and hematomas, also affect the region. The objective of this pictorial essay is to demonstrate what can be identified within inguinal hernias. Differentiating the types of herniated structures is of absolute importance for planning the appropriate treatment.

Resumo Embora o diagnóstico correto possa ser muitas vezes realizado pelo exame clínico, há várias situações em que os métodos de imagem representam a melhor opção para avaliar hérnias inguinais, seu conteúdo e eventuais complicações. Além disso, os abaulamentos da região inguinal nem sempre são hérnias, pois outras lesões como tumores, cistos e hematomas também acometem este sítio. O objetivo deste ensaio é demonstrar alguns diferentes conteúdos que podem ser diagnosticados no interior de hérnias inguinais. A diferenciação dos tipos de estruturas herniadas é de suma importância no planejamento do tratamento.

Value of high-frequency ultrasound combined with alpha-fetoprotein in accurate qualitative diagnosis of pediatric testicular tumors / 中国医师杂志

Objective:To explore the value of high frequency ultrasound combined with serum alpha-fetoprotein (AFP) in the accurate qualitative diagnosis of pediatric testicular tumors.Methods:The ultrasound characteristics (physical properties, calcification, alder blood flow classification) and AFP levels of 47 testicular tumors confirmed by operation and pathology were analyzed retrospectively. The tumors were further divided into two ways: malignant tumor group and benign tumor group, yolk sac tumor group and non yolk sac tumor group. The characteristics of ultrasound and the accurate qualitative diagnosis efficiency of AFP in testicular tumors were analyzed by receiver operating characteristic curve (ROC).Results:18 cases of yolk sac tumor showed solid or almost solid mass, which may be accompanied by several small anechoic areas without calcification. The Alder blood flow grade were grade 3. 29 cases of nonyolk sac tumor showed cystic, solid or mixed mass, most of them have calcification and some of them showed honeycomb echo. Alder blood flow grade were 0-3 grade. ROC curve analysis showed that the area under the curve, sensitivity and specificity of the ultrasound characteristics and AFP in the diagnosis of pediatric testicular malignancies were: solid or almost solid mass (0.894, 83.3%, 95.5%), and no calcification (0.904, 94.4%, 86.4%), Alder blood flow level 3 (0.941, 88.9%, 95.5%), AFP by best cut-off value 18.8 ng/ml (0.972, 100%, 95.5%), ultrasound features combined with AFP (0.992, 100%, 90.9%). All the testicular malignancies, such as yolk sac tumor, immature teratoma, teratoma combined with yolk sac tumor, can be identified by ultrasound features combined with AFP. Further analysis showed that the sensitivity and specificity of the diagnosis of yolk sac tumor with combined solid or almost solid and no calcification were both 100.0%, which can accurately distinguish all cases of yolk sac tumor.Conclusions:Pediatric testicular yolk sac tumor has specific ultrasound performance, high-frequency ultrasound can make a relatively accurate diagnosis, combined with serum AFP can further make a relatively accurate qualitative diagnosis of other malignant tumors of the testis in children.

Clinical analysis of testicular rhabdomyosarcoma / 北京大学学报(医学版)

