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1.
Medicine (Baltimore) ; 99(40): e22530, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019456

RESUMO

RATIONALE: Ovotesticular disorder of sex development (DSD), previously known as true hermaphroditism, is a disorder in which individuals have both testicular and ovarian tissues. Instances of tumors arising in the gonads of individuals with 46,XX ovotesticular DSD are uncommon. PATIENT CONCERNS: We report a case of a 36-year-old phenotypical male with a chief complaint of an abdominal mass for 3 months. He reported normal erections and regular menses. Computerized tomography showed a large tumor measuring 15 × 10 cm in size, a uterus, and a cystic ovary. DIAGNOSIS: 46, XX ovotesticular DSD with seminoma. INTERVENTIONS: The patient was treated with neochemotherapy (etoposide and cisplatin), surgery, chemotherapy, and testosterone replacement. OUTCOMES: At the 13-month follow-up, the patient reported satisfactory erections, and no evidence of disease was found. CONCLUSION: Cases of 46,XX ovotesticular DSD with seminoma are uncommon. Our case reveals the importance of surgery combined with neochemotherapy, chemotherapy, and testosterone replacement in these patients to improve the prognosis.


Assuntos
Transtornos Ovotesticulares do Desenvolvimento Sexual/complicações , Seminoma/complicações , Neoplasias Testiculares/complicações , Adulto , Humanos , Masculino , Transtornos Ovotesticulares do Desenvolvimento Sexual/diagnóstico , Transtornos Ovotesticulares do Desenvolvimento Sexual/patologia , Seminoma/patologia , Seminoma/terapia , Neoplasias Testiculares/patologia , Neoplasias Testiculares/terapia
2.
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
3.
Tokai J Exp Clin Med ; 45(2): 58-62, 2020 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-32602102

RESUMO

Here, we report the case of cutaneous metastases from testicular diffuse large B-cell malignant lymphoma (DLBCL) concurrent with Bowen disease evaluated with 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT). A 60-year-old male underwent orchiectomy to remove his left testicle because of DLBCL. Multiple skin lesions appeared 1 month postoperatively. Furthermore, an intractable erythematous plaque localized to the right lower leg was present from 2 years before the operation. 18F-FDG PET-CT images revealed multiple skin lesions with marked FDG uptakes in the face, neck, and thigh of this patient, as well as a lower leg lesion with minimal FDG uptake. Biopsy of both lesions revealed cutaneous metastases from DLBCL and Bowen disease (BD) of the lower leg lesion. 18F-FDG PET-CT images following chemotherapy and resection of BD demonstrated no FDG uptake.


Assuntos
Doença de Bowen , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/terapia , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/secundário , Neoplasias Testiculares/diagnóstico por imagem , Neoplasias Testiculares/terapia , Doença de Bowen/cirurgia , Fluordesoxiglucose F18 , Humanos , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Linfoma Difuso de Grandes Células B/cirurgia , Masculino , Pessoa de Meia-Idade , Compostos Radiofarmacêuticos
5.
Bull Cancer ; 107(9): 912-924, 2020 Sep.
Artigo em Francês | MEDLINE | ID: mdl-32653158

RESUMO

Seminomatous (SGCT) and non-seminomatous (NSGCT) germ cell tumors (GCT) are rare but their incidence are increasing. We will discuss different therapeutic strategies in relapse disease: patients with stage I germ cell tumor have an excellent prognosis with a cure rate approaching 98-99 %, whatever the histology and the chosen treatment (surveillance strategy or adjuvant treatment). Relapses are observed among 20% of patients with stage I SGCT or low risk NSGCT and 50 % of patients with high risk NSGCT. Patients are treated according to the international prognosis group (IGCCCG) for SGCT and low risk NSGCT, naïve of chemotherapy. After an adjuvant treatment, the protocol must be adapted to the number of previous cycles (1 or 2 BEP) and to the prognosis group. Five to 50% of patients relapse after a first line of metastatic chemotherapy according to initial prognosis group. Dose-dense chemotherapy according to the GETUG13 protocol reduces the risk of relapse for the patients with poor-risk group NSGCT and unfavorable tumor marker decline. The prognosis of patients with relapsed or refractory GCT after a first line is more negative since only half of them will be cured by salvage standard chemotherapy. An international therapeutic trial (TIGER) is ongoing in first line salvage treatment evaluating high-dose chemotherapy (HDCT) with hematopoietic stem cell transplantation (HSCT). Finally, developing biomarkers for predicting clinical relapse, the management in expert centers of these patients and participation in therapeutic innovation are important perspectives for a better understanding and treatment of these patients with a poorer prognosis.


