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1.
FP Essent ; 503: 23-27, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33856180

RESUMO

Scrotal and testicular conditions include benign masses, infections, testicular torsion, and testicular cancer. Common palpable benign scrotal masses include spermatocele, varicocele, and hydrocele. Most patients with these masses require no treatment. Some varicoceles are associated with impaired fertility, probably due to an increase in scrotal temperature that leads to testicular hyperthermia, oxidative stress, and reduced spermatogenesis. Patients with documented infertility or scrotal pain should be referred to a urology subspecialist for consideration of surgical management. Epididymitis and epididymo-orchitis are caused by infection with Neisseria gonorrhoeae, Chlamydia trachomatis, or enteric bacteria. Antibiotics and supportive measures (eg, scrotal elevation, bed rest) are recommended for management of acute epididymitis. Testicular torsion is a urologic emergency that requires rapid surgical exploration and orchidopexy to reduce the risk of testicular loss due to ischemia. Salvage rates exceed 90% when surgical exploration is performed within 6 hours of symptom onset. Testicular cancer commonly manifests as a painless, incidentally discovered mass in a single testis. Ultrasonography is recommended to confirm the diagnosis. The recommended primary intervention for a suspected malignant testicular tumor is radical inguinal orchiectomy.


Assuntos
Torção do Cordão Espermático , Neoplasias Testiculares , Humanos , Masculino , Saúde do Homem , Escroto/cirurgia , Torção do Cordão Espermático/diagnóstico , Torção do Cordão Espermático/terapia , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/terapia
2.
Int J Mol Sci ; 22(5)2021 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-33800799

RESUMO

Liquid biopsies constitute a minimally invasive means of managing cancer patients, entailing early diagnosis, follow-up and prediction of response to therapy. Their use in the germ cell tumor field is invaluable since diagnostic tissue biopsies (which are invasive) are often not performed, and therefore only a presumptive diagnosis can be made, confirmed upon examination of the surgical specimen. Herein, we provide an overall review of the current liquid biopsy-based biomarkers of this disease, including the classical, routinely used serum tumor markers-the promising microRNAs rapidly approaching the introduction into clinical practice-but also cell-free DNA markers (including DNA methylation) and circulating tumor cells. Finally, and importantly, we also explore novel strategies and challenges for liquid biopsy markers and methodologies, providing a critical view of the future directions for liquid biopsy tests in this field, highlighting gaps and unanswered questions.


Assuntos
Biópsia Líquida , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/sangue , Procedimentos Clínicos , DNA de Neoplasias/química , Gerenciamento Clínico , Feminino , Humanos , Masculino , MicroRNAs/análise , Proteínas de Neoplasias/análise , Neoplasias Embrionárias de Células Germinativas/sangue , Neoplasias Embrionárias de Células Germinativas/química , Neoplasias Embrionárias de Células Germinativas/patologia , Células Neoplásicas Circulantes , Neoplasias Ovarianas/sangue , Neoplasias Ovarianas/química , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/patologia , RNA Neoplásico/análise , Neoplasias Testiculares/sangue , Neoplasias Testiculares/química , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/patologia
3.
Biomed Environ Sci ; 34(2): 152-162, 2021 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-33685574

RESUMO

Objective: Testicular germ cell tumors (TGCT) are the most common cancer among men aged 15 to 39 years. Previous studies have considered factors related to TGCT survival rate and race/ethnicity, but histological type of the diagnosed cancer has not yet been thoroughly assessed. Methods: The data came from 42,854 eligible patients from 1992 to 2015 in the Surveillance Epidemiology and End Results 18. Frequencies and column percent by seminoma and nonseminoma subtypes were determined for each covariates. We used Cox proportional hazard regression to assess the impact of multiple factors on post-diagnostic mortality of TGCT. Results: Black males were diagnosed at a later stage, more commonly with local or distant metastases. The incidence of TGCT in black non-seminoma tumors increased most significantly. The difference in survival rates between different ethnic and histological subtypes, overall survival (OS) in patients with non-seminoma was significantly worse than in patients with seminoma. The most important quantitative predictor of death was the stage at the time of diagnosis, and older diagnostic age is also important factor affecting mortality. Conclusion: Histological type of testicular germ cell tumor is an important factor in determining the prognosis of testicular cancer in males of different ethnic groups.