Testicular rhabdomyosarcoma is relatively rare in testicular tumors, but the age of patient is relatively young and the degree of malignancy is high. Therefore, this article introduces 4 cases of testicular rhabdomyosarcoma who were admitted to Peking University Third Hospital from May 1994 to February 2019, and reviews the literature to improve the diagnosis and treatment of this disease. The average age of the 4 patients was 17.5 years (14-21 years), the average hospital stay was 22.0 d (17-31 d), and the average body mass index was 19.6 kg/m2 (14.7-25.8 kg/m2). All the patients underwent routine preoperative blood and urine routine, biochemical tests, as well as serum tumor markers. Preoperative examinations also included chest radiograph, electrocardiogram, ultrasound of the scrotum and groin, and abdominal enhanced CT. Lung CT or other examinations were performed if necessary. The median serum human chorionic gonadotropin (HCG) of the 4 patients was 0.20 IU/L (0.06-0.86 IU/L) (all normal), and the median serum alpha-fetoprotein (AFP) was 1.03 g/L (0.65-1.66 g/L) (all normal). The average maximum diameter of the tumor was 10.0 cm (4.5-15.0 cm). Testicular rhabdomyosarcoma was mainly diagnosed by pathology. The main treatment was radical orchiectomy combined with retroperitoneal lymph node dissection, with or without postoperative adjuvant chemotherapy. The clinical manifestations of the patients with testicular rhabdomyosarcoma had no specific characteristics, but most patients were young at onset with mainly painless masses in the testicles, which were already large when they were found. Patients with testicular rhabdomyosarcoma have a poor prognosis, most of whom recur within two years. Because of the small number of cases of testicular rhabdomyosarcoma, there is no standard treatment currently. It is recommended that patients with testicular rhabdomyosarcoma undergo radical testicular resection combined with retroperitoneal lymph node dissection. Retroperitoneal lymph node metastasis is an important prognostic factor, and patients with postoperative adjuvant chemotherapy can still survive for a longer time. If local recurrence or limited metastasis is found after operation, local resection and salvage radiotherapy are feasible.

Clinical characteristics and CYP17A1 gene mutation analysis in patients with 17α-hydroxylase/17, 20-lyase deficiency and testicular tumor / 中华内科杂志

The 17α-hydroxylase/17, 20-lyase deficiency (17-OHD) is a rare disease. The clinical characteristics and gene mutation of 2 late-diagnosed 17-OHD patients with testicular tumor admitted to our hospital from March 2018 to February 2019 were analyzed retrospectively. The two 17-OHD patients were female (46, XY). Laparoscopic abdominal exploration found undeveloped testicles in grey-yellow or grey-red in the groin and iliac fossa. The testicles were removed and showed malignancy in pathology study. Sequencing of the CYP17A1 gene identified c.1247G>A/c.1427T>C and c.985_987delTACinsAA/c.1306G>A complex heterozygous mutations. Taking together, the possibility of 17-OHD should be considered in patients with hypertension, hypokalemia, adrenal adenomatoid hyperplasia together with 46, XY gonadal dysplasia, so as to make early diagnosis and treatment, and avoid dysplastic testicular turning to malignancy.

Seminoma metastásico de primario gonadal / Metastatic seminoma of primary gonadal

El seminoma es la neoplasia testicular más frecuente alcanzando hasta el 50% de todos los casos de cancer del testículo. Dependiendo de su naturaleza, seminomatoso o no seminomatoso, las conductas de manejo y tratamiento médico quirúrgicas varían según los centros, los protocolos de manejo y la experiencia de los equipos de atención. Objetivos. Promover la discusión de adyuvancia o neoadyuvancia en caso de seminoma clásico. Paciente y Método. Presentar un caso de seminoma clásico tratado quirúrgicamente con orquidectomía y una década después se presenta con extensión metastásica mediastinal y retroperitoneal. Conclusiones. Para la etiología no seminomatosa, se establece la orquidectomía seguida de vigilancia; mientras que en caso de origen seminomatoso la discusión se basa en el momento del rol de la cirugía, radiación y quimioterapia, por lo tanto, se debe individualizar cada paciente según las características clínicas manifestadas. (AU)

Seminoma is the most common testicular neoplasm, reaching up to 50% of all cases of testicular cancer. Depending on its nature, seminomatous or non-seminomatous, the management behaviors and surgical medical treatment vary according to the centers, the management protocols and the experience of the care teams. Objective. Promote the discussion of adjuvant or neoadjuvant in case of classic seminoma. Patient and Method. To present a case of classic seminoma treated surgically with orchidectomy and a decade later it presents with mediastinal and retroperitoneal metastatic extension. Conclusions. For non-seminomatous etiology, orchidectomy followed by surveillance is established; while in the case of seminomatous origin, the discussion is based on the time of the role of surgery, radiation and chemotherapy, therefore, each patient must be individualized according to the clinical characteristics manifested. (AU)

