Hand, foot, and mouth disease presenting with a testicular mass in an adult.

The majority of solid testicular tumors are treated with orchiectomy given the high risk of malignancy. We present a case of a testicular mass in an adult patient in the setting of recent hand, foot, and mouth disease that was managed conservatively with serial ultrasounds. Even though cases of viral-associated testicular masses are rare, this differential diagnosis should be considered in patients with a new testicular mass in the setting of recent viral infection and negative tumor markers. For these patients, observation may be an option instead of immediate orchiectomy.

The application of polypropylene mesh for testicular prosthesis in surgical castration for patients with prostate cancer.

BACKGROUND: To explore whether a polypropylene mesh is suitable for application as a new material for testicular prostheses. METHODS: The data of 65 patients with advanced prostate cancer who underwent surgical castration in hospital were collected and analyzed. Patients who preferred to undergo traditional orchidectomy (n = 16) were assigned to the control group, and patients who underwent subcapsular orchiectomy plus implantation of a polypropylene mesh testicular prosthesis (n = 49) were assigned to the experimental group. The presence of hematoma, infection, and other complications in patients in these two groups were investigated at 3 and 12 months following the surgery. The patients were also followed up using a self-designed testicular castration satisfaction questionnaire. RESULTS: A higher score indicated greater satisfaction. The mean score was 15.33 ± 2.85 in the experimental group and 4.63 ± 1.45 in the control group at 3 months after the surgery. The mean score was 14.92 ± 1.74 in the experimental group and 4.25 ± 1.61 in the control group at 12 months after the surgery. The difference between the two groups was statistically significant at the two time points (P < 0.01). CONCLUSIONS: Compared with orchidectomy alone, patients were more satisfied with subcapsular orchiectomy plus the implantation of a polypropylene mesh testicular prosthesis for the treatment of advanced prostate cancer. Furthermore, the polypropylene mesh testicular prosthesis maintained its original character over the duration of the study, with a good long-term effect. Thus, implantation of a polypropylene mesh testicular prosthesis is indicated to be safe and effective, and polypropylene mesh is potentially useful as a new material for testicular prostheses.

KBG syndrome patient due to 16q24.3 microdeletion presenting with a paratesticular rhabdoid tumor: Coincidence or cancer predisposition?

KBG syndrome is a rare autosomal dominant disorder caused by constitutive haploinsufficiency of the ankyrin repeat domain-containing protein 11 (ANKRD11) being the result of either loss-of-function gene variants or 16q24.3 microdeletions. The syndrome is characterized by a variable clinical phenotype comprising a distinct facial gestalt and variable neurological involvement. ANKRD11 is frequently affected by loss of heterozygosity in cancer. It influences the ligand-dependent transcriptional activation of nuclear receptors and tumor suppressive function of tumor protein TP53. ANKRD11 thus serves as a candidate tumor suppressor gene and it has been speculated that its haploinsufficiency may lead to an increased cancer risk in KBG syndrome patients. While no systematic data are available, we report here on the second KBG syndrome patient who developed a malignancy. At 17 years of age, the patient was diagnosed with a left-sided paratesticular extrarenal malignant rhabdoid tumor. Genetic investigations identified a somatic truncating gene variant in SMARCB1, which was not present in the germline, and a constitutional de novo 16q24.3 microdeletion leading to a loss of the entire ANKRD11 locus. Thus, KBG syndrome was diagnosed, which was in line with the clinical phenotype of the patient. At present, no specific measures for cancer surveillance can be recommended for KBG syndrome patients. However, a systematic follow-up and inclusion of KBG syndrome patients in registries (e.g., those currently established for cancer prone syndromes) will provide empiric data to support or deny an increased cancer risk in KBG syndrome in the future.

Testicular prosthesis: Patient satisfaction and sexual dysfunctions in testis cancer survivors.

