Test Paper 3
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike in Get Through, 2017
Lymphoma can occur in the testis in one of three ways: as the primary site, as the initial manifestation of occult disease or as the site of recurrence. It is the most common bilateral tumour, and the epididymis and spermatic cord are commonly involved. The sonographic appearance of testicular lymphoma is variable and indistinguishable from that of germ cell tumours. Testicular lymphoma generally appears as discrete hypoechoic lesions, which may completely infiltrate the testicle. Primary leukaemia of the testis is rare. However, the testis is a common site of leukaemia recurrence in children. Seminoma is the most common pure germ cell tumour but affects unilateral testis. Metastases are rare but are reported most commonly in cases of primary prostate and lung cancer. Testicular fracture usually appears as a linear hypoechoic band extending across the testicular parenchyma.
Complications of Retroperitoneal Lymphadenectomy
Kevin R. Loughlin in Complications of Urologic Surgery and Practice, 2007
Approximately 25% of patients with pure seminoma present with metastatic disease and are treated with systemic chemotherapy. Management of residual masses in this population is controversial. The desmoplastic reaction and fibrosis encountered makes the surgery technically demanding, with incomplete resections and high patient morbidity (41–44). Even seminomatous elements in the retroperitoneum in patients with metastatic non-seminomatous disease increases patient morbidity at postchemotherapy surgery. Mosharafa et al. evaluated the morbidity of 97 patients with elements of seminoma in the dissected specimen compared to 1269 patients with no component of seminoma (45). Of the 97 patients in the seminoma group, 37 (38.1%) required a total of 47 additional intraoperative procedures including 25 nephrectomies, nine IVC resections, five arterial grafts, five bowel resections, and three hepatic resections/biopsies, compared with 340 of the 1269 patients (26.8%) in the group without seminomatous elements (P = 0.02). Postoperative complications occurred in 24 of 97 patients (24.7%) in the seminoma group versus 257 of 1269 (20.3%) in the group without seminomatous elements (P = 0.29).
General Surgery
Tjun Tang, Elizabeth O'Riordan, Stewart Walsh in Cracking the Intercollegiate General Surgery FRCS Viva, 2020
What are the long-term chances of malignancy in undescended testes?The undescended testes are 5–10 times more likely to develop a malignancy. Inguinal UDT − 1:80 riskIntra-abdominal testis 1:20 risk(lifetime risk of developing testicular CA = 1:190) Seminoma is the commonest tumour related to UDTTesticular self-examination should be promoted for early diagnosis.Effect of age at orchidopexy (based on a Swedish 35 year study in NEJM 2007, UDT post-orchidopexy versus population, if orchidopexy done before 13 years carries lower relative risk of cancer than done after 13 years (RR 2.2 vs. 5.4).
Multiparametric ultrasonographic analysis of testicular tumors: a single-center experience in a collective of 49 patients
Published in Scandinavian Journal of Urology, 2020
Vincent Schwarze, Constantin Marschner, Bastian Sabel, Giovanna Negrão de Figueiredo, Julian Marcon, Michael Ingrisch, Thomas Knösel, Johannes Rübenthaler, Dirk-André Clevert
The introduction and application of CEUS meant a significant refinement of the diagnostic performance of ultrasonography in the differential diagnosis of testicular pathologies [15]. Using CEUS, intratumoral microperfusion can dynamically be visualized at high spatial and temporal resolutions. It has previously been shown that neoplastic testicular lesions characteristically feature arterial hyperenhancement [9,16]. Absence of intratumoral vascularization is more likely associated with benign lesions [17]. Our findings go in line with the recent literature. In only three patients with malignant testicular lesions, no arterial enhancement could be registered by CEUS (Table 2). The histopathological correlation which revealed fibrotic seminoma (pat. #2), necrotic embryonal carcinoma (pat. #5) and necrotic teratoma (pat. #8) clarified the lack of contrast enhancement in those tumors. Two testicular tumors featured malignancy-associated wash-out (Figure 2D), histopathological correlation revealed underlying seminoma and mixed germ-cell tumor (Table S1).
Longitudinal kidney function outcome in aging testicular cancer survivors
Published in Acta Oncologica, 2020
Ragnhild V. Nome, Milada Cvancarova Småstuen, Trine Bjøro, Cecilie E. Kiserud, Sophie D. Fosså
Of the 1,813 invited TCSs, 1,436 participated in S1. In 1,273 of these, eGFR could be calculated with N = 670 also evaluable at S3 (Supplementary Figure 1). About half of the responders to S1 were diagnosed with seminoma and half had non-seminoma. Median age at diagnosis was 31 years with seminoma patients being slightly older (median 35 years) than those with non-seminoma (median age 28 years). At S3, TCSs had been followed for median 26 years (range 21–36 years) since diagnosis (Table 1), the interval between S1 and S3 being median 15 years. Initially non-metastatic disease was diagnosed in 71% of the patients. CBCT was administered to 39%, 42% received RT only and 19% surgery only. The treatment type distribution was similar at all three assessment time points (Table 1).
Metastatic seminoma presenting as neck and axillary lymphadenopathy in an elderly man
Published in Baylor University Medical Center Proceedings, 2023
Binoy Yohannan, Allen Omo-Ogboi, Johncy John Kachira, Syed H. Jafri
Metastatic seminomas are categorized as good risk if there is no metastasis to organs outside of LN and lungs. Intermediate-risk disease involves metastasis to organs other than lungs and LN. Cisplatin-based chemotherapy has changed the therapeutic landscape of testicular neoplasms. Seminomas are considered highly curable in younger patients, even in the metastatic setting, but the prognosis of older men (≥50 years) remains suboptimal, as they often have advanced disease at presentation and are at risk for treatment-related mortality.3,4 For men with good risk disease, either three cycles of BEP or four cycles of EP is recommended, and the latter is preferred in men at risk for pulmonary toxicity. In patients with intermediate-risk disease, four cycles of BEP is recommended; however, four cycles of cisplatin, vinblastine, and ifosfamide is an alternative regimen that can be used in patients at risk for pulmonary toxicity.9 Single agent carboplatin (AUC of 10 given every 21 days) is a less toxic option that has shown promising results in a multicenter study of 216 patients (15% with age >60) achieving an impressive 3-year progression-free survival of 96.5% and 5-year disease-specific survival of 98.5%.10 Treatment response can be assessed by monitoring tumor markers on day 1 of each chemotherapy cycle. Clinical outcomes of metastatic seminoma have improved substantially in recent times with 5-year overall survival of up to 95% in good-risk disease and 88% in intermediate-risk disease.11
Related Knowledge Centers
- Metastasis
- Seminiferous Tubule
- Testicular Atrophy
- Neoplasm
- Mediastinum
- Malignancy
- Germ Cell Tumor
- Testicle
- Germinal Epithelium
- Testicular Self-Examination