Assuntos
Recidiva Local de Neoplasia/terapia , Neoplasias Embrionárias de Células Germinativas/terapia , Neoplasias Testiculares/terapia , Algoritmos , Humanos , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Neoplasias Embrionárias de Células Germinativas/patologia , Neoplasias Testiculares/tratamento farmacológico , Neoplasias Testiculares/patologia
6.
J Cancer Res Clin Oncol ; 146(11): 2829-2841, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32719989

RESUMO

PURPOSE: Testicular granulosa cell tumors (tGrCT) are rare sex cord-stromal tumors. This review aims to synthesize the available evidence regarding the clinical presentation and clinicopathological characteristics, treatment and outcomes. METHODS: We conducted a systematic literature search using the most important research databases. Whenever feasible, we extracted the data on individual patient level. RESULTS: From 7863 identified records, we included 88 publications describing 239 patients with tGrCT. The majority of the cases were diagnosed with juvenile tGrCT (166/239, 69%), while 73/239 (31%) patients were diagnosed with adult tGrCT. Mean age at diagnosis was 1.5 years (± 5 SD) for juvenile tGrCT, and 42 years (± 19 SD) for adult tGrCT. Information on primary treatment was available in 231/239 (97%), of which 202/231 (87%) were treated with a radical orchiectomy and 20/231 (9%) received testis sparing surgery (TSS). Local recurrence after TSS was observed in 1/20 (5%) cases. Metastatic disease was never observed in men with juvenile tGrCT but in 7/73 (10%) men with adult tGrCT. In 5/7 men with metastatic tGrCT, metastases were diagnosed at initial staging, while 2/7 patients developed metastases after 72 and 121 months of follow-up, respectively. Primary site of metastasis is represented by the retroperitoneal lymph nodes, but other sites including lungs, liver, bone and inguinal lymph nodes can also be affected. In comparison with non-metastatic adult tGrCT, men with metastatic adult tGrCT had significantly larger primary tumors (70 vs 24 mm, p 0.001), and were more likely to present with angiolymphatic invasion (57% vs 4%, p 0.002) or gynecomastia (29% vs 3%, p 0.019). In five out of seven men with metastatic disease, resection of metastases or platinum-based chemotherapy led to complete remission. CONCLUSION: Juvenile tGrCT represent a benign entity whereas adult tGCTs have metastatic potential. Tumor size, presence of angiolymphatic invasion or gynecomastia represent risk factors for metastatic disease. The published literature supports the use of testis sparing surgery but there is only limited experience with adjuvant therapies. In the metastatic setting, the reviewed literature suggests that aggressive surgical and systemic treatment might cure patients.


Assuntos
Tumor de Células da Granulosa/patologia , Tumor de Células da Granulosa/terapia , Neoplasias Testiculares/patologia , Neoplasias Testiculares/terapia , Adolescente , Adulto , Criança , Pré-Escolar , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
7.
Int Braz J Urol ; 46(suppl.1): 79-85, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32568496

RESUMO

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.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Neoplasias Testiculares/terapia , Betacoronavirus , Humanos , Masculino , Pandemias
8.
Arch. esp. urol. (Ed. impr.) ; 73(5): 390-394, jun. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-189696

