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NCI CANCERLIT^® Search: Testicular Cancer - September 2002

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National Cancer Institute^®
Ultima Vez Modificado: 1 de septiembre del 2002

Validity of prognostic models: when is a model clinically useful?
[Sclerosing Sertoli cell tumor of the testis in an HIV patient]
[Paratesticular recurrence of renal carcinoma]
[Hereditary persistence of alpha-fetoprotein: report of a case]
[Intracavitary heart metastasis of testicular embryonic tumor]
Testicular microlithiasis: prospective analysis of prevalence and associated tumor.
Mature teratoma arising in intraabdominal undescended testis in an infant with previous inguinal exploration: case report and review of
Radiotherapy of carcinoma-in-situ of the testis.
5HT3 antagonists and radiotherapy.
Malignant germ cell tumor of the contralateral testis after radiotherapy for testicular intraepithelial neoplasia.
[Testicular cancer]
Laparoscopic retroperitoneal lymph node dissection after chemotherapy.
A 20% dose reduction of the original CISCA/VB regimen allows better tolerance and similar survival rate in disseminated testicular
How should a man with testicular cancer be counseled and what information is available to him?
Effect of hypoxia on human seminoma cells.
Prospective study of carboplatin-based chemotherapy for pediatric germ cell tumors.
Testicular function following chemotherapy.
Testicular implants and patient satisfaction: a questionnaire-based study of men after orchidectomy for testicular cancer.
Ultrasound guided needle localization and microsurgical exploration for incidental nonpalpable testicular tumors.
Re: organ sparing surgery for malignant germ cell tumor of the testis.
Testicular cancer.
Altered expression of connexins 26 and 43 in Sertoli cells in seminiferous tubules infiltrated with carcinoma-in-situ or seminoma.
[Polyembrioma of the testis: case report following chemotherapy for non-Hodgkin's lymphoma]
Fine-needle aspiration biopsy of nonteratomatous germ cell tumors of the mediastinum.
A case of clear cell adenocarcinoma of the mullerian duct in persistent mullerian duct syndrome: the first reported case.
Bilateral cryptorchidism with bilateral inguinal hernia and retrovesical mass in an infertile man: single-stage laparoscopic management.
[Primary testicular lymphoma diagnosed as central nervous recurrence six years after first complete remission]
No association between human parvovirus B19 and testicular germ cell cancer.
Bilateral testicular germ cell tumors: twenty-year experience at M. D. Anderson Cancer Center.
Expression of cancer testis genes in human brain tumors.
Expression patterns of cancer testis antigens in testicular germ cell tumors and adjacent testicular tissue.
MAGE-A4, a germ cell specific marker, is expressed differentially in testicular tumors.
The cancer-testis gene, NY-ESO-1, is expressed in normal fetal and adult testes and in spermatocytic seminomas and testicular carcinoma in situ.
On call. I've noticed that my newspaper always seems to have a story about testicular cancer in an athlete. Do athletes really get the
[Leydig cell tumor: report of 8 cases and review of the literature]
Testicular sperm extraction in azoospermic patients with gonadal germ cell tumors prior to chemotherapy--a new therapy option.
Perinatal determinants of germ-cell testicular cancer in relation to histological subtypes.
HER-2/neu expression in germ cell tumours.
Primary follicular lymphoma of the testis in childhood: an entity with peculiar clinical and molecular characteristics.
Leiomyosarcoma complicating chronic inflammation of the testis.
[Testicular microlithiasis and cancer of the testis]

1
UI - 12012295
AU - Vergouwe Y; Steyerberg EW; Eijkemans MJ; Habbema JD
TI - Validity of prognostic models: when is a model clinically useful?
SO - Semin Urol Oncol 2002 May;20(2):96-107
AD - Center for Clinical Decision Sciences, Department of Public Health, Erasmus University Rotterdam, The Netherlands.
Prognostic models combine patient characteristics to predict medical outcomes. Unfortunately, such models do not always perform as well for other patients as those from whose data the models were derived. Therefore, validity of prognostic models needs to be assessed in new patients. Predicted probabilities can be calculated with the model and compared with the actually observed outcomes. We may distinguish several aspects of validity: (1) agreement between predicted probabilities and observed probabilities (calibration), (2) ability of the model to distinguish subjects with different outcomes (discrimination), and (3) ability of the model to improve the decision-making process (clinical usefulness). We discuss those aspects and show some measures by using models for testicular and prostate cancer. We conclude that good calibration and discriminative ability are not sufficient for a model to be clinically useful. Application of a prognostic model is sensible, if the model is able to provide useful additional information for clinical decision making. Copyright 2002, Elsevier Science (USA). All rights reserved.

2
UI - 11852524
AU - De Diego Rodriguez E; Pascual Soria C; Portillo Martin JA; Martin Garcia
TI - B; Villanueva Pena A [Sclerosing Sertoli cell tumor of the testis in an HIV patient]
SO - Arch Esp Urol 2001 Dec;54(10):1129-32
AD - Servicio de Urologia y Oncologia Medica, Hospital Universitario Marques de Valdecilla, Santander, Cantabria, Espana.
OBJECTIVE: To describe an additional case of an uncommon variant of Sertoli cell testicular tumor. METHODS/RESULTS: A 34-year-old male infected with the human immunodeficiency virus presented with a right testicular tumor he had noted one year earlier. A right inguinal orchidectomy was performed. Histological examination demonstrated sclerosing Sertoli cell tumor. CONCLUSIONS: Sertoli cell tumor is a rare variant of testicular tumor from sexual cords. Although it is uncommon, histological variants have been described: classical Sertoli cell tumor, large calcifying cells and the sclerosing variant. The case of sclerosing Sertoli cell tumor described herein is a variant of which 11 cases have been reported in the world literature. The fact that our patient is HIV-positive makes this case even rarer.