Assuntos
Disparidades nos Níveis de Saúde , Neoplasias Embrionárias de Células Germinativas/etnologia , Neoplasias Embrionárias de Células Germinativas/mortalidade , Neoplasias Testiculares/etnologia , Neoplasias Testiculares/mortalidade , Adulto , Humanos , Masculino , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Neoplasias Embrionárias de Células Germinativas/patologia , Prognóstico , Fatores de Risco , Programa de SEER/estatística & dados numéricos , Seminoma/diagnóstico , Seminoma/etnologia , Seminoma/mortalidade , Seminoma/patologia , Taxa de Sobrevida/tendências , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/patologia , Estados Unidos/epidemiologia , Estados Unidos/etnologia
5.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33541948

RESUMO

In this manuscript, we describe a rare case of neuroendocrine tumour metastatic to the testicle, presenting with testicular mass as an isolated symptom. We describe the investigations and management leading us to this uncommon histological diagnosis and explore its significance and impact on further management.


Assuntos
Tumores Neuroendócrinos , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/cirurgia , Testículo/patologia , Colectomia , Humanos , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/secundário , Orquiectomia , Compostos Organometálicos , Tomografia por Emissão de Pósitrons , Neoplasias Testiculares/patologia , Ultrassonografia
6.
BMJ Case Rep ; 14(2)2021 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-33568414

RESUMO

Paratesticular tumours are tumours arising from within the scrotum not of testicular origin. They may originate from the epididymis, spermatic cord, tunica vaginalis and other supporting structures. Preoperative diagnosis can be difficult as benign and malignant cases are often indistinguishable and may be confused with other benign or malignant pathology (testicular tumours or hernias).We describe the presentation and management of a patient managed at our centre (a tertiary referral teaching hospital).A high index of suspicion for malignancy should be considered when managing atypical scrotal lumps to ensure optimal management. This is particularly important when managing sarcomas due to the risk of local recurrence and spread.


Assuntos
Radioterapia/métodos , Sarcoma/diagnóstico , Sarcoma/fisiopatologia , Sarcoma/radioterapia , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/fisiopatologia , Neoplasias Testiculares/radioterapia , Idoso de 80 Anos ou mais , Humanos , Masculino , Resultado do Tratamento
7.
Crit Rev Oncol Hematol ; 159: 103224, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33493632

RESUMO

Germ cell tumors (GCTs) represent the best and the only example of solid tumors curable in the large majority of patients. GCTs are one of the few malignancies for which specific biochemical markers have been identified: human chorionic gonadotropin (HCG) and alfa-fetoprotein (AFP). Due to their specificity and sensitivity they constitute formidable tools in the diagnosis and monitoring of treatment for GCTs. As a tumor mass marker, lactate dehydrogenase (LDH) is also considered. Tumor markers are expressed in 15-20% of seminoma and 60-80% of non-seminoma. With the aim to increase sensitivity and specificity, recent studies have proposed miRNAs as serum biomarkers. This review will focus on role of serum tumor markers in diagnosis, staging, prognosis, monitoring of response, and finally follow-up of GCTs.