Tumor desmoplásico de célula pequeña y redonda paratesticular/testicular: reporte de caso y revisión de la literatura / Paratesticular/testicular desmoplastic round small cell malignant tumor: case report and literature review

Resumen El tumor desmoplásico de célula redonda y pequeña (TDCRP) es una patología neoplásica maligna agresiva y poco común. Afecta predominantemente a hombres entre la segunda y tercera década de la vida. Los pacientes que la padecen tienen un pronóstico pobre, con una supervivencia global a 5 años de hasta el 30%. Por lo general se presenta como una masa en la cavidad abdominal, frecuentemente multifocal. Para su tratamiento se recomienda un enfoque multimodal con cirugía, quimioterapia y radioterapia. Poco más de 20 casos de TDCRP a nivel testicular/paratesticular se han reportado en la literatura. A continuación, se presenta un caso ilustrativo en esta localización, se discute el caso y se realiza revisión de la literatura.

Abstract Desmoplastic small round cell tumor (DSRCT) is an aggressive and rare malignant neoplasm. It mainly affects young men in their twenties and thirties. Patients with it have a poor prognosis, with a 5-year survival rate of up to 30%. It generally presents as a mass in the abdominal cavity, often multifocal. A multimodal approach is recommended for its treatment, with surgery, chemotherapy, and radiotherapy. Just over 20 cases of testicular/paratesticular DSRCT have been reported in the literature. Below, we present an illustrative case in this location, we discuss the case and review the literature.

Testicular tumors in 190 dogs: clinical, macroscopic and histopathological aspects / Neoplasmas testiculares em 190 cães: aspectos clínicos, macroscópicos e histopatológicos

This study aimed to characterize the prevalence and clinical, macroscopic and histopathological aspects of dogs affected by testicular tumors based on biopsy specimens from the Laboratório de Patologia Veterinária of the Universidade Federal de Santa Maria (LPV-UFSM) over 19 years. Parameters regarding the age, size, and breed of the affected dogs were also established. Of all dogs with some type of neoplasm submitted to histopathological analysis at the LPV over these 19 years (n=1,900), 213 (11.2%) had at least one testicular neoplasm. The tissues of 190 dogs (with 220 neoplasms) were available for histological reassessment. The dogs in this study had different types of testicular tumors with relatively similar frequencies. In descending order, the most frequent testicular neoplasms were seminomas (88/220), Leydig (interstitial) cell tumor (LCT; 64/220), Sertoli cell tumor (SCT; 61/220), and mixed germ cell-sex cord stromal tumor (MGSCT) (07/220). Among the dogs of defined breed (119 cases), large breeds had the largest number of cases (50/119), followed by small (47/119) and medium-sized (22/119) breeds. The ages of dogs affected by testicular tumors ranged from 10 months to 18 years. Increased testicular volume was the most common clinical manifestation. Eleven dogs presented information about clinical signs suggestive of hyperestrogenism syndrome (feminization). In seminomas, the diffuse pattern predominated over the intratubular pattern. Two sites (luminal and basal compartments) suggestive of the onset of neoplastic transformations in germ cells were observed in intratubular seminomas. They corroborate the hypothesis that canine seminomas possibly have pathogenesis similar to that observed in human spermatocytic seminomas. The SCTs and LCTs presented high cell morphology variation. SCTs had neoplastic cells organized in five different histological arrangements. As for LCT, solid-diffuse and cystic-vascular histological patterns were the most commonly observed. Through this study, it was possible to establish some of the leading clinical, macroscopic, and histopathological aspects of testicular neoplasms diagnosed over 19 years in the area covered by the LPV-UFSM.(AU)