3
UI - 11852526
AU - Marquez Moreno AJ; Machuca Santa Cruz J; Corral Garcia P; Jimenez Martin
TI - J; Ortega Jimenez MV; Polo Camacho M [Paratesticular recurrence of renal carcinoma]
SO - Arch Esp Urol 2001 Dec;54(10):1135-7
AD - Servicios de Anatomia Patologica y Urologia, Hospital Clinico Universitario, Malaga, Espana.
OBJECTIVE: To describe the clinical and histological findings of a case of renal cell carcinoma metastatic to the testes, an uncommon site of metastasis of this tumor type that can cause difficulty in making the differential diagnosis and consequently, in the staging and treatment of the disease. METHODS/RESULTS: A 65-year-old patient diagnosed of renal cell carcinoma presented a paratesticular mass. Histopathological examination of the orchidectomy specimen showed proliferation of clear cells arranged in a diffuse pattern, with intimate intertwining with vascular structures. Tumor cells were strongly positive for vimentin, CAM5.2 and EMA. CONCLUSIONS: Although renal cell carcinoma rarely metastasizes to the testes, it should be considered in the differential diagnosis of testicular masses. Histological examination is essential to diagnosis and correct management.

4
UI - 11876062
AU - Platini C
TI - [Hereditary persistence of alpha-fetoprotein: report of a case]
SO - Rev Med Interne 2002 Feb;23(2):182-8
AD - Service de radiotherapie et d'oncologie medicale, hopital Notre Dame de Bon-Secours, CHR de Metz-Thionville, 1, place Philippe-de-Vigneulles, BP 81065, 57038 Metz, France. cplatini@wanadoo.fr
INTRODUCTION: Hereditary persistence of alpha-fetoprotein is a rare disorder which exists with no simultaneous disease. The tenth case in the world (two brothers with seminoma and their father) is documented and a complete literature review was done. EXEGESIS: It is transmitted as an autosomal dominant; a disease point mutation has been identified. The failure to recognize hereditary persistence of alpha-fetoprotein sometimes involves unjustified treatments. CONCLUSION: The occurrence of this situation is probably underestimated and it could explain residual levels of alpha-fetoprotein.

5
UI - 11878164
AU - Kirancumar; Susano R; Pinto F; Goulart A; Camara J; Azevedo T
TI - [Intracavitary heart metastasis of testicular embryonic tumor]
SO - Acta Med Port 2001 Sep-Dec;14(5-6):515-8
AD - Servicos de Cardiologia, de Medicina e de Urologia, Hospital da Horta, Horta, Faial, Acores.
Cardiac intracavitary metastasis are very uncommon. A 19 years old patient with an embryonic tumour of the testes extending into the right ventricle, which manifested as heart failure, is presented. To our knowledge, this is the first case report of a teratoma with carcinoma of the testis involving the right ventricle.

6
UI - 12147838
AU - Middleton WD; Teefey SA; Santillan CS
TI - Testicular microlithiasis: prospective analysis of prevalence and associated tumor.
SO - Radiology 2002 Aug;224(2):425-8
AD - Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110, USA.
PURPOSE: To evaluate testicular microlithiasis (TM) prospectively with modern state-of-the-art equipment. MATERIALS AND METHODS: Information concerning indication for examination, presence and degree of TM, presence of testicular tumor, and patient age was prospectively recorded for all patients referred for scrotal ultrasonography between 1996 and 1999. High-frequency linear transducers (7.5 MHz or higher) were used. TM was divided into classic (CTM) and limited (LTM) on the basis of the presence of five or more microliths on one or more images of the testes. Fisher exact tests were used for determining significant differences in proportions. RESULTS: Data in 1,079 patients were analyzed. The overall prevalence of TM was 18.1% (195 of 1,079). Forty (3.7%) patients had CTM, and 155 (14.4%) had LTM; 15 (1.4%) had tumors visible at US. Tumors were present in three (8%) of 40 patients with CTM (seminoma in two, embryonal cell in one), nine (5.8%) of 155 with LTM (seminoma in six, mixed germ cell in one, Leydig cell in two), and three (0.3%) of 884 with no TM (seminoma in two, other in one). There was no difference between CTM and LTM (P =.72) in the rate of coexisting tumor. There was a significant difference between no TM and CTM or LTM (P 7
UI - 12149716
AU - Doi O; Itoh F; Aoyama K
TI - Mature teratoma arising in intraabdominal undescended testis in an infant with previous inguinal exploration: case report and review of intraabdominal testicular tumors in children.
SO - J Pediatr Surg 2002 Aug;37(8):1236-8
AD - Department of Pediatric Surgery, Kiyama Hospital, Kawasaki, Japan.
The authors report the youngest case of postoperative intraabdominal mature testicular teratoma in a 5-year-old boy after previous exploration for impalpable testis. A total of 26 cases of intraabdominal testicular tumor in children including our case were reviewed and discussed from both the English- and the Japanese-language literature. The average age was 2.5 years, and, in the 13 children younger than 1 year there were no malignant teratomas, although there was one immature teratoma. Four of these had undergone previous inguinal exploration in which 3 patients except our patient were more than 10 years old. This case report confirms the importance of finding an intraabdominal testis at operation for impalpable testis. Early detection of the testicular location near the internal inguinal ring in these patients supports the hypothesis that the intraabdominal testicular teratoma itself may have been the primary cause of the undescended testis. Furthermore, it is suspected that many of the intraabdominal testicular malignant teratomas in adults may have arisen from these mature testicular teratomas in infants. Copyright 2002, Elsevier Science (USA). All rights reserved.

