[A Case of de novo Neuroendocrine Prostate Cancer].

A 56-year-old man visited our hospital with a chief complaint of worsening urinary pain after a treatment by another doctor. Prostate specific antigen (PSA) was 429.66 ng/ml, and computed tomography (CT) revealed multiple lymph node enlargement and multiple bone metastases. Prostatic adenocarcinoma (Gleason score 4＋5) was detected on the first prostate biopsy. Based on these results, the clinical stage was determined to be cT4N1M1b Androgen deprivation therapy (ADT) was started, and PSA decreased to 0.03 ng/ml at 3 months, but micturition and perineal pain tended to worsen, and multiple liver metastases were confirmed on CT. The second biopsy examination was performed and a diagnosis of neuroendocrine prostate cancer (NEPC) was made. Chemotherapy for small cell lung cancer was immediately performed, but no response was seen, and he died 8 months after the first visit. Immunostaining of prostate tissue of the first biopsy revealed that de novo NEPC expressed both PSA and synaptophysin in tumor cells.

[A CASE OF CASTRATION-RESISTANT PROSTATE CANCER THAT COMPLETELY AMELIORATED AFTER TRANSITION TO BEST SUPPORTIVE CARE].

The patient was a 78-year-old man who, at 67 years of age, had been diagnosed with prostate cancer cT3bN1M0 (Gleason score 5+5) and started on androgen ablation therapy. Thereafter, the cancer had developed into castration-resistant prostate cancer; thus, after surgical castration, the patient was treated with 27 courses of docetaxel, as well as enzalutamide and abiraterone. However, new metastases appeared in the paraaortic lymph nodes, post which, the patient was treated with 25 courses of cabazitaxel. However, the paraaortic and intrapelvic lymph nodes became enlarged, the patient developed rectal occlusion and urinary retention due to growth of the primary tumor, and his general condition deteriorated. Hence, the patient decided to abandon treatment approximately 10 years after initial diagnosis, underwent cystostomy, and transitioned to best supportive care. After stopping treatment, his general condition started to improve, and approximately 6 months later, his PSA levels had fallen from 55.5 ng/mL to 19.3 ng/mL and the lymph nodes had also reduced in size. When the cancer was treated with local radiation, the enlarged tumor disappeared, and the patient was able to urinate again. It has now been 2.5 years since treatment was stopped, and both, the paraaortic and intrapelvic lymph nodes have reduced in size to < 1 cm, and the PSA value continues to remain less than 0.008 ng/ml.

[Granulocyte-colony stimulating factor-producing urothelial carcinoma of right renal pelvis : a case report].

A 78-year-old female patient with fever and general malaise was referred to our hospital. Laboratory examination showed the marked elevation of leukocyte and serum granulocyte-colony stimulating factor (GCSF) concentration without any infectious sign. A computed tomography scan demonstrated irregular enhanced mass of the right kidney with liver metastasis. The pathological findings of the needle biopsy was high-grade urothelial cancer with positive staining for G-CSF antibody. Systemic chemotherapy with gemcitabine and cisplatin was administered. The patient showed a partial response and the serum G-CSF level was normalized after 1 course of chemotherapy. After four courses of chemotherapy, the extent of liver metastasis increased and the G-CSF concentration became elevated. Although combined chemotherapy with paclitaxel and gemcitabine was administered, the patient died 7 months after her first visit.

Manserin as a novel histochemical neuroendocrine marker in prostate cancer.

OBJECTIVES: To investigate the presence of manserin in human prostate cancers and to correlate manserin expression with pathologic outcomes and progression-free survival. METHODS: Eighty-seven patients with recent prostate cancer were classified into 4 groups based on Gleason score, and manserin immunohistochemistry was correlated with Gleason sum grade. To investigate the validity of manserin as a prognostic factor, the Cox proportional hazards regression model was performed on 48 patients in our cohort with T3 or T4 prostate cancer who were initially treated with androgen deprivation therapy. RESULTS: The manserin-positive rates of patients with Gleason sums of 6, 7, 8, and ≥9 were 0%, 20.0%, 35.0%, and 48.1%, respectively. Manserin-positive rates were positively correlated with Gleason sums (P = 0.0001). Median times to cancer progression in groups with (n = 8) and without (n = 40) manserin expression were 8 months and 28 months, respectively (P = 0.01). Univariate Cox analysis revealed that manserin expression, clinical stage T4, and high Gleason sum were significantly associated with progression. Multivariate analysis revealed that only 2 factors, manserin expression (hazard ratio (HR) 4.99, P = 0.01) and clinical stage T4 (HR 4.77, P = 0.03), were independent risk factors for progression. CONCLUSIONS: This is the first report of manserin expression in human prostate cancers. Manserin may serve as a marker of prostate cancer progression.