RESUMO

OBJETIVOS: Establecer la prioridad de los distintos procedimientos diagnósticos, terapéuticos y de seguimiento sobre el cáncer de testículo para adaptarse adecuadamente a la situación asistencial de cada centro. Valorar precauciones y adaptaciones durante la situación actual de desescalada en el curso de la pandemia COVID-19. Valoración del paciente con cáncer de testículo en presencia de pandemia infectiva. MATERIAL Y MÉTODOS: Revisión de la literatura relevante publicada hasta la fecha, elaboración de un borrador corregido por técnica de grupo nominal modificada, hasta obtener un documento de consenso entre los autores. RESULTADOS: En ausencia de evidencia científica relevante la mayor parte de las publicaciones, y la conclusiónde los autores, abogan por priorizar los procedimientos diagnósticos y terapéuticos de los pacientes. Una vez priorizados será menos complejo adaptar los recursos limitados a las necesidades más perentorias de los pacientes. En el cáncer de testículo los procedimientos iniciales que incluyen ecografía escrotal, orquiectomía, estudio de extensión, y tratamiento complementario si necesario, son de máxima necesidad. Se propone disminuir el uso de fármacos con potencial toxicidad respiratoria, y aumentar la utilización de los estimulantes de colonias hematopoyéticas, asi como promover seguimiento activo en estadio clínico I sin factores de riesgo. En caso de infección activa subrayamos que la mayoría de los pacientes son potencialmente curables. CONCLUSIONES: En el proceso de desescalada los pacientes con cáncer de testículo deben ser atendidos de forma preferente, especialmente durante evaluación y tratamiento iniciales. Las revisiones de pacientes con remisiones estables pueden retrasarse razonablemente sin excesivo riesgo de progresion en estadios bajos


OBJECTIVES: To provide a priority algorithm for determinate diagnostic, therapeutic and follow-up procedures regarding at testicular cancer, adjusted by institutional requirements. Testicular cancer patient assessment during COVID-19 Pandemia. MATERIAL AND METHODS: Review of relevant manuscript published up to date, draft creation corrected though modified nominal group until final corrected manuscript. RESULTS: A lack of scientific evidence exists through a large amount of manuscripts. The authors support prioritizing diagnostic and therapeutic procedures. Once priorities have been established, that will facilitate providing each patients the limited resources. Initial diagnostic procedures for testicular cancer such as scrotal US, orchiectomy, staging CT and adjuvant treatment (if required) are priority. Reducing the usage of chemotherapy with respiratory toxicity and increasing the usage of growth factors during chemotherapy treatment are the main stakeholders of treatment. Besides, providing active surveillance on non-risk factor clinical stage I is also a priority. In case of positive COVID-19, it is important to highlight that the vast majority of patients are tentatively cured. CONCLUSIONS: During de-escalation phases, patients diagnosed with testicular cancer should receive priority care during initial assessment. The follow-ups of patients with low -risk and without recurrence for a long time, might be delayed


Assuntos
Humanos , Masculino , Infecções por Coronavirus/prevenção & controle , Pandemias , Prioridades em Saúde , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/terapia , Guias de Prática Clínica como Assunto , Seguimentos , Prognóstico
10.
Indian J Cancer ; 57(2): 129-138, 2020.
Artigo em Inglês | MEDLINE | ID: covidwho-350395

RESUMO

The Corona Virus Disease-2019 (COVID-19), one of the most devastating pandemics ever, has left thousands of cancer patients to their fate. The future course of this pandemic is still an enigma, but health care services are expected to resume soon in a phased manner. This might be a long drawn process and we need to have policies in place, to be able to fight both, the SARS-CoV-2 virus and cancer, simultaneously, and emerge triumphant. An extensive literature search for impact of delay in management of various urological malignancies was carried out. Expert opinions were sought wherever there was paucity of evidence, in order to reach a consensus and come up with recommendations for directing uro-oncology services in the times of COVID-19. The panel recommends deferring treatment of patients with renal cell carcinoma by 3 to 6 months, except for those with ongoing hematuria and/or inferior vena cava thrombus, which warrant immediate surgery. Metastatic renal cell cancers should be started on targeted therapy. Low grade non-muscle invasive bladder cancers can be kept on active surveillance while high risk non-muscle invasive bladder cancers and muscle invasive bladder cancers should be treated within 3 months. Neoadjuvant chemotherapy should be avoided. Management of low and intermediate risk prostate cancer can be deferred for 3 to 6months while high risk prostate cancer patients can be initiated on neoadjuvant androgen deprivation therapy. Patients with testicular tumors should undergo high inguinal orchiectomy and be treated according to stage without delay, with stage I patients being offered surveillance. Penile cancers should undergo penectomy, while clinically negative groins can be kept on surveillance. Neoadjuvant chemotherapy should be avoided and adjuvant therapy should be deferred. We need to tailor our treatment strategies to the prevailing present conditions, so as to fight and defeat both, the SARS-CoV-2 virus and cancer. Protection of health care workers, judicious use of available resources, and a rational and balanced outlook towards different malignancies is the need of the hour.