8
UI - 12177118
AU - Classen J; Dieckmann KP
TI - Radiotherapy of carcinoma-in-situ of the testis.
SO - J Clin Oncol 2002 Aug 15;20(16):3559-60

9
UI - 9137804
AU - Mitchell G; Huddart R
TI - 5HT3 antagonists and radiotherapy.
SO - Ann Oncol 1997 Mar;8(3):302

10
UI - 10893614
AU - Dotsch M; Brauers A; Buttner R; Nolte-Ernsting C; Eble MJ; Jakse G
TI - Malignant germ cell tumor of the contralateral testis after radiotherapy for testicular intraepithelial neoplasia.
SO - J Urol 2000 Aug;164(2):452-3
AD - University Clinic of Urology, Institute of Pathology, Department of Radiology, and Clinic of Radiotherapy, Aachen, Germany.

11
UI - 12082863
AU - Daugaard KG; von der Maase H
TI - [Testicular cancer]
SO - Ugeskr Laeger 2002 Jun 3;164(23):3063-7
AD - Onkologisk klinik 5073, Finsencentret, H:S Rigshospitalet, DK-2100 Kobenhavn o. gedske@rh.dk

12
UI - 12100938
AU - Palese MA; Su LM; Kavoussi LR
TI - Laparoscopic retroperitoneal lymph node dissection after chemotherapy.
SO - Urology 2002 Jul;60(1):130-4
AD - Department of Surgery, Division of Urology, University of Maryland Medical System, Baltimore, Maryland, USA.
OBJECTIVES: To assess the operative feasibility, clinical outcomes, and complications of laparoscopic retroperitoneal lymphadenectomy (RPLND) after chemotherapy. METHODS: A retrospective review of clinical records from 7 patients who underwent laparoscopic RPLND after chemotherapy was performed. Five patients presented with nonseminomatous germ cell tumor after orchiectomy. One patient was diagnosed with pure seminoma and one with epididymal small cell cancer. All 7 patients received multiagent chemotherapy for clinical Stage IIA or higher disease, followed by laparoscopic RPLND for findings of a residual retroperitoneal mass on computed tomography or a prechemotherapy mass size greater than 3.0 cm. The mean tumor diameter was 3.07 cm before chemotherapy and 1.91 cm after chemotherapy. A modified laparoscopic left (n = 3), right (n = 3), and bilateral (n = 1) template was used. None of the patients had received radiotherapy before surgery. RESULTS: Postchemotherapy laparoscopic RPLND was successfully completed in 5 (71.4%) of 7 patients. Two patients required a conversion to open surgery. The overall complication rate was 57.1% (4 of 7), with a major complication incidence of 42.8% (3 of 7). No mortalities were recorded. Of the 5 patients who presented with nonseminomatous germ cell tumor after orchiectomy, 3 were found to have retroperitoneal lymph nodes consistent with mature teratoma, 1 had necrotic tissue, and 1 had residual viable tumor. CONCLUSIONS: Laparoscopic RPLND is a feasible operation in patients after systemic chemotherapy. This technique remains challenging at this time and should be reserved for patients with limited residual disease and should only be performed at institutions with considerable laparoscopic expertise.

13
UI - 11863094
AU - Fizazi K; Do KA; Wang X; Finn L; Logothetis CJ; Amato RJ
TI - A 20% dose reduction of the original CISCA/VB regimen allows better tolerance and similar survival rate in disseminated testicular non-seminomatous germ-cell tumors: final results of a phase III randomized trial.
SO - Ann Oncol 2002 Jan;13(1):125-34
AD - Department of Genitourinary Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, USA. fizazi@igr.fr
BACKGROUND: This prospective randomized clinical trial was designed to compare the efficacy of a low-dose regimen of cisplatin, doxorubicin and cyclophosphamide alternated with vinblastine and bleomycin (CISCA/VB) with the original CISCA/VB regimen in patients with disseminated nonseminomatous germ-cell tumors (NSGCT) and a predicted favorable outcome. PATIENTS AND METHODS: One hundred and twenty-five patients with disseminated NSGCT and a predicted favorable outcome according to the M.D. Anderson Cancer Center classification [testicular primary and human chorionic gonadotropin (hCG) serum level <50000 mIU/ml] were randomized to receive the original CISCA/VB regimen (100% dose) or a low-dose CISCA/VB regimen (80% dose). RESULTS: Among the 124 eligible patients, there was no significant difference in the number of patients in the two treatment arms who achieved a complete response to therapy: 53 of 65 patients (82%) on the original CISCA/VB regimen and 53 of 59 patients (90%) on the low-dose CISCA/VB regimen (P = 0.29). Overall, the original CISCA/VB regimen resulted in a significantly higher relative dose intensity (P <0.0001). After a median follow-up of 6.8 years (range 0.37 to 12.94 years), there was no significant difference in disease-free survival (P = 0.87) or in overall survival (P = 0.88) between the two treatment arms. The 5-year overall survival rate was 93.7% [95% confidence interval (CI) 88% to 100%] and 94.1% (95% CI 84% to 100%) in the original CISCA/VB arm and the low-dose CISCA/VB arm, respectively. The 5-year overall survival rate for the entire study population was 98% (95% CI 94% to 100%) and 88% (95% CI 76% to 100%) in the good- and intermediate-prognosis groups, respectively, as defined by the International Germ Cell Consensus Classification Group (IGCCCG). The low-dose CISCA/VB regimen resulted in significantly less neutropenic fever (P <0.001), grade 4 thrombocytopenia (P <0.03) and severe mucositis (P <0.01) than the original CISCA/VB regimen. CONCLUSIONS: CISCA/VB is highly efficient in patients with good or intermediate prognosis NSGCT according to the IGCCCG criteria. Although equivalent antitumor efficacy cannot be claimed, the low-dose CISCA/VB regimen appears to be a better mode of delivery than the original CISCA/VB regimen with respect to toxicity, since survival is comparable.