Este estudo teve por objetivo caracterizar a prevalência, aspectos clínicos, macroscópicos e histopatológicos dos cães acometidos por neoplasmas testiculares, a partir dos espécimes de biópsias do Laboratório de Patologia Veterinária da Universidade Federal de Santa Maria (LPV-UFSM) em 19 anos. Parâmetros quanto à idade, porte, raça dos cães acometidos também foram estabelecidos. De todos os cães com algum tipo de neoplasma submetido à análise histopatológica no LPV nesses 19 anos (n=1.900), 213 (11,2%) tinham ao menos um neoplasma testicular. Os tecidos de 190 cães (com 220 neoplasmas) estavam disponíveis para reavaliação histológica. Os cães deste estudo apresentaram diferentes tipos de neoplasmas testiculares com frequências relativamente semelhantes. Em ordem decrescente, os neoplasmas testiculares mais frequentes foram: seminomas (88/220), leydigomas (64/220), sertoliomas (61/220) e o tumor misto de células germinativas e do estroma do cordão sexual (MGSCT; 07/220). Dentre os cães com raça definida (119 casos), as raças de grande porte tiveram o maior número de casos (50/119), seguido das raças de pequeno (47/119) e médio porte (22/119). As idades dos cães acometidos por neoplasmas testiculares variaram de 10 meses a 18 anos. Aumento de volume testicular foi a manifestação clínica mais comum. Onze cães tinham informações sobre sinais clínicos sugestivos da síndrome da feminilização. Nos seminomas, houve o predomínio do padrão difuso sobre o intratubular. Dois locais (compartimentos luminal e basal) sugestivos de início das transformações neoplásicas nas células germinativas foram observados nos seminomas intratubulares, corroborando com a hipótese de que os seminomas caninos possivelmente tem patogênese semelhante à observada nos seminomas espermatocíticos humanos. Sertoliomas e leydigomas foram neoplasmas com alta variação na morfologia celular. Os sertoliomas tinham células neoplásicas dispostas em cinco arranjos histológicos distintos. Quanto aos leydigomas, os padrões histológicos sólido-difuso e cístico-vascular foram os mais comumente observados. Através deste estudo foi possível estabelecer alguns dos principais aspectos clínicos, macroscópicos e histopatológicos dos neoplasmas testiculares diagnosticados em 19 anos na área de abrangência do LPV-UFSM.(AU)

Priorities in testis cancer care during Covid-19 Pandemic

ABSTRACT Introduction: There is little information on how to prioritize testis cancer (TC) patients' care during COVID-19 pandemic in order to relieve its pressure on the health care systems. Objective: To describe the recommendations for diagnosis, treatment and follow-up of patients with TC amidst COVID- 19 pandemic. Material and Methods: Pubmed search and review of the main urological association guidelines on TC. Results: The biology of TC requires immediate care of patients during diagnosis, initial surgical therapy and management of recurrent disease. Active surveillance is the first choice of management and should be offered to all compliant clinical stage I TC patients provided they understand the need to self-isolate. Active surveillance may also help decrease the demand for intensive care unit beds, ventilators, personal protective equipment, and other critical hospital and human resources by minimizing surgeries without compromising patient outcomes. Complications of therapy and symptomatic patients represent medical emergencies and should be treated immediately. Telemedicine may be useful during follow-up periods. Conclusions: Most stages of testis cancer require urgent care; however, all recommendations must be adapted to local health care priorities considering that most of these patients are at low risk of severe COVID-19 infection.

Evaluation of nuclear NF-κB, transglutaminase2, and ERCC1 as predictors of platinum resistance in testicular tumors