Assuntos
Infecções por Coronavirus/epidemiologia , Neoplasias Renais/terapia , Pneumonia Viral/epidemiologia , Neoplasias da Bexiga Urinária/terapia , Neoplasias Urogenitais/terapia , Carcinoma de Células Renais , Infecções por Coronavirus/prevenção & controle , Humanos , Índia/epidemiologia , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Masculino , Oncologia/métodos , Oncologia/normas , Pandemias/prevenção & controle , Neoplasias Penianas/terapia , Pneumonia Viral/prevenção & controle , Neoplasias da Próstata/terapia , Neoplasias Testiculares/terapia
11.
Indian J Cancer ; 57(2): 129-138, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32445315

RESUMO

The Corona Virus Disease-2019 (COVID-19), one of the most devastating pandemics ever, has left thousands of cancer patients to their fate. The future course of this pandemic is still an enigma, but health care services are expected to resume soon in a phased manner. This might be a long drawn process and we need to have policies in place, to be able to fight both, the SARS-CoV-2 virus and cancer, simultaneously, and emerge triumphant. An extensive literature search for impact of delay in management of various urological malignancies was carried out. Expert opinions were sought wherever there was paucity of evidence, in order to reach a consensus and come up with recommendations for directing uro-oncology services in the times of COVID-19. The panel recommends deferring treatment of patients with renal cell carcinoma by 3 to 6 months, except for those with ongoing hematuria and/or inferior vena cava thrombus, which warrant immediate surgery. Metastatic renal cell cancers should be started on targeted therapy. Low grade non-muscle invasive bladder cancers can be kept on active surveillance while high risk non-muscle invasive bladder cancers and muscle invasive bladder cancers should be treated within 3 months. Neoadjuvant chemotherapy should be avoided. Management of low and intermediate risk prostate cancer can be deferred for 3 to 6months while high risk prostate cancer patients can be initiated on neoadjuvant androgen deprivation therapy. Patients with testicular tumors should undergo high inguinal orchiectomy and be treated according to stage without delay, with stage I patients being offered surveillance. Penile cancers should undergo penectomy, while clinically negative groins can be kept on surveillance. Neoadjuvant chemotherapy should be avoided and adjuvant therapy should be deferred. We need to tailor our treatment strategies to the prevailing present conditions, so as to fight and defeat both, the SARS-CoV-2 virus and cancer. Protection of health care workers, judicious use of available resources, and a rational and balanced outlook towards different malignancies is the need of the hour.


Assuntos
Infecções por Coronavirus/epidemiologia , Neoplasias Renais/terapia , Pneumonia Viral/epidemiologia , Neoplasias da Bexiga Urinária/terapia , Neoplasias Urogenitais/terapia , Carcinoma de Células Renais , Infecções por Coronavirus/prevenção & controle , Humanos , Índia/epidemiologia , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Masculino , Oncologia/métodos , Oncologia/normas , Pandemias/prevenção & controle , Neoplasias Penianas/terapia , Pneumonia Viral/prevenção & controle , Neoplasias da Próstata/terapia , Neoplasias Testiculares/terapia
12.
Orv Hetil ; 161(16): 623-631, 2020 04 01.
Artigo em Húngaro | MEDLINE | ID: mdl-32323966