Assuntos
Neoplasias Embrionárias de Células Germinativas , Seminoma , Neoplasias Testiculares , Biomarcadores Tumorais , Humanos , Masculino , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Neoplasias Embrionárias de Células Germinativas/terapia , Prognóstico , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/terapia
8.
Methods Mol Biol ; 2195: 1-11, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32852753

RESUMO

This chapter introduces the macroscopic and light microscopic features of testicular germ cell tumors (GCT) commonly encountered in clinical practice. Accurate diagnosis of these histologically diverse neoplasms is essential not only for clinical management but also for serving as the basis for interpretation of research findings. We will focus on general histopathologic concepts and discuss the use of immunohistochemistry (IHC) as an aid to the diagnosis.


Assuntos
Gradação de Tumores , Estadiamento de Neoplasias , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Biomarcadores Tumorais , Biópsia , Carcinoma in Situ , Tomada de Decisão Clínica , Diagnóstico Diferencial , Gerenciamento Clínico , Feminino , Humanos , Imuno-Histoquímica/métodos , Masculino , Microscopia/métodos , Gradação de Tumores/métodos , Estadiamento de Neoplasias/métodos , Pesquisa , Neoplasias Testiculares/diagnóstico
9.
Methods Mol Biol ; 2195: 31-47, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32852755

RESUMO

Testicular germ cell tumors are among the most common malignancies seen in children and young adults. Genomic studies have identified characteristic molecular profiles in testicular cancer, which are associated with histologic subtypes and may predict clinical behavior including treatment responses. Emerging molecular technologies analyzing tumor genomics, transcriptomics, and proteomics may now guide precision management of testicular tumors. Laser-assisted microdissection methods such as laser capture microdissection efficiently isolate selected tumor cells from routine pathology specimens, avoiding contamination from nontarget cell populations. Laser capture microdissection in combination with next generation sequencing makes precise high throughput genetic evaluation effective and efficient. The use of laser capture microdissection (LCM) for molecular testing may translate into great benefits for the clinical management of patients with testicular cancers. This review discusses application protocols for laser-assisted microdissection to investigate testicular germ cell tumors.


Assuntos
Biomarcadores Tumorais , Microdissecção , Técnicas de Diagnóstico Molecular , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Neoplasias Embrionárias de Células Germinativas/etiologia , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/etiologia , Tomada de Decisão Clínica , Diagnóstico Diferencial , Gerenciamento Clínico , Suscetibilidade a Doenças , Humanos , Imuno-Histoquímica/instrumentação , Imuno-Histoquímica/métodos , Masculino , Microdissecção/instrumentação , Microdissecção/métodos , Técnicas de Diagnóstico Molecular/métodos
10.
Methods Mol Biol ; 2195: 49-63, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32852756

RESUMO

Gains of genetic material or internal rearrangements of chromosome 12p, including 12p overrepresentation or isochromosome 12p [i(12p)], are observed in virtually all germ cell tumors (GCT), in all histologic subtypes, and from various body locations. The chromosomal region involved in these alterations contains the growth and survival promoting oncogene KRAS (12p12.1). Gains or rearrangements of 12p characterize GCT from in situ to chemoresistant stages. Fluorescence in situ hybridization (FISH) detection of chromosome 12p anomalies is a sensitive and specific test for the diagnosis of germ cell tumors. Here we provide a detailed protocol for FISH detection of isochromosome 12p and chromosome 12p overrepresentation. The method is helpful for diagnosis of germ cell origin, and for selection of patients who may benefit from cisplatin-based chemotherapy.


Assuntos
Aberrações Cromossômicas , Cromossomos Humanos Par 12 , Hibridização in Situ Fluorescente , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Neoplasias Embrionárias de Células Germinativas/genética , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/genética , Biomarcadores Tumorais , Diagnóstico Diferencial , Estudos de Associação Genética , Predisposição Genética para Doença , Humanos , Imuno-Histoquímica , Hibridização in Situ Fluorescente/métodos , Hibridização in Situ Fluorescente/normas , Masculino , Controle de Qualidade
11.
Methods Mol Biol ; 2195: 113-123, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32852761