PURPOSE: We studied patient satisfaction about sexual activity after prosthesis implantation using validated questionnaires with the aim to discover if testicular prosthesis could be responsible of sexual dysfunctions (erectile dysfunction or premature ejaculation). MATERIALS AND METHODS: We evaluated a total of 67 men who underwent radical orchiectomy for testicular cancer and a silicon testicular prosthesis implantation from January 2008 to June 2014 at our Hospital. These patients completed 5 validated questionnaires the day before orchiectomy and 6 months after surgery: the International Index of Erectile Function 5 (IIEF5), the Premature Ejaculation Diagnostic Tool (PEDT), the Body Exposure during Sexual Activities Questionnaire (BESAQ), the Body-Esteem Scale and the Rosenberg Self- Esteem Scale. We also evaluated 6 months after surgery any defects of the prosthesis complained by the patients. RESULTS: The questionnaires completed by patients didn't show statistically significant changes for erectile dysfunction (p > 0.05) and premature ejaculation (p > 0.05). On the contrary the psychological questionnaires showed statistically significant change for the BESAQ (p < 0.001) and the Body Esteem Scale (p < 0.001), but not for the Rosenberg Self-Esteem Scale (p > 0,05). A total of 15 patients (22.37%) were dissatisfied about the prosthesis: the most frequent complaint (8 patients; 11.94%) was that the prosthesis was firmer than the normal testis. CONCLUSIONS: Testicular prosthesis implantation is a safe surgical procedure that should be always proposed before orchiectomy for cancer of the testis. The defects complained by patients with testicular prosthesis are few, they don't influence sexual activity and they aren't able to cause erectile dysfunction or premature ejaculation.

Metastatic embryonal carcinoma in the maxillary gingiva.

Gingival metastases from embryonal carcinoma are very rare and often associated with widespread disease and poor prognosis. Because of their indistinct clinical appearance, they may be difficult to discriminate from more frequent gingival hyperplastic or reactive lesions. The case of a 35-year-old man who presented with a swelling in the left maxillary gingiva, extending from the first premolar to the second molar is reported. This medical history revealed that, 2 years previously, he had been diagnosed with a testicular mixed germ cell tumor (GCTs), for which he had undergone right inguinal orchidectomy and chemotherapy, leading to complete remission. Histology revealed a metastatic embryonal carcinoma. Imaging of the chest and abdomen showed this was the only site of metastasis. He is currently undergoing chemotherapy and responding well. This case draws attention to the multiple diseases that may present as gingival masses and stresses the difficulty of making a correct diagnosis. It is emphasized that in some mixed cases of testicular GCT it may be the more aggressive component that metastasizes, without being clearly apparent.

Mediastinal metastasectomy from a primary germ cell testicular tumour resulting in occult thoracic duct injury and chylothorax.

A 22-year-old man underwent mediastinal metastasectomy for a testicular germ cell tumour via median sternotomy. Intraoperatively, the tumour was massive, measuring 88 mm in anterior-posterior (AP) diameter. It was densely adherent to the trachea and aggressive debulking resulted in tracheal injury. Therefore, the patient was kept nil by mouth for 3 days postoperatively and was discharged uneventfully. He represented only 2 days later with a large right-sided chylothorax. His chylothorax was managed conservatively with insertion of an intercostal catheter (ICC) and a low-fat diet. Over the course of 9 days, the ICC drained approximately 5 L of fluid. His admission was further complicated by severe gastroparesis requiring feeding Nasojejunal (NJ) tube placement. The delayed feeding in this case resulted in late detection of the occult thoracic duct injury. This case illustrates that conservative and multidisciplinary management of a postoperative chylothorax from a suspected thoracic duct injury achieves favourable outcomes avoiding further surgical intervention.

Melanotic neuroectodermal tumor of the epididymis in infancy: case report and review of the literature.

Melanotic neuroectodermal tumor of infancy (MNTI) is a rare, benign tumor that usually involves the upper or lower jaw, but it may also arise in other sites. We describe a case of MNTI located in the left epididymis of a 6-month-old boy. Left orchiectomy was performed. Immunohistochemical and ultrastructural studies revealed two types of cells: small, poorly differentiated cells that were positive for neuron-specific enolase protein and vimentin, and larger epithelial cells that were positive for melanoma antigen (HMB45) and frequently contained large and elongated melanosomes, similar to those described in retinal pigmented epithelium. At 12 months of follow-up, no recurrences or metastases were seen. Primary involvement of the epididymis has been previously reported in only 16 cases. Immunohistochemical and ultrastructural studies suggest that the neoplasm is of neural crest origin.