[A case of bladder metastasis of renal cell carcinoma: a case report and literature review].

The patient was a 74-year-old man. Computed tomography (CT) detected a right renal tumor with paraaortic lymph node swelling. Radical nephrectomy and left lymphadenectomy were performed in September 2008. Interferon-alpha (6 million international units three times per week) was administered as adjuvant therapy. Due to the development of side effects, including fatigue, the patient's immunotherapy was discontinued after 6 months. Radiofrequency ablation for pulmonary metastasis was performed 9 months after surgery. A nodular pedunculated tumor was detected on the posterior wall of the urinary bladder by CT, and transurethral resection was performed 18 months after nephrectomy/lymphadenectomy. Since the pathological diagnosis of the bladder tumor was clear cell carcinoma, that tumor was thought to have originated from the renal cell carcinoma. We have summarized 43 cases of bladder metastasis of renal cell carcinoma in Japanese patients, including ours.

[Usefulness of survivin/glyceraldehyde-3-phosphate dehydrogenase ratio in urine exfoliated cells for the detection of bladder tumor].

OBJECTIVE: Survivin is one of the apoptosis inhibitor proteins and is rarely expressed in adult normal tissues. However, survivin expression has been detected in various tumors. In this study, we evaluated the usefulness of urinary survivin/glyceraldehyde-3-phosphate dehydrogenase (GAPDH) ratio as a marker for bladder tumor. PATIENTS AND METHODS: Urine samples were obtained from 72 patients with bladder tumor, 36 with urinary tract inflammation as controls. Survivin and GAPDH mRNA expression was measured by quantitative real-time PCR assay in urine cells. The GAPDH housekeeping gene was used for normalization of survivin expression. We also analyzed survivin protein levels using urine samples and recombinant protein by western blotting. RESULTS: High expression of survivin was confirmed on the protein level using urine samples of bladder tumor by western blotting. Survivin/GAPDH mRNA ratios of bladder tumor quantified by real-time PCR was significantly higher than those of controls (p=0.001). In pathological stage of bladder tumor, survivin/ GAPDH mRNA ratio of pTis was significantly high compared with pTa and pT1 (p < 0.001, p=0.001, respectively). Grade3 tumors expressed high level of survivin/GAPDH mRNA ratio compared with Grade 1 and Grade 2 tumors (p=0.03). The sensitivity, the specificity and AUC(area under the curve) of survivin/ GAPDH mRNA ratio was 83.3%, 86.1% and 0.898, respectively. CONCLUSION: Measuring survivin/GAPDH mRNA ratio in urine is non-invasive and high sensitive examination. Therefore, survivin/GAPDH mRNA ratio is useful marker for the detection of bladder tumor, especially to detect carcinoma in situ.

Naftopidil, a selective {alpha}1-adrenoceptor antagonist, suppresses human prostate tumor growth by altering interactions between tumor cells and stroma.

In prostate cancer, tumor-stroma interactions play a critical role in the promotion of tumorigenesis, and thus the prevention of those interactions is a promising target to suppress tumor growth. Several studies demonstrated that alpha(1)-adrenoceptor (α(1)-AR) antagonists, therapeutic drugs for benign prostatic hyperplasia, have growth inhibitory effects on human prostate cancer (PCa) cells through induction of apoptosis or G(1) cell-cycle arrest. However, their direct actions on stromal cells surrounding cancer cells have not yet been elucidated. In this study, we investigated the effects of subtype-selective α(1)-AR antagonists (naftopidil, tamsulosin, and silodosin) on prostate tumor growth with a focus on the role of stroma, using commercially available fibroblast cells (PrSC). Tumorigenic studies in vivo showed significant reductions in tumor growth when E9 cells (an androgen low-sensitive LNCaP subline) grafted with PrSC were treated with naftopidil. In in vitro analyses, naftopidil and silodosin showed antiproliferative effects on PCa cells regardless of androgen sensitivity and α(1)-AR subtype expression. In PrSC, a strong growth inhibitory effect was observed with naftopidil but not silodosin. Flow cytometric analysis revealed that naftopidil, but not silodosin, induced G(1) cell-cycle arrest in both PCa cells and PrSC. In naftopidil-treated PrSC, total interleukin-6 protein was significantly reduced with increased suppression of cell proliferation. Silodosin induced weak early apoptosis only in PCa cells. These findings demonstrated that naftopidil strongly suppressed cell proliferation of stromal cells, resulting in decreased tumorigenic soluble factor, suggesting that naftopidil might be effective in preventing stromal support of tumor cells.

