Is contralateral testicular biopsy warranted at the time of orchidectomy? (original) (raw)
Related papers
Orchidectomy alone in stage I nonseminomatous testicular germ cell tumors
Cancer, 1987
Fifty-four patients with Stage I nonseminomatous testicular germ cell tumors (NSTGCT) were treated from 1982 to 1984. In 1982 and 1983, the orchidectomy was followed by an exploratory laparotomy to conclude the dissemination study. In 1984, laparotomy was performed only if indicated. The mean followup was 29 months. A relapse occurred in 11 patients (20%). The relapse rate in patients who underwent exploratory laparotomy was as high as that in patients who did not. All patients treated for relapse by chemotherapy and surgery entered a complete remission for at least 1 year. It proved impossible to establish criteria for prediction of a subsequent relapse. Both serum tumor marker assays and roentgenography are important aids in diagnosing a relapse. With careful follow-up of Stage I NSTGCT patients, a wait-and-see attitude can be adopted until a relapse occurs.
APMIS, 1998
Purpose: Testicular intraepithelial neoplasia (TIN; so-called carcinoma in situ of the testis), the precursor of testicular germ cell neoplasms can be detected by testicular biopsy many years before the clinical manifestation of the tumour. This study looked at the prevalence of contralateral TIN in patients with testicular germ cell cancer. The purpose was to evaluate this new approach of early detection of testicular cancer and to evaluate the current management strategies. Patients, methods: 1954 consecutive patients with unilateral testicular germ cell tumour underwent contralateral biopsy. All specimens were examined immunohistologically with staining for placental alkaline phosphatase. Patients with TIN were usually submitted to low-dose radiotherapy of the testis. A rebiopsy was performed after 3 months. Endocrinological evaluations were done before, during and after treatment. Results: TIN was observed in 4.9% (95% confidence intervals 3.95% ~ 5.91%). Testicular atrophy constitutes a 4.3 fold increased risk of having contralateral TIN. 64% of the cases with TIN were found in clinically normal testes. Patients with TIN were significantly younger than those without (p<0.017). No case with TIN was found in patients older than 50 years. Three patients developed a second testicular tumour during follow-up despite a negative biopsy. After radiotherapy, all of 23 patients had complete disappearance of TIN in the rebiopsy. After chemotherapy, 3 of 10 patients had persistent TIN histologically. After radiotherapy, 12 of 41 patients required testosterone replacement. Conclusion: The prevalence of contralateral TIN accords well with the known prevalence of bilateral testicular tumours. Testicular atrophy is a strong indicator for the presence of TIN but about 60' !4 of TIN-cases occur without atrophy. Local radiotherapy to the testis with 18 ~ 20 Gy is efficaceous in eradicating TIN, but it causes significant damage to almost one quarter of these patients. Chemotherapy is an unsafe treatment for TIN. This study shows the feasibility of early detection of testicular cancer in a high-risk population by means of searching for TIN. Although the management of the condition still needs refinement, the TIN-concept offers an avenue for the early detection of testicular cancer and early conservative management.
Andrology, 2015
The precursor of testicular germ cell tumours (GCTs), called testicular intra-epithelial neoplasia (TIN/CIS), is safely diagnosed immunohistologically. Testicular biopsy provides a valuable tool for early detection of GCTs in risk groups. Although this knowledge is undisputed, testicular biopsies are utilized poorly. The patterns of care regarding the use of biopsies remain unknown. Uncertainty exists about the prevalence and specific treatment of TIN/CIS. We asked clinical urologists in Germany whether or not they employed contralateral biopsies in GCT patients. We evaluated the prevalence of contralateral TIN/CIS in a retrospective analysis of 780 consecutive GCT patients. All had contralateral double biopsies. Discordance of TIN/CIS findings among biopsy pairs as well as age, histology of the primary tumour and clinical stage was noted. Evaluation of data comprised descriptive statistical methods. To evaluate treatment options for TIN/CIS, we performed a literature search. 52.1% ...