14
UI - 8833384
AU - Rieker PP
TI - How should a man with testicular cancer be counseled and what information is available to him?
SO - Semin Urol Oncol 1996 Feb;14(1):17-23
AD - Department of Psychiatry, Harvard Medical School and the Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA.
The peak incidence of testicular cancer occurs in early adulthood (between the ages 19 to 34) when men are physically robust and actively formulating social and sexual identities. This is also a time when they are pursuing career and family goals. The disease not only interrupts these pursuits but its very location threatens the integrity of the body and an organ that is associated with self-esteem, sexuality, fertility, and masculinity-psychosocial issues of importance to both ill and healthy men alike. This paper discusses approaches to counseling these men. Effective counseling depends on understanding the illness itself and four psychosocial domains: the context of patients' lives, the assault on the sense of self, the impact on intimate relationships, and treatment options and psychosexual effects.

15
UI - 11956589
AU - Fujii T; Otsuki T; Moriya T; Sakaguchi H; Kurebayashi J; Yata K; Uno M;
TI - Kobayashi T; Kimura T; Jo Y; Kinugawa K; Furukawa Y; Morioka M; Ueki A; Tanaka H Effect of hypoxia on human seminoma cells.
SO - Int J Oncol 2002 May;20(5):955-62
AD - Department of Urology, Kawasaki Medical School, Okayama 701-0192, Japan.
Since hypoxia has been considered to enhance metastatic potential in solid tumors via a neo-angiogenesis caused by vascular endothelial cell growth factors (VEGFs) induced by hypoxia inducible factor-1alpha (HIF-1alpha), the effects of hypoxia on human seminoma cell lines were examined in terms of growth, morphology, gene expression, protein expression and cell cycle perturbation. Growth was inhibited in long-term cultures with morphological changes to the spindle form. The gene expression of VEGF-C was markedly enhanced and the production of VEGF-A increased during hypoxia, although HIF-1alpha was not upregulated at the protein or message level. Hypoxic culture caused G1 cell cycle arrest with upregulation of the p15/ink4b and p27/Kip1 genes, whereas no increase of apoptotic cells was observed on up-regulation of the heat shock protein (HSP) 70 gene. The adhesion molecules were only slightly altered.

16
UI - 12210444
AU - Stern JW; Bunin N
TI - Prospective study of carboplatin-based chemotherapy for pediatric germ cell tumors.
SO - Med Pediatr Oncol 2002 Sep;39(3):163-7
AD - Division of Oncology, The Children's Hospital of Philadelphia and The University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. julie.stern@lvh.com
BACKGROUND: Survival of pediatric patients with malignant germ cell tumors has improved dramatically with the use of cisplatin-based chemotherapy, though patients are at high risk of significant long-term complications. In a prospective study, carboplatin was substituted for cisplatin in an attempt to minimize nephro- and oto-toxicities, while achieving excellent disease-free survival. PROCEDURE: All consecutive patients with malignant germ cell tumors at The Children's Hospital of Philadelphia were treated between 1989 and 1998. After pathologic confirmation of disease and pretreatment evaluation of pulmonary, renal, and otologic function, patients received etoposide 150 mg/m(2) days 1, 2, 3; carboplatin 600 mg/m(2) day 2; and bleomycin 10 mg/m(2) day 3 for at least four courses. RESULTS: Twenty-three patients were entered for study, and were available for evaluation. All patients achieved either a complete or partial remission following therapy with surgery and chemotherapy. With a median of 58 months of follow-up, overall survival is 91% and event-free survival is 87%. Therapy was given as an outpatient, and well tolerated, with 20 admissions for fever and neutropenia. Ototoxicity and nephrotoxicity, when evaluated, have been extremely limited. Three patients, all with stage III disease, have relapsed; one of these remains alive and disease free. CONCLUSIONS: Carboplatin can successfully substitute for cisplatin during the treatment of pediatric germ cell tumors without sacrificing response or survival. Long-term effects, especially nephrotoxicity and ototoxicity, were rare or mild among the small number of patients evaluated. Carboplatin appears to be a safe and efficacious alternative in the treatment of germ cell tumors, and should be considered as primary therapy for pediatric patients. Copyright 2002 Wiley-Liss, Inc.