RESUMO

Testicular germ cell tumors (TGCTs) are typically exquisitely sensitive to DNA interstrand cross-link (ICLs) agents. ICLs covalently link both strands of the DNA duplex, impeding fundamental cellular processes like DNA replication to cause cell death. A leading drug used for the treatment of TGCTs is cisplatin, which introduces ICLs and leads to formation of double strand breaks (DSBs), a DNA lesion that can be repaired in the S/G2 phases of the cell cycle by homologous recombination (HR, also termed homology-direct repair). Although most TGCTs respond to cisplatin-induced ICLs, a fraction is resistant to treatment. One proposed mechanism of TGCT resistance to cisplatin is an enhanced ability to repair DSBs by HR. Other than HR, repair of the ICL-lesions requires additional DNA repair mechanisms, whose action might also be implemented in therapy-resistant cells. This chapter describes GFP assays to measure (a) HR proficiency following formation of a DSB by the endonuclease I-SceI, and (b) HR repair induced by site-specific ICL formation involving psoralen. These experimental approaches can be used to determine the proficiency of TGCT cell lines in DSB repair by HR in comparison to HR repair of ICLs, providing tools to better characterize their recombination profile. Protocols of these assays have been adapted for use in Embryonal Carcinoma (EC) TGCT cell lines. Assays only require transient introduction of plasmids within cells, affording the advantage of testing multiple cell lines in a relatively short time.


Assuntos
Testes Genéticos , Recombinação Homóloga , Neoplasias Embrionárias de Células Germinativas/genética , Reparo de DNA por Recombinação , Neoplasias Testiculares/genética , Técnicas de Cultura de Células , Linhagem Celular Tumoral , Dano ao DNA , Replicação do DNA , Ficusina , Expressão Gênica , Genes Reporter , Testes Genéticos/métodos , Humanos , Masculino , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Neoplasias Testiculares/diagnóstico
12.
Methods Mol Biol ; 2195: 189-223, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32852766

RESUMO

Genomewide association studies (GWAS) have been widely used in recent years to identify common variants that are associated with multiple types of cancer, including testicular germ cell tumors. These studies require no a priori hypotheses and have advantages, including the ability to highlight new pathways relevant to the biology of common diseases. GWAS require collection of germline DNA from individuals with and without the disease of interest. Following DNA extraction and quantification, a variety of array based platforms are available to evaluate common and moderately rare germline variation throughout the genome in an agnostic fashion. Here, we describe DNA extraction methods from samples typically used in the evaluation of germline genetic variation (blood and saliva). We also describe assays used to assess DNA quality and quantity. Finally, we include methods describing array based genotyping using the Illumina platform and validation of relevant variants using the iPLEX Agena Multiplexed Genotyping (formerly Sequenom).


Assuntos
Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Neoplasias Embrionárias de Células Germinativas/genética , Neoplasias Testiculares/genética , Alelos , Biomarcadores Tumorais , Estudo de Associação Genômica Ampla/métodos , Genótipo , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Biópsia Líquida/métodos , Masculino , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Neoplasias Embrionárias de Células Germinativas/epidemiologia , Saliva/metabolismo , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/epidemiologia
13.
Methods Mol Biol ; 2195: 245-261, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32852768