Effect of transforming growth factor α overexpression on urogenital organ development in mouse.

Transforming growth factor-α (TGFα) promotes cell proliferation by binding to the epidermal growth factor receptor (EGFR). TGFα and EGFR overexpression have been reported in various human cancers. However, whether TGFα induces cancer by itself is unknown in urogenital organs. To investigate whether TGFα overexpression induces carcinogenesis in urogenital organs, we analyzed the phenotypes of urogenital organs in male TGFα transgenic (TG) mice of the CD1 strain. Urogenital organs including the kidney, bladder, prostate, seminal vesicles, testes, and epididymis were isolated from 4- to 48-week-old TGFα TG and wild-type (WT) CD1 mice. Prostates were separated into anterior prostate (AP), dorsolateral prostate (DLP), and ventral prostate (VP). Neither tumor formation nor epithelial hyperplasia was observed in the TGFα TG mouse urogenital organs that we have investigated. Histopathologically, in prostate, we found an increased number of p63-positive basal epithelial cells in the TGFα TG mice AP and DLP. There was no morphological change in the stromal component, such as hypercellular stroma or fibrosis. However, bladder weight was greater in TGFα TG mice than that in WT mice, and distended bladders were observed macroscopically in 19 of 20 TGFα TG mice over 20 weeks of age. Ki67 labeling index was increased significantly in the TGFα TG mouse urethral epithelium, whereas neither epithelial hyperplasia nor hypertrophy was observed. In conclusion, our results suggest that TGFα overexpression in mouse urogenital organs alone may not be responsible for tumor formation and epithelial hyperplasia, but is involved in bladder outlet obstruction.

[Schwannoma originating from the obturator nerve with suspicion of lymph node metastasis].

A 58-year-old man, received polypectomy to evaluate the polyp of sigmoid colon. Pathological examination of the specimen revealed non-invasive adenocarcinoma. Systemic work up including abdominal computed tomography (CT) demonstrated a bladder tumor 11 x 18 mm in diameter associated with left obturator lymph node swelling (16 x 14 mm). In the preoperative staging, this nodule was suspected to be lymph node metastasis, even though both cancers were diagnosed to be early stage. Transurethral resection of bladder tumor (TUR-Bt) and lymph node open biopsy were performed. The final diagnosis of bladder tumor was pTa, urothelial cancer grade 2 and low grade. The nodule had originated from the obturator nerve itself, and pathological diagnosis demonstrated benign schwannoma. To the best of our knowledge, this is the 14th report of benign schwannoma of the obturator nerve in Japan.

Third-line gemcitabine monotherapy for platinum-resistant advanced urothelial cancer.

OBJECTIVE: To evaluate the efficacy and toxicity of third-line gemcitabine monotherapy (Gem) in patients with platinum-resistant advanced urothelial cancer (UC). PATIENTS AND METHODS: From July 2005 to March 2009, 13 patients were enrolled. All patients had previously received methotrexate, vinblastine, doxorubicin, and cisplatin as first-line therapy. Second-line therapy consisted of paclitaxel/carboplatin (Pca) therapy: paclitaxel (175 mg/m(2)) followed by carboplatin (area under the curve = 5) was intravenously infused on day 1 of each 21-day cycle. Following Pca failure, Gem was given as third-line treatment: gemcitabine (1,000 mg/m(2)) was intravenously administered on days 1, 8, and 15 of each 28-day cycle. All patients were eligible for toxicity assessment. Survival curves were produced using the Kaplan-Meier method. RESULTS: An average of 3.2 Gem cycles (range, 1-8 cycles) were given. Following Gem treatment, overall response rates were 0% CR, 7.7% PR (n = 1), 53.8% SD (n = 7), and 38.5% PD (n = 5). Grade 3-4 toxicities included anemia (31%), neutropenia (31%), and thrombocytopenia (31%). One case experienced grade 3-4 hepatic dysfunction during treatment with Gem. Low-grade alopecia was observed in all 13 patients (100%). Median time to progression and overall survival was 2 and 7.3 months, respectively, following Gem. The 1- and 2-year overall survival rate was 30.8% and 15.3%, respectively, for Gem. CONCLUSION: Gem as third-line therapy was performed safely with good tolerability in platinum-resistant advanced UC, even though the efficacy was very limited.