RESUMO

The prevalence of testicular adrenal rest tumours varies in different forms of congenital adrenal hyperplasia. Patients with 21-hydroxilase deficiency usually have bilateral and palpable testicular nodules. Although adrenal rest tumours are well documented in the literature, the diagnosis and management require a multidisciplinary approach: the cooperative work of endocrinologists, urologists, pathologists and radiologists is essential. In the case of an early diagnosis, appropriately increased corticosteroid treatment may reduce the tumour mass. In advanced stages, tumours can lead to irreversible parenchymal damage causing infertility. The importance of an early and accurate diagnosis cannot be emphasized enough, since the therapy differs significantly from other benign or malignant testicular neoplasia. A case of a testicular adrenal rest tumour is presented along with the multidisciplinary perspectives of the diagnosis and management of these lesions. Orv Hetil. 2020; 161(16): 623­631.


Assuntos
Hiperplasia Suprarrenal Congênita/epidemiologia , Tumor de Resto Suprarrenal/diagnóstico , Neoplasias Testiculares/diagnóstico , Tumor de Resto Suprarrenal/terapia , Humanos , Masculino , Neoplasias Testiculares/terapia
13.
Nat Rev Urol ; 17(4): 201-213, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32157202

RESUMO

Testicular germ cell tumours (TGCTs) are the most frequent cancer type in young men and originate from the common precursor germ cell neoplasia in situ (GCNIS). For decades, clinical management of patients with TGCT has relied on classic serum tumour markers: α-fetoprotein, human chorionic gonadotropin subunit-ß and lactate dehydrogenase. In the past 10 years, microRNAs have been shown to outperform classic serum tumour markers in the diagnosis of primary tumours and in follow-up monitoring and prediction of relapse. miR-371a-3p is the most consistent marker and exhibits >90% diagnostic sensitivity and specificity in TGCT. However, miR-371a-3p cannot be used to diagnose GCNIS or mature teratoma. Future efforts must technically standardize the microRNA-based methods internationally and introduce miR-371a-3p as a molecular liquid biopsy-based marker for TGCTs in the clinic.


Assuntos
Biomarcadores Tumorais/metabolismo , MicroRNAs/metabolismo , Recidiva Local de Neoplasia/diagnóstico , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Neoplasias Testiculares/diagnóstico , Assistência ao Convalescente , Biomarcadores Tumorais/genética , Gonadotropina Coriônica Humana Subunidade beta/metabolismo , Humanos , L-Lactato Desidrogenase/metabolismo , Biópsia Líquida , Masculino , Recidiva Local de Neoplasia/metabolismo , Neoplasias Embrionárias de Células Germinativas/genética , Neoplasias Embrionárias de Células Germinativas/metabolismo , Neoplasias Embrionárias de Células Germinativas/terapia , Seminoma/diagnóstico , Seminoma/genética , Seminoma/metabolismo , Seminoma/terapia , Sensibilidade e Especificidade , Teratoma/diagnóstico , Teratoma/genética , Teratoma/metabolismo , Teratoma/terapia , Neoplasias Testiculares/genética , Neoplasias Testiculares/metabolismo , Neoplasias Testiculares/terapia , alfa-Fetoproteínas/metabolismo
14.
Medicine (Baltimore) ; 99(12): e19463, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32195944