RESUMO

While the majority of patients with advanced testicular germ cell tumors (GCT) achieve complete responses after chemotherapy and if indicated after postchemotherapy resection of residual lesions, about 20% of patients have incomplete responses or show relapses. Moreover, toxicity of chemotherapy is high, and severe adverse chronic effects have been described. Therefore, there is an urgent need for biomarkers that could help to improve tumor staging, and support decision-making, ideally including monitoring of therapy response and prediction of relapse. Besides the well-established serum markers lactate dehydrogenase, α-fetoprotein, and ß-subunit of human chorionic gonadotropin, during recent years new noninvasive liquid biopsy markers have been investigated in GCT, including cell-free nucleic acids like microRNAs, and circulating tumor cells (CTCs).Prognostic relevance has been demonstrated for circulating tumor cells (CTCs) in patients with different cancers. However, little is known in GCT patients. Histologically, GCT are a very heterogeneous group of tumors comprising pure seminomas (consisting of cells that remember primordial germ cells) and nonseminomas, which are either undifferentiated (embryonal carcinoma) or differentiated, exhibiting different degrees of embryonic (teratoma) or extraembryonic (yolk sac tumor and choriocarcinoma) differentiation. This heterogeneity hampers capture and detection of CTCs deriving from those tumors using a single method or a single antibody. To date, label-independent capture methods that enrich tumor cells according to the density of GCT cells, which is similar to that of mononuclear cells, have been successfully applied. Since testicular GCT might also express epithelial proteins, methods based on enrichment of CTCs using epithelial markers are promising to detect CTCs in certain subgroups of patients with GCTs as well.Here, we describe and discuss a combination of methods to capture and detect GCT cells with epithelial and germ cell characteristics in blood.


Assuntos
Biomarcadores Tumorais , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Neoplasias Embrionárias de Células Germinativas/etiologia , Células Neoplásicas Circulantes/patologia , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/etiologia , Linhagem Celular Tumoral , Separação Celular/métodos , Células Cultivadas , Imunofluorescência , Humanos , Imuno-Histoquímica , Hibridização in Situ Fluorescente , Biópsia Líquida , Masculino , Técnicas de Diagnóstico Molecular , Células Neoplásicas Circulantes/metabolismo , Prognóstico
14.
Am J Surg Pathol ; 45(1): 127-136, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32991342

RESUMO

Rare hepatoid teratomas (HTs) in testicular germ cell tumor patients mimic hepatoid yolk sac tumor (HYST) and hepatocellular carcinoma (HCC). We compared the features of 2 metastatic HTs, 12 HYSTs, and 16 HCCs. The mean ages were 36, 40, and 62.5 years, respectively. The HTs formed sheets of hepatocyte-like cells with macrovesicular fat arranged in vague lobules with intervening fibrous bands containing biliary ductule-like structures and abortive portal triads. HTs lacked basement membrane deposits, with hepatoid cells staining for glypican-3, arginase, and HepPar-1 (2/2), whereas stains for CK19 (2/2) and CK7 (1/2) highlighted ductules and for villin hepatoid cells and ductules (1/2). SALL4 and CDX2 stains were negative (0/2). HYSTs formed nests, trabeculae, cords, and occasional gland-like structures, and most (10/12; 83%) produced intercellular basement membrane. No Mallory-Denk bodies were seen. Stains for SALL4 (100%), glypican-3 (100%), CK19 (88%), CDX2 (88%), and villin (75%) were positive, whereas those for HepPar-1 highlighted rare tumor cells (70%) and for arginase were mostly negative (26%). All HCCs lacked basement membrane deposits, with Mallory-Denk bodies occurring in 50%. Stains for HepPar-1 (100%) and arginase (94%) were positive, glypican-3 infrequent (19%), and SALL4, CK19, villin, and CDX2 negative. In summary, HTs are distinguished from HYST by the formation of ductules and abortive portal tracts, lack of basement membrane deposits, more consistent staining for arginase and HepPar-1, and negativity for SALL4 and CDX2. Contrasting features of HCCs with HYSTs include negativity for SALL4, CK19, and CDX2, frequent Mallory-Denk bodies, and absence of basement membrane deposits.