Structural changes in alpha1-adrenoceptor antagonist-treated human prostatic stroma.

Alpha1-adrenoceptor antagonists (alpha1-blockers) are currently used as first-line drugs for the treatment of benign prostatic hyperplasia (BPH). However, cases of BPH are often encountered in which the efficacy of alpha1-blockers decreases and switching to surgical treatment is required. One factor responsible for this resistance includes structural changes in prostatic tissue architecture following repeated oral administration of alpha1-blockers. Forty patients suspected of having prostate cancer, but without evidence of malignancy on prostatic biopsy were divided into two groups: an untreated group (n = 17) and an oral alpha1-blocker-treated group (n = 23). Twenty-one patients exhibiting resistance to oral alpha1-blocker therapy who underwent surgery were assigned into the surgically treated group. Each tissue sample was subjected to Masson's trichrome staining to distinguish collagen fibers from smooth muscle constituting prostatic stroma. The mean collagen fiber share was 62.2 +/- 10.4% in the untreated group, 72.1 +/- 9.1% in the oral alpha1-blocker-treated group, and 72.2 +/- 15.7% in the surgically treated group. Focusing on cases exhibiting high-collagen fiber share (70% or more), the distribution in each of the two alpha1-blocker-treated groups (16 of the 23 cases from the oral alpha1-blocker-treated group and 10 of the 21 cases from the surgically treated group) differed significantly from that in the untreated group (2 of the 17 cases). Our findings suggest that the accumulation of collagen fibers in prostatic stroma could be one of the factors responsible for alpha1-blocker treatment.

[Epididymal sarcoidosis: a case report].

A 33-year-old male complained of poor vision and visited the ophthalmology department of our hospital. Right iridoncus suspected as a metastatic nodule, was found. A systemic examination was done. Abdominal computed tomographic (CT) scan showed an enhanced mass in the right scrotum, 15 mm in diameter and enlargement of iliac lymph nodes. Chest CT scan demonstrated bilateral enlargement of mediastinal lymph nodes and enlargement of lymph nodes above the collarbone. Since malignant lymphoma or testicular malignancy was suspected, right orchiectomy was planned. A hard and nodular mass at the head of the epididymis, completely separated from the testis, was recognized. Only open biopsy was done, because no malignancy was found by the intraoperative biopsy. Pathological findings of the epididymal tissue revealed non-caseating epithelioid cell granulomas. Sarcoidosis was diagnosed based on pathological findings and systemic evaluations. Steroid ocular instillation therapy was started. To the best of our knowledge, this is the 18th report of epididymis sarcoidosis in Japan.

[Clinical analysis of 278 radical prostatectomies].

A retrospective analysis was done on the outcomes of 278 patients who underwent radical prostatectomies at our institutions from November, 1994 to April, 2006. The treatment outcomes measured were disease-specific survival and prostate specific antigen (PSA) biochemical failure-free survival rates. Univariate and multivariate analyses were performed on patient age, clinical T-stage, Gleason sum at the time of prostate biopsy, PSA value before treatment, and any patient history of neoadjuvant hormone therapy. For all patients, the overall survival and the disease-specific survival rates at 10 years were 96.3 and 99.3%, respectively, with PSA biochemical failure-free survival rates at 5 and 10 years of 67.9 and 55.1%, respectively. On multivariate analysis, both the PSA values (> 20 ng/ml) and Gleason sums (> or = 7) were statistically significant independent risk factors for PSA biochemical failure after radical prostatectomy. Neoadjuvant hormone therapy was found to have no effect on PSA biochemical failure.

[Bladder stones caused by spontaneous migration of surgical staples after cloacal repair: a case report].