17
UI - 11476348
AU - Howell SJ; Shalet SM
TI - Testicular function following chemotherapy.
SO - Hum Reprod Update 2001 Jul-Aug;7(4):363-9
AD - Department of Endocrinology, Christie Hospital NHS Trust, Manchester, UK.
Testicular dysfunction is a common long-term sequela of cytotoxic chemotherapy used in the treatment of many malignancies. The degree to which testicular function is affected is dose- and agent-dependent. The impact on germinal epithelial function of standard multi-agent regimens used in the treatment of lymphomas has been widely studied. Procarbazine-containing regimens result in azoospermia in the vast majority of patients, but much lesser degrees of long-term gonadotoxicity are apparent with the newer forms of chemotherapy. High-dose chemotherapy used as preparation before bone marrow transplant is also associated with irreversible germinal epithelial failure in the majority of men. Treatment of testicular cancer with cisplatin and carboplatin regimens leads to temporary azoo- and oligozoospermia in most men, with a recovery to normospermia in 80% by 5 years. There is also evidence of mild Leydig cell impairment in a proportion of men treated with cytotoxic agents, although the clinical significance of this is not clear. Several methods of preserving testicular function during potentially sterilizing treatment have been considered. At present, sperm banking remains the only proven method, although hormonal manipulation to enhance recovery of spermatogenesis and cryopreservation of testicular germ cells are possibilities for the future.

18
UI - 11678751
AU - Adshead J; Khoubehi B; Wood J; Rustin G
TI - Testicular implants and patient satisfaction: a questionnaire-based study of men after orchidectomy for testicular cancer.
SO - BJU Int 2001 Oct;88(6):559-62
AD - Department of Urology, Watford NHS Trust, Linda Jackson Centre and Department of Medical Oncology, Mount Vernon Hospital, Middlesex, UK.
OBJECTIVES: To assess the satisfaction of men with their testicular implants after undergoing orchidectomy for testicular cancer, and to determine their reasons for accepting or declining a prosthesis. PATIENTS AND METHODS: In all, 424 men who had undergone radical orchidectomy and were part of the testicular cancer follow-up programme were sent an anonymous questionnaire comprising 10 questions covering two main areas. First, the reasons for accepting or declining an implant and second (if they received an implant) their satisfaction with the size, position, feel, shape and overall comfort; 234 men (55%) responded. RESULTS: About a third (71 men) accepted an implant, a third declined and a third were not offered the choice. Of the men who replied 91% felt that it was extremely important to be offered an implant at the time of surgery. Of the 71 who received an implant, 19 (27%) were dissatisfied and felt that they had an average or poor cosmetic result. The reasons for this dissatisfaction are presented and discussed. CONCLUSIONS: All men undergoing orchidectomy should be offered a testicular implant, irrespective of age. Sample implants in all sizes should be available in the outpatient department. This will give men realistic expectations and allow them to choose a suitable size of implant. The dimensions of the available implants should be improved to create a more elliptical prosthesis, to avoid dissatisfaction with the shape. Adequate fixation to the base of the scrotum is important to avoid the 'high riding' implant.

19
UI - 12187228
AU - Hopps CV; Goldstein M
TI - Ultrasound guided needle localization and microsurgical exploration for incidental nonpalpable testicular tumors.
SO - J Urol 2002 Sep;168(3):1084-7
AD - Center for Male Reproductive Medicine and Microsurgery, Cornell Institute for Reproductive Medicine, New York Weill Cornell Medical Center, New York, NY 10021, USA.
PURPOSE: We describe a technique by which incidental, nonpalpable intratesticular tumors are excised using intraoperative ultrasonography and the operating microscope. MATERIALS AND METHODS: Men with impalpable intratesticular tumors incidentally detected by ultrasonography underwent intraoperative ultrasound guided needle localization and microsurgical exploration of the mass. The testis was delivered through an inguinal incision and placed on ice to minimize warm ischemia. Two rubber shod vascular clamps were placed across the spermatic cord. The tumor was identified by ultrasound and localized with a 30 gauge needle, which was placed adjacent to the tumor. An operating microscope providing 6x to 25x magnification was used to excise the lesion with a 2 to 5 mm. margin. Tissue diagnosis was obtained by frozen section. Multiple random biopsies of the remaining parenchyma were done to confirm absent malignancy. RESULTS: Ultrasound showed incidental, nonpalpable testis tumors in 4 of the 65 men who underwent infertility evaluation and were entered into the microsurgical testis biopsy hypoechoic. Frozen section analysis of the lesions revealed 2 Leydig cell tumors, 1 mass with an inconclusive pathological diagnosis and 1 inflammatory mass. On permanent section the latter 2 lesions were seminoma. The seminomas were 1.6 and 0.9 cm. in the greatest diameter, and the Leydig cell tumors were 0.35 and 0.2 cm., respectively. Random biopsies were positive for seminoma and intratubular germ cell neoplasia in both testes with seminoma. These 2 patients subsequently opted to undergo radical orchiectomy. No residual tumor was detected in either radical orchiectomy specimen. CONCLUSIONS: Intraoperative ultrasound guided needle localization with microsurgical exploration is a safe and effective approach to even small impalpable testicular masses. This technique provides the opportunity to identify and remove benign and malignant lesions, and preserve the testis when the lesion is benign. In cases of a solitary testis or bilateral synchronous lesions the technique allows a potentially testis sparing operation for small malignancies.