Assuntos
Carcinoma Hepatocelular/patologia , Neoplasias Hepáticas/patologia , Neoplasias Embrionárias de Células Germinativas/patologia , Teratoma/patologia , Neoplasias Testiculares/patologia , Adolescente , Adulto , Carcinoma Hepatocelular/diagnóstico , Diagnóstico Diferencial , Tumor do Seio Endodérmico , Humanos , Imuno-Histoquímica , Neoplasias Hepáticas/diagnóstico , Masculino , Pessoa de Meia-Idade , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Teratoma/diagnóstico , Neoplasias Testiculares/diagnóstico , Adulto Jovem
15.
J Urol ; 205(1): 137-144, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32856980

RESUMO

PURPOSE: Current serum tumor markers for testicular germ cell tumor are limited by low sensitivity. Growing evidence supports the use of circulating miR-371a-3p as a superior marker for malignant (viable) germ cell tumor management. We evaluated the real-world application of serum miR-371a-3p levels in detecting viable germ cell tumor among patients undergoing partial or radical orchiectomy. MATERIALS AND METHODS: Serum samples were collected from 69 consecutive patients before orchiectomy. Performance characteristics of serum miR-371a-3p were compared with conventional serum tumor markers (⍺-fetoprotein/ß-human chorionic gonadotropin/lactate dehydrogenase) between patients with viable germ cell tumor and those without viable germ cell tumor on orchiectomy pathology. Relative miR-371a-3p levels were correlated with clinical course. The Kruskal-Wallis test and linear and ordinal regression models were used for analysis. RESULTS: For detecting viable germ cell tumor, combined conventional serum tumor markers had a specificity of 100%, sensitivity of 58% and AUC of 0.79. The miR-371a-3p test showed a specificity of 100%, sensitivity of 93% and AUC of 0.978. Median relative expression of miR-371a-3p in viable germ cell tumor cases was more than 6,800-fold higher than in those lacking viable germ cell tumor. miR-371a-3p levels correlated with composite stage (p=0.006) and, among composite stage I cases, independently associated with embryonal carcinoma percentage (p=0.0012) and tumor diameter (p <0.0001). Six patients underwent orchiectomy after chemotherapy and were correctly predicted to have presence or absence of viable germ cell tumor by the miR-371a-3p test. CONCLUSIONS: If validated, the miR-371a-3p test can be used in conjunction with conventional serum tumor markers to aid clinical decision making. A positive miR-371a-3p test in patients after preoperative chemotherapy or with solitary testes could potentially guide subsequent orchiectomy or observation.


Assuntos
Biomarcadores Tumorais/sangue , MicroRNA Circulante/sangue , MicroRNAs/sangue , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Orquiectomia , Neoplasias Testiculares/diagnóstico , Adulto , Estudos de Casos e Controles , Quimioterapia Adjuvante , Tomada de Decisão Clínica/métodos , Estudos de Viabilidade , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Estadiamento de Neoplasias , Neoplasias Embrionárias de Células Germinativas/sangue , Neoplasias Embrionárias de Células Germinativas/patologia , Neoplasias Embrionárias de Células Germinativas/terapia , Período Pré-Operatório , Neoplasias Testiculares/sangue , Neoplasias Testiculares/patologia , Neoplasias Testiculares/terapia , Testículo/patologia , Testículo/cirurgia , Conduta Expectante
16.
Cesk Patol ; 56(3): 153-160, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33076667

RESUMO

The great majority of testicular tumors can be diagnosed on the basis of morphology, while immunohistochemistry and molecular genetics assist in only a small proportion of cases. Similar to other areas of pathology, ancillary diagnostic methods have to be used responsibly and assessed in correlation with morphological, serological and clinical findings. Prior to their effective use, a limited differential diagnosis based on morphology is required.The significance of germ cell tumors is underscored by the fact that they represent the most frequent solid neoplasms occurring in men between 20-30 years and if diagnosed correctly and in early stage, they have excellent prognosis. From the molecular genetic standpoint, germ cell tumors stand apart from the current trend of tumor stratification based on molecular profiles. It is mainly due to the low mutational load, since the main genetic abnormality are chromosomal aneuploidies. Given the frequency of germ cell tumors among testicular neoplasms and since morphology is usually diagnostically most valuable, this review article is focused mainly on germ cell tumors, emphasizing the morphological features. Sertoli cell tumor, NOS is the only sex-cord stromal tumor included in this review as its diagnosis can be challenging. For practical purposes, this reviewis focused on differential diagnosis, including only entities where misdiagnosis would have impact on clinical outcome.