An 11-year-old female consulted our department with complaints of urinary incontinence and pyuria. She had had a cloacal repair 7 years ago. The radiograph showed four stones in the pelvis. Magnetic resonance imaging showed two diverticula next to the urethra and several low intensity masses in one diverticulum were regarded as stones. Voiding cystourethrography showed normal urinary bladder contraction, although there were residual urine in the diverticula. Preoperatively, these stones were thought to be formed as a result of the long-standing residual urine. Cystourethroscopy showed that the two diverticula existed within the proximal area of the urethral sphincter and four white stones were found in them. Transurethral cystolithotripsy was performed and a surgical staple was found in the core of each stone. The surgical staples had been used for the cloacal repair and they had migrated into the bladder resulted in stone formation. To the best of our knowledge, this is the first report of bladder stones caused by the migration of surgical staples into the bladder after cloacal repair.

Gemcitabine and capecitabine chemotherapy in Japanese patients with immunotherapy-resistant renal cell carcinoma.

The objective of this study was to evaluate the efficacy and toxicity of combined gemcitabine and capecitabine (Gca) chemotherapy in patients with advanced renal cell cancer after immunotherapy failure. Nine patients were enrolled in this trial. Gemcitabine (1000 mg/m(2)) was injected on days 1 and 8, followed by oral administration of capecitabine (1660 mg/m(2)) on days 1-14. The response rate was 11%, with a partial response in one patient (11%), stable disease in five patients (56%) and disease progression in three patients (33%). Grade 3-4 neutropenia was observed in one patient (11%) and thrombocytopenia in two patients (22%). The quality of life (QOL) questionnaire scales showed no significant changes induced by chemotherapy. The median progression-free survival was 4 months with an overall 1-year survival rate of 78%. Gemcitabine and capecitabine chemotherapy can be safely administered as second-line therapy in renal cell cancer patients, maintaining QOL baseline parameters.

Intermittent docetaxel therapy with estramustine for hormone-refractory prostate cancer in Japanese patients.

BACKGROUND: We evaluated the efficacy and toxicity of intermittent docetaxel (DCT) with estramustine (EM) for hormone-refractory prostate cancer (HRPC). METHODS: Fifteen patients were enrolled. They received injected DCT (70 mg/m2 body surface) on day 1 in association with oral EM 560 mg/day (days 1-5). Treatments were repeated every 3 weeks. Serum prostate-specific antigen (PSA) levels were categorized based on the first three courses. Patients exhibiting either a response or stable disease (SD) could have a holiday from treatment (intermittent schedule). The holiday continued until elevation of the PSA level from the nadir baseline level occurred three times. All patients were evaluated for toxicity and quality of life (QOL). Survival curves were established using Kaplan-Meier graphs. RESULTS: The median number of courses of DCT/EM therapy was five (range, 3-12 courses). The response rate of the first cycle was 53%: 3 patients with complete response (CR), 5 patients with partial response (PR), 4 patients with SD, and 3 patients with disease progression. Eight patients were able to begin the second re-entry cycle. No patients showed a CR, 2 patients exhibited PR, 4 patients had SD, and the overall response rate was 25%. The survival rates were 93% at 1 year, and 26.1% at 2 years Grade 3-4 anemia was observed in 2 patients (13.3%), neutropenia in 11 (73.3%), and thrombocytopenia in 2 (13.3%). The QOL scale showed good QOL after 6 months, with improvement in the score for nausea and vomiting. CONCLUSION: Intermittent DCT/EM therapy was well tolerated, and has the potential to prolong survival, with a high QOL, in patients with HRPC.

[Case of bladder cancer following adjuvant external beam radiation for prostate cancer].

A 57-year-old male with a history of right renal cell carcinoma was diagnosed with prostate carcinoma associated with a high PSA level (5.2 ng/ml). Histological examination of the resected prostate specimen obtained by radical prostatectomy revealed well differentiated adenocarcinoma, Gleason score 3 + 3, and pT3aN0M0. After six months of observation, an elevation of PSA level was recognized and local recurrence was suspected. Therefore, radiotherapy with a total of 61.2 Gy was administered. Seventeen months later, bladder cancer was diagnosed. It had to be treated with pelvic evisceration because of suspicious heavy adhesions due to prior treatments. Histology findings were urothelial carcinoma in situ, G3, and pTisN0M0.