RESUMO

RATIONALE: Primary testicular lymphoma (PTL) is a rare type of extranodal non-Hodgkin's lymphoma (NHL). Although data of PTL in patients with diffuse large B-cell lymphoma (DLBCL) are accumulating, there are still patients respond poorly to prognosis. PATIENT CONCERNS: All patients had disease of the DLBCL subtype and those patients had primary involvement of the testis. In our studies, eleven patients had stage I/II disease, and 3 patients had advanced disease with B symptoms. Four patients exhibited a MYC+, BCL2+, and BCL6- expression pattern, 4 patients had a MYC+, BCL6+, and BCL2- expression pattern, and 3 patients had a MYC+, BCL2+, and BCL6+ expression pattern. Additionally, 43% (7/16) of PT-DLBCL patients had a germinal center B-cell-like (GCB) phenotype, while the others had a non-GCB phonotype. DIAGNOSES: In our case, most patients presented with unilateral painless scrotal swelling and the enlargement of the testicles in the first examination. After hospitalization, all patients underwent preoperative imageological examination of the testis and epididymis and postoperative revealed that all patients were the diffuse infiltration of a large number of anomalous lymphocytes. In addition, no invasion of other sites was observed within 3 months after diagnosis. INTERVENTIONS AND OUTCOMES: Underwent orchiectomy on the affected side was performed by urologists after all patients were diagnosed with PTL. Meanwhile, some patients received at least one course of chemotherapy, or received postoperative combined RT and chemotherapy. Because of it particularity, nineteen instances of lymph node region involvement were discovered in 12 patients since the operation. LESSONS: PT-DLBCL has unique biological characteristics, and its treatment modalities are becoming increasingly standardized. In the future, systematic interventions need to be actively considered in the early stages of PTL.


Assuntos
Linfoma Difuso de Grandes Células B/metabolismo , Linfoma Difuso de Grandes Células B/patologia , Neoplasias Testiculares/metabolismo , Neoplasias Testiculares/patologia , Testículo/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimiorradioterapia/métodos , Centro Germinativo/patologia , Humanos , Linfoma Difuso de Grandes Células B/diagnóstico , Linfoma Difuso de Grandes Células B/terapia , Linfoma não Hodgkin/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Orquiectomia/métodos , Fenótipo , Prognóstico , Estudos Retrospectivos , Neoplasias Testiculares/terapia , Testículo/diagnóstico por imagem , Ultrassonografia/métodos
15.
J Urol ; 204(1): 96-103, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32003612

RESUMO

PURPOSE: We analyzed the oncologic outcomes of men undergoing primary retroperitoneal lymph node dissection and characterized the use of adjuvant chemotherapy and template dissections. MATERIALS AND METHODS: Retrospective review of the Indiana University testis cancer database identified patients who underwent primary retroperitoneal lymph node dissection between January 2007 and December 2017. Patients and providers were contacted to obtain information regarding adjuvant therapy, recurrence and survival. The primary outcome was recurrence-free survival. Kaplan-Meier curves assessed survival differences stratified by pathological stage, template of dissection and use of adjuvant chemotherapy. RESULTS: A total of 274 patients were included in the study. Most men presented with clinical stage I disease (214, 78%). A modified unilateral template was performed in 257 (94%) and bilateral template in 17 (6%). Overall 148 (54%) and 126 (46%) men had pathological stage (PS) I and PS-II disease, respectively. Thirteen patients (10%) with PS-II disease were treated with adjuvant chemotherapy. With a median followup of 55 months only 33 (12%) patients had recurrence. Of the 113 patients with PS-II disease who did not receive chemotherapy 21 (19%) had disease relapse and 81% were cured with surgery alone and never had recurrence. No difference in recurrence-free survival was noted between modified and bilateral template dissections. CONCLUSIONS: The use of adjuvant chemotherapy has been minimal during the last decade. The majority (81%) of men with PS-II disease were cured with retroperitoneal lymph node dissection alone and were able to avoid chemotherapy. Modified unilateral template dissection provided excellent oncologic control while minimizing morbidity.


Assuntos
Quimioterapia Adjuvante/estatística & dados numéricos , Excisão de Linfonodo , Espaço Retroperitoneal/cirurgia , Neoplasias Testiculares/patologia , Neoplasias Testiculares/terapia , Adulto , Seguimentos , Humanos , Masculino , Recidiva Local de Neoplasia , Neoplasias Embrionárias de Células Germinativas/mortalidade , Neoplasias Embrionárias de Células Germinativas/patologia , Neoplasias Embrionárias de Células Germinativas/terapia , Espaço Retroperitoneal/patologia , Estudos Retrospectivos , Seminoma/mortalidade , Seminoma/patologia , Seminoma/terapia , Teratoma/mortalidade , Teratoma/patologia , Teratoma/terapia , Neoplasias Testiculares/mortalidade
16.
BMC Cancer ; 20(1): 162, 2020 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-32106829