Assuntos
Neoplasias Embrionárias de Células Germinativas , Tumor de Células de Sertoli , Tumores do Estroma Gonadal e dos Cordões Sexuais , Neoplasias Testiculares , Biomarcadores Tumorais , Humanos , Imuno-Histoquímica , Masculino , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Neoplasias Embrionárias de Células Germinativas/genética , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/genética
17.
PLoS One ; 15(9): e0238813, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32936794

RESUMO

INTRODUCTION: We sought to assess the impact of Affordable Care Act Dependent Care Expansion (ACA-DCE), which allowed dependent coverage for adults aged 19-25, and Medicaid expansion on outcomes for men with testicular cancer. METHODS: Using a US-based cancer registry, we performed adjusted difference-in-difference (DID) analyses comparing outcomes between men aged 19-25 (n = 8,026) and 26-64 (n = 33,303) pre- (2007-2009) and post-ACA-DCE (2011-2016) and between men in states that expanded Medicaid (n = 2,296) to men in those that did not (n = 2,265)pre- (2011-2013) and post-Medicaid expansion (2015-2016). RESULTS: In ACA-DCE analysis, rates of uninsurance decreased (DID -5.64, 95% confidence interval [CI] -7.23 to -4.04%, p<0.001) among patients aged 19-25 relative to older patients aged 26-64. There was no significant DID in advanced stage at diagnosis (stage≥II; p = 0.6) or orchiectomy more than 14 days after diagnosis (p = 0.6). For patients who received chemotherapy or radiotherapy as their first course of treatment, treatment greater than 60 days after diagnosis decreased (DID -4.84%, 95% CI -8.22 to -1.45%, p = 0.005) among patients aged 19-25 relative to patients aged 26-64. In Medicaid expansion states, rates of uninsurance decreased (DID -4.20%, 95% CI -7.67 to -0.73%, p = 0.018) while patients receiving chemotherapy or radiotherapy greater than 60 days after diagnosis decreased (DID -8.76, 95% CI -17.13 to -0.38%, p = 0.040) compared to rates in non-expansion states. No significant DIDs were seen for stage (p = 0.8) or time to orchiectomy (p = 0.1). CONCLUSIONS: Men with testicular cancer had lower uninsurance rates and decreased time to delivery of chemotherapy or radiotherapy following ACA-DCE and Medicaid expansions. Time to orchiectomy and stage at diagnosis did not change following either insurance expansion.


Assuntos
Cobertura do Seguro/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Neoplasias Testiculares , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Patient Protection and Affordable Care Act/estatística & dados numéricos , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/terapia , Tempo para o Tratamento/estatística & dados numéricos , Estados Unidos , Adulto Jovem
18.
Rev. int. androl. (Internet) ; 18(3): 96-100, jul.-sept. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-193600

RESUMO

INTRODUCCIÓN: La microlitiasis testicular (MT) es un hallazgo clínico poco frecuente en población general masculina; dichas calcificaciones son reportadas por ultrasonidos testiculares y constituyen un hallazgo incidental. La presencia de MT se encuentra asociada a carcinoma testicular. OBJETIVOS: Analizar la relación entre variables clínicas, demográficas, comorbilidades y marcadores tumorales con la presencia o ausencia de microlitiasis en sujetos con cáncer testicular. MATERIAL Y MÉTODOS: Estudio retrospectivo donde se incluyó un total de 66 pacientes con diagnóstico de carcinoma testicular del año 2012 al 2017 en un hospital del noreste de México. Se dividió el total de los pacientes en 2 grupos según la presencia o ausencia de MT, y se analizaron las características clínicas de estos. RESULTADOS: La prevalencia general de MT fue de un 31,8%. El principal tumor observado en los reportes de patología fue el tumor de células germinales no seminomatoso (54,4%). La incidencia de metástasis a órganos fue del 27,3%. No se encontraron diferencias estadísticamente significativas al comparar las variables de interés en el grupo con y sin MT. Se encontró una relación entre la elevación de alfa-fetoproteína y los tumores no seminomatosos (p = 0,003). CONCLUSIONES: De acuerdo con los resultados obtenidos, se puede decir que las MT constituyen un hallazgo clínico que no tiene relación con el pronóstico de la enfermedad y que además no se relacionan con ninguna de las comorbilidades y datos clínicos analizados