BMJ, 1986
Carcinoma in situ in the contralateral testis was diagnosed in 27 of 500 patients (5.4%) with unilateral testicular germ cell cancer. Eight of the 27 patients received intensive chemotherapy for spread of their initial testicular cancer. Follow up biopsy studies did not detect changes of carcinoma in situ in any of these patients, and none developed a contralateral testicular tumour (observation time 12-88 months). Of the remaining 19 patients with carcinoma in situ, seven developed contralateral testicular cancer. The estimated risk of developing invasive growth was 40% within three years and 50% within five years. None of the 473 patients without carcinoma in situ detected by screening biopsy developed contralateral testicular cancer (observation time 12-96 months). No serious complications arose from the biopsy procedures.
Testis-preserving surgery in bilateral testicular germ cell tumours
Journal of Pediatric Surgery, 1997
Objective To evaluate the indications, techniques and 14-163) and the 13 patients are currently free of disease; one patient had local recurrence 9 months outcome of organ-preserving tumour enucleation in patients with bilateral testicular germ cell tumours after tumour enucleation but after orchidectomy the patient is free of disease after a follow-up of 156 (BTGCT) rather than standard bilateral radical orchidectomy which results in loss of fertility and a lifelong months. Serum concentrations of luteinizing hormone and testosterone were within the normal range in all requirement for androgen replacement. Patients and methods In 13 patients with BTGCT of patients and no androgen substitution was necessary. A testicular biopsy taken 6 months post-operatively 6-30 mm in diameter, the tumours were enucleated under cold ischaemia after inguinal testicular explo-revealed Sertoli cells only in all patients who had received radiation therapy. ration, and biopsies of the tumour bed and the peripheral parenchyma were taken. Histology of the Conclusions These results suggest that organ-sparing surgery in patients with BTGCT represents a new orchidectomy specimen revealed a seminoma in four cases, an embryonal carcinoma in three, a teratocarci-therapeutic approach with endocrinological and psychological advantages. In our experience, enucle-noma and a mixed-germ cell tumour in two each, and a mature teratoma in one. Histology of the enucleated ation resection of testicular tumours is possible with certain prerequisites, i.e. the tumour is organ-confined tumours showed a seminoma in seven cases, an embryonal carcinoma in five and a mature teratoma with no infiltration of the rete testis, multiple biopsies of the tumour bed and peripheral parenchyma should in one. Six of the 13 patients underwent testicular radiation (20 Gy) for carcinoma in situ (CIS) and five be taken, any associated CIS treated by radiation therapy, and patients must be followed closely. patients had adjuvant local therapy. Six months postoperatively, a testicular biopsy was taken to determine Keywords Bilateral testicular cancer, bilateral germ cell tumour, tumour enucleation, organ-sparing surgery, the success of therapy. Results The median follow-up was 62 months (range follow-up improved dramatically during the last decade, with
Role of organ-sparing surgery in germ cell tumors of the testis
Urology, 2004
G erm cell tumors of the testis are the most frequent type of cancer in men aged 15 to 35 years and currently account for 1% of all malignant tumors in men. Contemporary epidemiologic studies have reported on the increasing incidence of testicular cancer in the United States in the past two decades. 1,2 Although it is not clear whether the incidence of bilateral testicular cancer has correspondingly increased, patients who develop testicular carcinoma in one testis are 500 to 1000 times more likely to develop testicular carcinoma in the contralateral testis. 3-9 Removal of both gonads is still considered the reference standard therapy for bilateral testicular cancer, which invariably results in infertility and lifelong dependency on androgenreplacement therapy, in addition to the distressful psychological effect of castration at a young age.
Incidentally detected testicular lesions <10 mm in diameter: can orchidectomy be avoided?
BJU international, 2017
To investigate the pathology of excised testicular lesions <10 mm. The pathological reports of 2,681 patients from Barts Health NHS Trust and Oxford University Hospitals NHS Foundation Trust (OUHFT) were reviewed as part of a service evaluation audit from January 2003 to May 2016. Cases with a maximum diameter of <10 mm were selected. Clinical features were also accessed, where available, to look for patient demographics, pre-diagnostic levels of serum markers, ultrasonograophic (US) findings and clinical details. 81 cases with a tumour size <10 mm on histology were identified and of these, 16 cases (20%) had a diameter <5 mm. 56/81 cases (69%) were benign. 15 of the 16 benign cases <5 mm underwent orchidectomy; just one underwent partial-orchidectomy. Pre-operative tumour markers were available in 47/81 cases: out of the 47 cases, none of the 16 malignant tumours had raised tumour markers, while 7 of 31 remaining benign lesions had raised alpha-Fetoprotein (AFP) and ...