Metastatic testicular tumor requiring inferior vena cava resection.

A patient undergoing radical retroperitoneal lymphadenectomy for metastatic embryonal cell testicular carcinoma is presented. Tumor resection required removal of the inferior vena cava due to transmural invasion. The inferior vena cava was replaced using externally stented polytetrafluoroethylene (PTFE) graft. Patency was documented by postoperative Doppler studies, duplex scanning, and computed tomographic scanning. Stented PTFE is currently the graft of choice for inferior vena caval replacement.

Preoperative lymph-node staining with liposomes containing patent blue violet. A clinical case report.

A case study is reported using patent blue violet entrapped in liposomes to localize lymph nodes before surgery. Liposomes containing 44 mg patent blue violet were injected into foot lymphatics of a patient due to undergo retroperitoneal staging-lymphonodectomy. Lymph nodes were readily visualized and removed, and urine and serum was collected for assay of the dye. The maximum concentration of patent blue violet in serum was 2.7 micrograms mL-1, 1.5 h after the termination of the injection, almost no dye was detectable by the time of the operation 24 h later. In the first urine sample (2 h after the termination of the injection) the concentration of patent blue violet was 1.3 micrograms mL-1, and subsequently diminished, with the last urine sample to contain detectable dye being collected 20 h later. A total of 0.8 mg dye (2% of the injected amount) was excreted in the urine suggesting 10% of the circulating amount of dye was renally excreted. Endolymphatic injection of patent blue violet simplifies the often difficult process of finding the lymph nodes and additionally reduces side-effects. All surgery cases demanding a radical lymphonodectomy may profit, including testicular or bladder cancers and many gynaecological tumours.

Duodenal fistula after reconstruction of the inferior vena cava with an externally stented PTFE graft.

Reconstructions of the inferior vena cava with externally stented grafts may result in erosion and fistulation into an adjacent intestinal segment. Paraprosthetic infection may cause intravascular thrombosis and dissemination of septic thrombi.

[Acceptance of silicone testicular prostheses in long-term follow-up]. / Akzeptanz von Silikonhodenprothesen im Langzeitverlauf.

The loss of a testicle is a psychological trauma, in particular for young men. The cosmetic defect can be corrected by implantation of a silicone testicular prosthesis (STP). The recurring discussion regarding the problems of silicone implants mainly concerns breast implants. STPs are made of equivalent material. Since we have been using STPs for 20 years, we wanted to research the opinion of our patients regarding these issues. Between 1978 and 1998, 51 STPs were implanted--37 times by groin incision and 14 times by scrotal incision--in 51 patients. The average age of the patients at the time of the operation was 23.3 years (14.3-55.4). Three implants had to be removed early. A questionnaire was distributed to all patients with STPs; 39 of the questionnaires were returned completed. The results--10.1 years postoperative--showed no serious late complications, an acceptance rate of 97% by the patients and about 50% by their female partners. Therefore, we will continue to offer the option for implantation of STP to our patients.

[Metastatic testicular tumor requiring inferior vena cava resection with polytetrafluoroethylene graft replacement: a case report].

A 31 year-old man with a biopsy-proved retroperiotoneal yolk sac tumor was referred to our clinic. Physical examination revealed a thum- tip sized left supra-clavicular mass, a huge right abdominal mass and a tiny hard mass of the right testis. On CT scan, the abdominal tumor, 13 cm in diameter, encircled the inferior vena cava. Serum levels of LDH, AFP and hCG-beta were 2,585 U/l, 19,922 ng/ml and 6.6 ng/ml, respectively. No visceral metastasis was found. Following the right high orchiectomy, 4 cycles of VIP chemotherapy consisting of ifosfamide, etoposide and cisplatin were given, which resulted in partial response of the retroperitoneal mass and complete regression of the supraculavicular node with normalization of all tumor markers. Thus, retroperitoneal lymph node dissection was carried out. Because of the marked adhesion to the tumor, the inferior vena cava was segmentally resected together with the tumor, which was followed by reconstruction of the vena cava using a 16 cm long polytetrafluoroethylene graft, since no collateral venous route was found on the pretreatment venacavography. Histologically, the tumor was nearly necrotic with mature teratoma in small part. Postoperative clinical course was uneventful except feeling of numbness at the right tip toe, and the inferior vena cava has been patent 18 months after the operation with no evidence of recurrence.