INTRODUCTION: Testicular microlithiasis (TM) is an uncommon finding in general male population. These calcifications are reported by testicular ultrasound performed by some testicular pathology and constitute an incidental finding. The presence of TM is regularly associated to testicular neoplasms. OBJECTIVES: To investigate the relationship between clinical and demographic factors, comorbidities and tumor biomarkers, and the presence or absence of microlithiasis in patients with testicular cancer. MATERIAL AND METHODS: A retrospective study including a total of 66 patients diagnosed with testicular carcinoma from 2012 to 2017 in a hospital in Northeastern Mexico. The total of patients was divided into 2 groups according to the presence or absence of MT and the clinical features of these were analyzed. RESULTS: There was a general prevalence of TM of 31.8%. The main tumor found in the pathology reports corresponded to the non seminomatous germ cells tumor (54.4%). The incidence of metastasis to organs was of 27.3%. No statistically significant differences were found when comparing the variables of interest in the group with and without MT. A relationship was found between the elevation of alpha-fetoprotein and non-seminomatous tumors compared to seminomatous tumors (PY=Y.003). CONCLUSIONS: According to the results obtained, it can be suggested that TM is a clinical finding that is not related to the prognosis of the disease or any of the comorbidities and clinical data analyzed in our study


Assuntos
Humanos , Masculino , Adulto Jovem , Adulto , Neoplasias Testiculares/complicações , Neoplasias Testiculares/diagnóstico , Doenças Testiculares/complicações , Calcinose/complicações , Estudos Retrospectivos , Estudos Transversais , Neoplasias Embrionárias de Células Germinativas/complicações , Comorbidade
20.
Medicine (Baltimore) ; 99(26): e20861, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590786

RESUMO

RATIONALE: Primary non-Hodgkin lymphoma (NHL) of the testes is rare, representing about 9% of testicular neoplasms and 1% to 2% of non-Hodgkin lymphomas. PATIENT CONCERNS: A previously healthy 47-month-old boy came to our institution for 3 months unilateral testicular swelling without tenderness. After preliminary examination, inguinal orchiectomy was performed to resect the right scrotal mass. The histopathological diagnosis of high-grade lymphoma was rendered and paraffin blocks were sent for immunophenotyping. DIAGNOSIS: The final diagnosis by histopathological combined with immunohistochemical staining revealed primary testicular T-cell lymphoblastic lymphoma (St Jude Children's Research Hospital Staging System, stage I). INTERVENTIONS: The patient was treated with right inguinal orchidectomy followed by chemotherapy (SMCC-2011 protocol modified based on the BFM-90/95 regimen from Germany) without prophylactic radiotherapy to the contralateral testis. OUTCOMES: After 36 months of follow-up, the patient is now disease-free without any complication. LESSONS: T-lymphoblastic lymphoma should be considered in the differential diagnosis of testicular masses in children. Intensive chemotherapy may improve the prognosis of such patients.


Assuntos
Linfoma não Hodgkin/diagnóstico , Neoplasias Testiculares/diagnóstico , Pré-Escolar , China , Humanos , Linfoma não Hodgkin/patologia , Masculino , Orquiectomia/métodos , Neoplasias Testiculares/patologia , Resultado do Tratamento
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