20
UI - 12187245
AU - Shafik A
TI - Re: organ sparing surgery for malignant germ cell tumor of the testis.
SO - J Urol 2002 Sep;168(3):1111; discussion 1111-2

21
UI - 11981269
AU - Hellerstedt BA; Pienta KJ
TI - Testicular cancer.
SO - Curr Opin Oncol 2002 May;14(3):260-4
AD - University of Michigan Medical Center, Ann Arbor, Michigan 48019, USA.
Testicular cancer remains a major success story in the realm of solid tumors. Although testicular cancer is highly treatable and curable, there are still many young men who succumb to the disease. Over the past year, important data regarding the diagnosis, treatment, and prognosis of testicular cancer have been reported. The significance of genetic and molecular alterations, such as i12p and epidermal growth factor receptor expression, remain at the forefront of research. However surgery and platinum-based chemotherapy are still the main treatment modalities. Attempts to limit chemotherapy and surgery while preserving cure rates are promising. The contribution of long-term platinum retention to the well-documented risk of late toxicity is unknown but provides a specific avenue for research. New tumor markers, such as lactate dehydrogenase isoenzyme-1, may provide a greater risk stratification. Positron emission tomography imaging may reduce the need for surgical resection posttherapy and provide a more comprehensive means of observation.

22
UI - 12210085
AU - Brehm R; Marks A; Rey R; Kliesch S; Bergmann M; Steger K
TI - Altered expression of connexins 26 and 43 in Sertoli cells in seminiferous tubules infiltrated with carcinoma-in-situ or seminoma.
SO - J Pathol 2002 Aug;197(5):647-53
AD - Institute of Veterinary Anatomy, University of Giessen, Germany.
The expression of connexins (cx) 26 and 43 in testis infiltrated with carcinoma-in-situ (CIS) or seminoma was examined to gain insight into the relationship between aberrant gap junctional communication and spermatogenic impairment in the neoplastic testis. In uninvolved tubules with normal spermatogenesis, cx43 immunostaining was localized to the Sertoli-Sertoli junctional complex and cx26 was absent. In contrast, infiltrated tubules with spermatogonial arrest or CIS-only were negative for cx43, but displayed strong intracytoplasmic Sertoli cell staining for cx26. The Sertoli cells in these tubules re-expressed cytokeratin 18 (ck18), signifying a reversion to a less differentiated state. Western blot analysis for cx43 revealed a single immunoreactive band at 43 kD (normal spermatogenesis) and three bands at 43, 41, and 39 kD (impaired spermatogenesis with CIS or seminoma). For cx26, a doublet band at 26/28 kD (normal spermatogenesis) and an additional doublet band at 52/54 kD (impaired spermatogenesis with CIS or seminoma) were observed. The altered expression of cx26 and cx43 in Sertoli cells in testes infiltrated with CIS or seminoma suggests that a derangement in intercellular communication between Sertoli cells and between Sertoli cells and germ cells may play a role in the resulting spermatogenic impairment and possibly in the proliferation and neoplastic progression of CIS cells. Copyright 2002 John Wiley & Sons, Ltd.

23
UI - 12109226
AU - Carlomagno N; Nastro P; Lombari P; Tammaro V; Gargiulo S; Borrelli A;
TI - Pettinato G; Renda A [Polyembrioma of the testis: case report following chemotherapy for non-Hodgkin's lymphoma]
SO - G Chir 2002 Mar;23(3):65-70
AD - Dipartimento di Scienze Chirurgiche, Anestesiologico-Rianimatorie e dell'Emergenza, Universita degli Studi Federico II, Napoli.
Testicular tumours represent 2% of all male malignancies, mostly concerning young men (20-40 years old). The polyembryoma is one of the uncommonest lesions and just recently it has been identified as autonomous nosographic entity. The reported case is peculiar because the patient was older than the most ones described in the literature and the tumour arose after polychemotherapy for non Hodgkins' disease. The Authors analyse some aspects concerning etiology, pathology and clinical approach to such rare neoplasm.

24
UI - 12219784
AU - Chhieng DC; Lin O; Moran CA; Eltoum IA; Jhala NC; Jhala DN; Simsir A
TI - Fine-needle aspiration biopsy of nonteratomatous germ cell tumors of the mediastinum.
SO - Am J Clin Pathol 2002 Sep;118(3):418-24
AD - Department of Pathology, University of Alabama at Birmingham, USA.
We assessed the usefulness of fine-needle aspiration biopsy (FNAB) in the diagnosis of mediastinal germ cell tumors (GCTs). In the archives of 3 pathology departments, we found records of 7 patients with mediastinal GCTs who underwent mediastinal FNAB as part of the diagnostic workup. The FNAB smears, results of the immunocytochemical analysis, the corresponding histologic findings, and the clinical charts were reviewed. All patients were men (age range, 24-44 years; mean, 32 years). One patient had a history of testicular mixed GCT 10 years earlier. The 6 primary mediastinal GCTs consisted of 3 seminomas and 3 yolk sac tumors. Based on the cytologic features and immunocytochemicalfindings, a cytologic diagnosis of GCT was made in 5 cases, including the case of metastatic GCT In 2 cases, the differential diagnosis was between poorly differentiated carcinoma and GCT Results of ancillary studies were noncontributory in 1 case, and the aspirate of the second case demonstrated extensive necrosis. Our findings demonstrate that a diagnosis of mediastinal GCT, primary or secondary, can be established with a high degree of accuracy on the basis of FNAB. Immunocytochemical analysis helps confirm the diagnosis.