ABSTRACT Purpose: Testicular germ cells tumor (TGCT) are associated with a high cure rate and are treated with platinum-based chemotherapy. However, a group of testicular cancer patients may have a very unfavorable evolution and insensitivity to the main therapeutic agent chemotherapy (CT) cisplatin. The aim of this study was to evaluate the risk of recurrence and overall survival related to the expression of nuclear factor kappa-B (NF-κB), transglutaminase 2 (TG2) and excision repair cross-complementation group 1 (ERCC1) in patients with TGCT treated with platinum combinations. Patients and Methods: A retrospective study was performed with TGCT patients treated with platinum-based chemotherapy. Immunohistochemical analysis was performed and the expression was correlated with clinical and laboratory data. Results: Fifty patients were included, the mean age was 28.4 years (18 to 45), and 76% were non-seminoma. All patients were treated with standard cisplatin, etoposide and bleomycin or cisplatin, and etoposide. Patient's analyzed immunodetection for NF-κB, TG2, and ERCC1 were positive in 76%, 54% and 42%, respectively. Multivariate analysis identified that positive expressions to ERCC1 and NF-κB are independent risk factors for higher recurrence TGCT after chemotherapy (RR 2.96 and 3.16, respectively). Patients with positive expression of ERCC1 presented a poor overall survival rate for 10-year follow (p=0.001). Conclusions: The expression of ERCC1 and NF-κB give a worse prognosis for relapse, and only ERCC1 had an influence on the overall survival of TGCT patients treated with platinum-based chemotherapy. These may represent markers that predict poor clinical outcome and response to cisplatin.

Linfoma testicular primario tipo B de célula grande: aspectos clínicos, histopatológicos, diagnóstico terapéutico y pronósticos / Large cell type B primary testicular lymphoma: clinical, histopathological, therapeutic diagnosis and prognostic aspects

RESUMEN Fundamento: el linfoma testicular constituye entre el 1 y el 9 % de los tumores testiculares, es el tumor testicular maligno más frecuente en los varones mayores de 50 años. El pronóstico es reservado debido a una gran tendencia a la propagación sistémica temprana. La presentación clínica más habitual, dolor testicular a la palpación y espontáneo, con aumento del volumen y de la consistencia testicular. Su tratamiento se sustenta en tres pilares fundamentales: orquiectomía, quimioterapia y radioterapia. Objetivo: describir un enfermo con linfoma testicular tipo B de célula grande. Presentación del caso: paciente masculino de 55 años de edad, hipertenso, fumador 10 cigarrillos al día, bebedor ocasional. Acude a consulta por aumento de volumen testicular izquierdo. En la analítica se observa elevación del lactato deshidrogenasa. Ecografía: teste izquierdo con ecogenicidad muy heterogénea, parénquima desestructurado, sin lesiones nodulares. Engrosamiento difuso del epidídimo. Vascularización incrementada. Se realiza orquiectomía radical inguinal, al ser el diagnóstico anatomopatológico linfoma difuso de células grandes tipo B, en la actualidad ha sido tratado con quimioterapia, por presentar además afectación ósea. Pero ha evolucionado favorablemente. Conclusiones: el linfoma testicular es una enfermedad poco frecuente, a pesar de ser considerado el tumor testicular más común en mayores de 60 años. En su mayoría se trata de linfomas no Hodgkin difusos de grado intermedio alto de malignidad e inmunofenotipo B. El pronóstico siempre es reservado debido a su gran tendencia a la propagación sistémica. El tratamiento está basado en la cirugía (orquiectomía radical inguinal), quimioterapia y radioterapia.

ABSTRACT Background: testicular lymphoma constitutes between 1 and 9 % of testicular tumors; it is the most frequent malignant testicular tumor in men over 50 years of age. The prognosis is reserved due to a great tendency to early systemic spread. The most common clinical presentation is testicular pain on palpation and spontaneous, with increased volume and testicular consistency. Its treatment is based on three fundamental pillars: orchiectomy, chemotherapy and radiotherapy. Objective: to describe a patient with large cell type B testicular lymphoma. Case report: 55-year-old male patient, hypertensive, smoker 10 cigarettes a day, occasional drinker. He goes to consultation due to left testicular volume increase. In the laboratory tests, the lactate dehydrogenase is elevated. Ultrasound Scand: Left testicle with very heterogeneous echogenicity, unstructured parenchyma, no nodular lesions. Diffuse thickening of the epididymis. Increased vascularization. Inguinal radical orchiectomy is performed, the anatomic-pathological diagnosis being diffuse large B cell type lymphoma, it has now been treated with chemotherapy, because he alsopresented bone involvement. But he has evolved favorably. Conclusions: testicular lymphoma is a very rare entity, despite being considered the most common testicular tumor in people over 60 years of age. The majority are diffuse non-Hodgkin lymphomas of high intermediate degree of malignancy and immune-phenotype B. The prognosis is always reserved due to its great tendency to systemic spread. The treatment is based on surgery (radical inguinal orchiectomy), chemotherapy and radiotherapy.