Concomitant reconstruction of infrarenal aorta and inferior vena cava after en bloc resection of retroperitoneal rhabdomyosarcoma.

Adult paratesticular rhabdomyosarcoma (PRMS) with invasion of the retroperitoneum and involvement of the infrarenal aorta and inferior vena cava (IVC) is rare. We describe a 23-year-old male diagnosed with PRMS in 2008, previously treated with right orchiectomy, chemotherapy, and radiation, who presented with new onset of lower back pain. Computed tomography (CT) scan revealed a 4.8 × 4.2 cm mass involving both the infrarenal aorta and the IVC. We resected the tumor en bloc with in situ reconstruction of the aorta utilizing a Dacron graft and the IVC with a bovine pericardium roll graft. His postoperative period was uneventful, and he was discharged on postoperative day 6 in stable condition. At 2-month follow-up, the patient recovered well from the surgery, patent grafts on CT scan with no clinical signs of lower extremity ischemia or edema, and he continues to receive cycles of chemotherapy.

Pure choriocarcinoma of testis with rare gingival and skin metastases.

A 22-year-old man presented with complaints of gingival and skin lesions. Physical examination revealed the presence of two nodular lesions, one over the sternum, 3 cm in size, and another, on the right side of chin, 1 cm in size. There was another fleshy soft tissue deposit over the left lower gingiva, in the oral cavity. He had noticed these lesions ten days prior to his visit to the hospital. In addition, there was left testicular non-tender swelling which had been present for two months, but was not investigated. Fine-needle aspiration cytology from skin and gingival lesions was suggestive of metastatic deposits. Patient underwent left high orchidectomy, and histopathological examination was consistent with the diagnosis of pure choriocarcinoma. Although rare, cases of testicular neoplasms and especially choriocarcinoma of the testis leading to skin metastases have been reported, but case reports of choriocarcinoma of testis metastatic to gingiva have been reported exceptionally in the English literature. We report this unique case of a young man with pure choricarcinoma of testis with unusual gingival and skin metastases.

[Testicular prosthesis. Study of complications, apropos of 63 cases]. / Les prothèses testiculaires. Etude des complications, à propos de 63 cas.

The authors report 63 cases of insertion of testicular prostheses (Lattimer model in Silastic, manufactured by Dow Corning) in patients who had undergone castration for testicular cancer. A study of the early and late post-operative complications, which were relatively rare and always benign, allows several simple rules to be proposed regarding this surgical procedure. There does not seem to be any problem with long term tolerance to medical silicones, after a ten year follow up period for the earliest cases. The insertion of an implant does not in any way delay continuation of treatment for testicular cancer.

The treatment of ejaculation disorders after retroperitoneal lymph node dissection.

In 14 patients by bilateral retroperitoneal lymph node dissection for nonseminoma tumors of the testes, several sexual functions before and after node dissection were compared. All patients had normal sexual function before the operation. After the operation, antegrade ejaculation was found to have disappeared completely in 12 patients, retrograde ejaculation was demonstrable in ten of these patients. In ten patients, antegrade ejaculation was restored after treatment with 25 mg imipramine twice daily by mouth. In the two patients who still showed antegrade ejaculation, albeit diminished, imipramine medication led to an increased number of spermatoza. During imipramine medication, the partners of five patients became pregnant. The preliminary conclusion from these findings is that ejaculation disorders, which most males develop after bilateral retroperitoneal lymph node dissection, can be successfully treated with daily oral doses of 25-50 mg imipramine in the majority of patients who still desire children.

Imaging properties of polydioxanone and titanium ligating clips following para-aortic lymphadenectomy for testicular cancer.

Stainless steel ligating clips produce serious artefacts on CT scans. Polydioxanone (PDS) and titanium ligating clips were used in 15 patients during para-aortic lymphadenectomy for residual metastatic testicular teratoma following chemotherapy, and follow-up CT images were compared with those following the use of stainless steel ligating clips. PDS ligating clips did not produce any artefacts and were progressively absorbed. Titanium ligating clips produced artefacts similar to but less intense than those of stainless steel. PDS ligating clips should be used when follow-up CT scanning is important.