25
UI - 12218580
AU - Shinmura Y; Yokoi T; Tsutsui Y
TI - A case of clear cell adenocarcinoma of the mullerian duct in persistent mullerian duct syndrome: the first reported case.
SO - Am J Surg Pathol 2002 Sep;26(9):1231-4
AD - Department of Pathology, Kakegawa City General Hospital, Kakegawa, Japan.
We report a case of a 67-year-old man with clear cell adenocarcinoma of the remnant uterus in persistent Mullerian duct syndrome. He had a normal penis, urethra, and scrotum, and there was also a vagina and uterus. He died in a traffic accident, and clear cell adenocarcinoma was discovered incidentally at autopsy. Clear cell adenocarcinoma of the remnant uterus metastasized to the retroperitoneal lymph nodes and bilateral lungs. Persistent Mullerian duct syndrome is characterized by the persistence of Mullerian derivatives in otherwise normally virilized males. A variety of germ cell tumors of the testis have been reported in association with persistent Mullerian duct syndrome. However, no malignant change of the persistent Mullerian duct structures has been reported. This represents the first reported case of malignant change of the persistent Mullerian duct structures in persistent Mullerian duct syndrome.

26
UI - 11905867
AU - Ansari MS; Mandal S; Ray R; Hemal AK
TI - Bilateral cryptorchidism with bilateral inguinal hernia and retrovesical mass in an infertile man: single-stage laparoscopic management.
SO - J Laparoendosc Adv Surg Tech A 2002 Feb;12(1):73-5
AD - Department of Urology, All India Institute of Medical Sciences, New Delhi.
A 30-year-old married man presented with the complaint of inability to procreate. Examination revealed bilateral nonpalpable testes and bilateral inguinal hernia. Ultrasonography of the abdomen could not locate the testis; instead, a hypoechoic 5 x 5-cm mass was found behind the bladder. A CT scan of the abdomen revealed the right testis near the right inguinal canal. The left testis could not be identified beside the soft tissue mass. The patient was taken for diagnostic as well as therapeutic laparoscopy. The testis on the right was found just proximal to the internal inguinal ring, and right orchidopexy was done. The left testis was small and rudimentary; hence, orchidectomy was done. Bilateral laparoscopic herniorrhaphy was carried out with polypropylene mesh by fixing it intracorporeally to the pubic bone, Cooper's ligament, inguinal ligament, and conjoint tendon. Subsequently, the retrovesical mass was excised and retrieved by dilating the umbilical port site. The operative time was 3.5 hours with minimal blood loss. The postoperative period was uneventful, and the patient was discharged after 24 hours. The histopathology examination of the retrovesical mass showed an extragonadal germ cell tumor compatible with seminoma.

27
UI - 12170757
AU - Tsujioka T; Wada H; Yata K; Suemori S; Yamada O; Sugihara T; Sadahira Y
TI - [Primary testicular lymphoma diagnosed as central nervous recurrence six years after first complete remission]
SO - Nippon Naika Gakkai Zasshi 2002 Jun 10;91(6):1873-5
AD - Division of Hematology, Department of Medicine, Kawasaki Medical School, Kurashiki.

28
UI - 12185288
AU - Tolfvenstam T; Papadogiannakis N; Andersen A; Akre O
TI - No association between human parvovirus B19 and testicular germ cell cancer.
SO - J Gen Virol 2002 Sep;83(Pt 9):2321-4
AD - Department of Clinical Virology and Department of Pathology, Huddinge University Hospital, F68, Karolinska Institutet, SE-141 86 Stockholm, Sweden. thomas.tolfvenstam@impi.ki.se
The incidence of testicular germ cell cancer, which is the most common cancer among young male adults, is increasing. The aetiology remains unknown, although a virus has been proposed. A previous study has shown a high prevalence of human parvovirus B19 (B19) DNA in the testes of patients with testicular germ cell tumours (85%) and suggested that B19 may play a role in tumour development. To address this question of causality, seroreactivity to B19 was studied among cases (n=80) and controls (n=241) using serum samples drawn before the onset of disease, in addition to an elucidation of the frequency of virus DNA in a retrospectively collected 2-year testicular carcinoma series. No association was found between B19 seropositivity and the risk of testicular cancer (odds ratio=1.03; 95% confidence interval=0.60-1.77) nor was there any dose-response relation (P for trend=0.53). This study did, however, confirm the observation that B19 DNA can be detected in testicular carcinoma tissue, as 4 of 24 cases were found to be positive, while no B19 DNA could be detected in the control cases. It is speculated that this finding may be due to susceptibility of the carcinoma cells to B19 virus owing to high-level expression of the viral receptor glycosphingolipid (Gb4) and possible other putative cellular factors resulting in a localized persistence initiated after the development of cancer.