Predictive and prognostic impact of preoperative complete blood count based systemic inflammatory markers in testicular cancer

ABSTRACT Purpose To determine the utility of preoperative complete blood count (CBC) based systemic inflammatory markers in the prediction of testicular cancer and its prognosis. Material and Methods Between 2008-2017 the data of all testicular tumor patients undergoing radical orchiectomy were retrospectively analyzed. Patient baseseline characteristics (age, tumor stage, tumor markers, etc.) and results of routine preoperative blood tests including mean platelet volume (MPV), red cell distribution width (RDW), lymphocyte ratio (LR) and neutrophil ratio (NR) were retrieved. In addition, neutrophil to lymphocyte ratio (NLR) was calculated. Results Mean age of the tumor and control group was 36.0±15 and 30.50±11 years, respectively. Mean RDW, NR and NLR were significantly higher in the tumor group with p values<0.001; whereas LR and MPV were significantly higher in the control group (p<0.001). Receiver Operating Characteristic (ROC) analyses of LR, NR, RDW, MPV, and NLR are shown in Table-3. The cut off values for RDW and NR were found as 13,7 (Area under the curve (AUC): 0.687, sensitivity = 42.2%, specificity = 84.8%) and 55.3 (AUC:0.693, sensitivity 72.2%, specificity 62%), respectively. Area under the curve for NLR in tumor group was 0.711, with a threshold value of 1.78 and sensitivity=81.8% and specificity=55.4% (AUC:0.711/sig<0.001) that together with RDW exhibited the best differential diagnosis potential which could be used as an adjuvant tool in the prediction of testicular tumor and its prognosis. Conclusion Several systemic inflammatory markers, which are obtained by routinely performed cost-effective blood tests, could demonstrate incremental predictive and prognostic information adjuvant to preoperativly achieved testiscular tumor markers.

The relationship of neutrophil to lymphocyte ratio with testicular cancer

ABSTRACT Purpose: To assess the relationship between testicular germ cell tumors (TGCT) and neutrophil to lymphocyte ratio (NLR) and to determine whether this ratio can be used as a serum tumor marker. Material and Methods: Sixty-one patients with testicular germ cell tumors were included into the study. Patients were grouped as localized and non-localized. Histologically patients were categorized as seminoma and nonseminomatous germ cell tumors. Complete blood cell count was measured the day before surgery and at the postoperative 1st month. Preoperative and postoperative mean NLR values were compared. Results: Thirty-six patients (59%) had seminomas and 25 patients (41%) had nonseminomatous testicular cancer. Forty-five patients (73.8%) had localized and 16 patients (26.2%) had non-localized testicular cancer. There was a statistically significant difference between preoperative and postoperative mean NLR of the localized patients (p=0.001) but no such difference was detected for non-localized patients (p=0.576). Nineteen patients with localized seminomas had normal preoperative serum tumor markers. There was a significant difference between preoperative and postoperative mean NLR in this group of patients (p=0.010). Twenty-six patients with localized tumors had preoperative increased serum tumor markers which normalized after orchiectomy. Mean NLR of these patients significantly decreased from 3.10±2.13 to 1.62±0.59 postoperatively (p=0.010). Conclusions: NLR appears to be a useful marker for TGCT. It is successful in predicting localized and non-localized disease in early postoperative period.