Improvement in predicting tumorigenic phenotype of androgen-insensitive human LNCaP prostatic cancer cell subline in recombination with rat urogenital sinus mesenchyme.

Hormone-refractory prostate cancer, a heterogeneous disease, has varying degrees of androgen sensitivity. To understand the physiological changes in the hormone-refractory state, the present study used a lineage-derived androgen receptor (AR)-positive, androgen-insensitive prostate cancer cell line and evaluated the tumorigenic phenotype, focusing on tumor-stromal interactions in vivo. First, tumorigenic differences of cancer cells alone were examined in an androgen-insensitive AR-positive LNCaP subline, AIDL, compared with those of the androgen-sensitive AR-positive parental LNCaP and the androgen-insensitive AR-negative PC-3 cells transplanted into subcutaneous, sub-renal and prostatic orthotopic graft sites. Next, cancer cells were recombined with rat urogenital sinus mesenchyme (rUGM) to simulate the tumor-stromal microenvironment. Tumors of AIDL and LNCaP without stromal components both formed well-defined globular tumors and contained large blood-filled areas, with no significant difference in tumor growth or histopathology regardless of the cell line's androgen sensitivity or graft site. In contrast, tumors of AIDL and LNCaP recombined with rUGM both showed reduction of blood-filled areas in the tumors and increased tumor growth compared with cancer cells alone. Tumors of AIDL + rUGM recombinants were approximately three times as large as those of LNCaP + rUGM recombinants, whereas tumors of AIDL and LNCaP without rUGM were not different in size. In addition to the tumor size, cell proliferation (Ki-67 labeling index) in tumors of AIDL + rUGM recombinants was significantly higher than that in tumors of LNCaP + rUGM recombinants. Immunoreactivities of AR, E-cadherin and beta-catenin were decreased in AIDL + rUGM recombinants relative to AIDL alone and LNCaP + rUGM recombinants. These results demonstrated that tumorigenic features of androgen-insensitive AR-positive prostate cancer cells could be significantly influenced by rUGM. Therefore, this in vivo recombination model with rUGM may be useful in developing new treatment strategies.

Comparison of radical nephrectomy techniques in one center: minimal incision portless endoscopic surgery versus laparoscopic surgery.

This study was designed to assess the intraoperative and postoperative benefits of two techniques for treating renal cell carcinoma (portless endoscopic surgery with radical nephrectomy [PLES-RN] and laparoscopic radical nephrectomy [LRN]) carried out at a single center. Radical nephrectomy with either PLES-RN (14 cases) or LRN (15 cases) was carried out on 29 patients with cT1 renal cell carcinoma. There were no statistically significant between-group differences in patient characteristics (except tumor side), operation time, and amount of blood loss (chi(2) and Fisher's test). No blood transfusions were required in either group. The mean incision length of PLES-RN was not significantly longer than that of LRN. No minor or major complications resulted. From postoperative data, the first intake of fluid (P = 0.07) and food (P = 0.02) tended to be sooner in the PLES group than the LRN group. Postsurgically, white blood cell count and C-reactive protein were not significantly different between the two groups. The added cost of disposable instruments needed in LRN was 111 570 Japanese yen (1115.7 United States dollars). Both techniques are optimal options for surgically treating early renal cell carcinoma. The comparison related to invasiveness between the two methods should be evaluated using a large number of cases focusing on the various aspects for the future.

[A case of primary testicular malignant lymphoma associated with contralateral testicural recurrence after a seven-year interval].

A 70-year-old male presented to our hospital in October 1999 complaining of right scrotal swelling. Right high ligation of testis was performed. Pathological examination demonstrated a diffuse large B-cell lymphoma (DLBCL) originating from the right testis. He underwent four courses of adjuvant chemotherapy consisting of CHOP (cyclophosphamide, doxorubicin, vincristin, prednisone) together with 40 Gy radiotherapy to the contralateral testis. Following this treatment he achieved complete remission. Seven years later in March 2006, he developed swelling of the left scrotum. He underwent left high orchidectomy based on the suspicion of a contralateral testicular malignant lymphoma. Pathological examination of the testicular specimen confirmed a diagnosis of DLBCL. He underwent chemotherapy and has survived without evidence of recurrence. We have summarized the cases of bilateral asynchrony primary testicular lymphoma.