29
UI - 12216089
AU - Che M; Tamboli P; Ro JY; Park DS; Ro JS; Amato RJ; Ayala AG
TI - Bilateral testicular germ cell tumors: twenty-year experience at M. D. Anderson Cancer Center.
SO - Cancer 2002 Sep 15;95(6):1228-33
AD - Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
BACKGROUND: The incidence of testicular carcinoma in the United States has increased significantly over the last two decades. Germ cell tumors form the majority of malignant testicular tumors. With advances in diagnosis and therapeutic approaches, germ cell tumors are now highly sensitive to treatment, providing long-term survival. It has been speculated that the incidence of bilateral germ cell tumors may increase due to the improved survival of patients with unilateral germ cell tumors. In this report, the authors present a study of bilateral germ cell tumors of the testis in men who were treated at The University of Texas M. D. Anderson Cancer Center over a 20-year period with emphasis on their incidence, histologic features, and clinical features. METHODS: Between 1978 and 1999, 2431 patients with testicular germ cell tumors were treated at The University of Texas M. D. Anderson Cancer Center. Among these, 24 patients with bilateral germ cell tumors were identified. Clinical records and all available pathology slides of the tumors were reviewed. RESULTS: The overall incidence of bilateral germ cell tumors in the patients with testicular germ cell tumors was 1% (24 of 2431 patients). The incidence was 1.8% (14 of 776 patients) in patients with seminoma and 0.6% (10 of 1655 patients) in patients with nonseminomatous germ cell tumors. Patients with seminoma who were age 30
UI - 11051238
AU - Sahin U; Koslowski M; Tureci O; Eberle T; Zwick C; Romeike B; Moringlane
TI - JR; Schwechheimer K; Feiden W; Pfreundschuh M Expression of cancer testis genes in human brain tumors.
SO - Clin Cancer Res 2000 Oct;6(10):3916-22
AD - Department of Medicine, Saarland University Medical School, Homburg, Germany.
Cancer-testis (CT) genes are expressed in a variety of human cancers but not in normal tissues, except for testis tissue, and represent promising targets for immunotherapeutic and gene therapeutic approaches. Because little is known about their composite expression in human brain tumors, we investigated the expression of seven CT genes (MAGE-3, NY-ESO-1, HOM-MEL-40/SSX-2, SSX-1, SSX-4,HOM-TES-14/SCP-1, and HOM-TES-85) in 88 human brain tumor specimens. Meningiomas expressed only HOM-TES-14/SCP-1 (18% of meningiomas were HOM-TES-14/SCP-1 positive) and did not express any other CT genes. One ependymoma was negative for all CT genes tested. SSX-4 was the only CT gene expressed in oligodendrogliomas (2 of 5 cases), and it was also expressed in oligoastrocytomas (3 of 4 cases) and astrocytomas (10 of 37 cases). Astrocytomas were most frequently positive for HOM-TES-14/SCP-1 (40%) and SSX-4 (27%), followed by HOM-TES-85 (13%), SSX-2 (11%), and MAGE-3 (7%). Whereas MAGE-3 was detected only in grade IV astrocytomas, the expression of the other CT genes showed no clear correlation with histological grade. Of 39 astrocytomas, 60% expressed at least one CT gene, 21% expressed two CT genes, and 8% coexpressed three CT genes of the seven CT genes investigated. We conclude that a majority of oligoastrocytomas and astrocytomas might be amenable to specific immunotherapeutic interventions. However, the identification of additional tu-mor-specific antigens with a frequent expression in gliomas is warranted to allow for the development of widely applicable polyvalent glioma vaccines.

32
UI - 11753951
AU - Aubry F; Satie AP; Rioux-Leclercq N; Rajpert-De Meyts E; Spagnoli GC;
TI - Chomez P; De Backer O; Jegou B; Samson M MAGE-A4, a germ cell specific marker, is expressed differentially in testicular tumors.
SO - Cancer 2001 Dec 1;92(11):2778-85
AD - GERM-INSERM U. 435, Universite de Rennes I, Campus de Beaulieu, Bretagne, France.
BACKGROUND: Testicular germ cell tumors are the most common malignancy in young males, and the frequency of these tumors has risen dramatically over the last century. Because it is known that the MAGE genes are expressed in a wide variety of tumors but are expressed only in the mitotic spermatogonia (germ cells) and in the primary spermatocytes in the normal testis, the authors screened the expression of MAGE-A4 in a panel of testicular germ cell tumors. METHODS: Monoclonal antibody 57B raised against MAGE-A4 was tested immunohistochemically on 12 classical seminomas, 5 anaplastic seminomas, 10 various specimens of nonseminomatous germ cell tumors (NSGCTs), 2 combined tumors containing seminoma components, 1 Sertoli cell tumor, 2 Leydig cell tumors, and 15 carcinomas in situ (CIS). In addition, monoclonal antibody 57B was tested on embryonic gonad (age 8 weeks) and fetal gonads (ages 15 weeks, 17 weeks, and 28 weeks). RESULTS: Classical seminomas uniformly and specifically expressed MAGE-A4 compared with anaplastic seminomas and NSGCTs, which were negative for this antigen. Specific expression of MAGE-A4 also was seen in subpopulations of CIS cells, providing additional evidence for heterogeneity of the phenotype of these cells, in which it is believed that differentiation and proliferation generate seminomas and NSGCTs. Finally, MAGE-A4 was expressed in the fetal precursors of the stem germ cells from 17 weeks of gestation onward, in accordance the fact that CIS can arise from prespermatogonia in the fetus. CONCLUSIONS: MAGE-A4 can be considered a potential specific marker for normal premeiotic germ cells and germ cell tumors and can be used to characterize classical seminomas. Copyright 2001 American Cancer Society.

33
UI - 12065688
AU - Satie AP; Rajpert-De Meyts E; Spagnoli GC; Henno S; Olivo L; Jacobsen
TI - GK; Rioux-Leclercq N; Jegou B; Samson M The cancer-testis gene, NY-ESO-1, is expressed in normal fetal and adult testes and in spermatocytic seminomas and testicular carcinoma in situ.
SO - Lab Invest 2002 Jun;82(6):775-80
AD - GERM-INSERM U. 435, Universite de Rennes I, Campus de Beaulieu, Rennes, France.
Cancer/testis genes are potential targets for therapeutic genetic and immunologic approaches, and are highly expressed in a large variety of human cancers. However, they are not expressed in normal tissues, with the exception of the testis. The NY-ESO-1 gene is the most recently identified member of the cancer/testis family and its product is one of the most immunogenic tumor antigens. We used immunohistochemistry to investigate the expression of NY-ESO-1 in healthy human prenatal and adult testes and in 59 human t

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