RESUMO

BACKGROUND: Malignant mesothelioma of the tunica vaginalis is a rare tumour which comprises less than 1% of all mesotheliomas. CASE PRESENTATION: 69-years old patient with painful hard mass and hydrocele in the right scrotum to whom a right hydrocelectomy was performed. Any history of scrotal trauma or exposure to asbestos was not present. Excisional biopsy revealed a multinodular tumour with focal areas of necrosis and infiltrative growth. According to morphological and immunohistochemical findings, diagnosis of malignant biphasic mesothelioma of the tunica vaginalis testis was made. Two months after hydrocelectomy, right inguinal orchidectomy was performed. Post-surgical whole body CT scan revealed paraaortic and pararenal lymphadenopathy, likely to be metastatic. Adjuvant treatment with 6 cycles of cisplatin and pemetrexed was applied. After 3 cycles of chemotherapy, CT scan showed progression and the treatment was changed to gemcitabine 1 month after. CONCLUSIONS: Although malignant mesothelioma of the tunica vaginalis is a rare malignancy, it poses a diagnostic challenge which can mimic common inguinal or scrotal diseases such as hydrocele. Despite aggressive surgical procedures or adjuvant therapies, the prognosis remains poor.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias Pulmonares/diagnóstico , Mesotelioma/diagnóstico , Hidrocele Testicular/cirurgia , Neoplasias Testiculares/diagnóstico , Idoso , Biópsia , Cisplatino/uso terapêutico , Desoxicitidina/análogos & derivados , Desoxicitidina/uso terapêutico , Progressão da Doença , Evolução Fatal , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/terapia , Linfadenopatia , Masculino , Mesotelioma/complicações , Mesotelioma/terapia , Orquiectomia , Pemetrexede/uso terapêutico , Prognóstico , Hidrocele Testicular/etiologia , Neoplasias Testiculares/complicações , Neoplasias Testiculares/terapia
17.
J Urol ; 204(1): 33-41, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31967523

RESUMO

PURPOSE: We performed a systematic review of studies assessing the diagnosis and effectiveness of management strategies for germ cell neoplasia in situ. MATERIALS AND METHODS: Paired investigators independently searched for studies on the diagnosis and management of testicular germ cell neoplasia in situ using PubMed®, Embase® and the Cochrane Central Register of Controlled Trials from January 1, 1980 through August 2018. The reviewers then extracted data and assessed quality. RESULTS: Eighteen studies met inclusion criteria. Among patients with a testicular germ cell tumor the prevalence of contralateral germ cell neoplasia in situ was 4.0% to 8.1%. No significant difference in the risk of metachronous malignancy was identified between unscreened groups vs those with routine contralateral testicular screening (cumulative incidence 1.9% vs 3.1%, p=0.097, respectively). Patients who presented with a history of testicular atrophy, age less than 40 years or cryptorchidism had an elevated risk of germ cell neoplasia in situ. In patients with germ cell neoplasia in situ the use of 18 to 20 Gy radiation therapy demonstrated the lowest rate of disease on followup biopsies (0% to 2.5%), compared to a median of 30% on biopsies in patients treated with cisplatin based chemotherapy. Carboplatin based treatment regimens demonstrated positive disease in 66% to 75% on repeat biopsies. Rates of treatment related hypogonadism were 30.8% to 38.5% and 13% to 20% for patients treated with 18 to 20 Gy and cisplatin based chemotherapy, respectively. CONCLUSIONS: In patients with a testicular germ cell tumor the risk of having contralateral germ cell neoplasia in situ is 4% to 8%, with a greater risk in patients with testicular atrophy, cryptorchidism or age less than 40 years. The risk is high enough to support use of contralateral testicular biopsy in patients with these risk factors for germ cell neoplasia in situ. However, routine screening is not advised. Radiation therapy with 18 to 20 Gy was associated with much better eradication of germ cell neoplasia in situ than chemotherapy. Chemotherapy may eradicate germ cell neoplasia in situ in up to two-thirds of patients undergoing chemotherapy as adjuvant treatment for a primary germ cell tumor. Further research and data are needed to strengthen many aspects of the evidence base.


Assuntos
Neoplasias Embrionárias de Células Germinativas/diagnóstico , Neoplasias Embrionárias de Células Germinativas/terapia , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/terapia , Terapia Combinada , Humanos , Masculino , Medição de Risco , Fatores de Risco
18.
Curr Opin Urol ; 30(2): 235-244, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31922967

RESUMO

PURPOSE OF REVIEW: The presence of vascular solid tumors within the testicle is considered to be malignant until proven otherwise. However, it is prudent for clinicians to be aware of rare benign and malignant intratesticular lesions as management can differ from the established treatment algorithms for germ-cell tumors. RECENT FINDINGS: Utilizing certain histopathologic findings can assist with the diagnosis of rare testis tumors. Often times the tumor subtypes are an important consideration in the grading and classification of the disease, which drives management. The multidisciplinary management of rare malignant testis tumors at an experienced center seems to provide optimal patient outcomes. Regardless of the primary treatment, prolonged follow-up for sex cord stromal tumors and other rare testis malignancies is advocated due to the delayed metastatic potential. SUMMARY: The clinical presentation of rare benign and malignant testis tumors is often similar to that of germ-cell tumors. Likewise, imaging characteristics are also often indistinguishable. However, the management of these rare tumors is often different from the well established treatment algorithms of germ-cell tumors. To that end, it is important for the practicing urologist to be familiar with the current principles of these tumor characteristics and the management.


Assuntos
Doenças Testiculares/diagnóstico , Neoplasias Testiculares/diagnóstico , Humanos , Masculino , Prognóstico , Doenças Testiculares/patologia , Doenças Testiculares/terapia , Neoplasias Testiculares/patologia , Neoplasias Testiculares/cirurgia , Neoplasias Testiculares/terapia
20.
Curr Opin Urol ; 30(2): 258-263, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31972634

RESUMO

PURPOSE OF REVIEW: miRNAs 371 and 302/367 clusters are abundantly secreted in the blood of patients with active germ cell malignancy (aGCM), both seminoma and nonseminoma. The serum concentration of those micro-RNAs correlates with tumor burden and to the activity of specific treatments; therefore, representing attractive biomarkers for the diagnosis and follow-up of patients with germ cell tumors. This review summarizes the most relevant evidence supporting their clinical validity in germ cell tumors. RECENT FINDINGS: Several retrospective studies have reported high sensitivity and specificity of those micro-RNAs in identifying aGCM prior to the orchiectomy or in patients with metastatic germ cell tumor prior to or during chemotherapy. Most recently, few prospective studies have confirmed their clinical validity during the follow-up of patients after surgery and/or chemotherapy. Large studies are panned across the spectrum of germ cell tumors to assess their clinical utility and several efforts to identify biomarkers of teratoma are underway. SUMMARY: The integration of those micro-RNAs in the management of germ cell tumors has the potential to refine the therapeutic decision, especially in some clinical situations characterized by high uncertainty, such as clinical stage I, clinical stage IIA with normal tumor markers and residual disease postchemotherapy.


Assuntos
MicroRNAs/genética , Neoplasias Embrionárias de Células Germinativas/genética , Neoplasias Testiculares/genética , Biomarcadores Tumorais/sangue , Biomarcadores Tumorais/genética , Humanos , Masculino , Neoplasias Embrionárias de Células Germinativas/sangue , Neoplasias Embrionárias de Células Germinativas/patologia , Neoplasias Embrionárias de Células Germinativas/terapia , Orquiectomia , Estudos Prospectivos , Neoplasias Testiculares/sangue , Neoplasias Testiculares/patologia , Neoplasias Testiculares/terapia , Carga Tumoral/genética
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