Dizygotic twinning, cryptorchism, and seminoma in a sibship

Population-based investigation of familial undescended testis and its association with other urogenital anomalies

OBJECTIVE

Up to now, observation of familial undescended testis (UDT) has been confined to the description of individual cases. The aim of our study was to evaluate the frequency of a positive family history and of associated urological anomalies in family members, and to calculate the risk of newborn male individuals having UDT if a family member is affected.

METHODS

A total of 374 patients who underwent surgery because of UDT and 374 controls without UDT were interviewed by means of a special questionnaire. We asked for a family history of UDT, as well as for other urogenital anomalies (varicocele, hydrocele, hypospadias, testicular cancer, renal anomalies). For statistical analysis the odds ratio was calculated.

RESULTS

Of the analysed patients, 85 (22.73%) had family members with UDT versus 7.5% of the control group. Of these 85 cases, brothers were involved in 37.3%, fathers in 35.2%, uncles in 23.5%, cousins in 16.5%, great-cousins in 8.2% and grandfathers in 7.1%. The risk of UDT in a newborn male is 3.6-fold overall, and 6.9-fold if a brother and 4.6-fold if the father is affected. The rate of family members with UDT and/or other urogenital anomalies in the patient group was nearly 2-fold higher than in the control group.

CONCLUSIONS

Due to the increased familial risk and the higher percentage of a positive family history for UDT and other urogenital anomalies in patients with UDT, a genetic predisposition seems probable.

Occurrence of seminoma and dysgerminoma in father and daughter

We report the occurrence of seminoma and dysgerminoma in father and daughter. Both tumors exhibited similar histological appearances. This case supports the concept of a common genetic basis for these germ cell tumors.

Familial testicular cancer: report of six cases and review of the literature

The cause of testicular cancer, like most other cancers, is unknown. Certain risk factors such as cryptorchidism, carcinoma in situ, and a preceding contralateral testicular germ cell neoplasm are known to predispose a person to the subsequent development of a testicular malignant lesion. Familial testicular cancer has been debated as a potential and possibly independent risk factor. Evidence in favor of such a hypothesis, based on various genetic studies reported during the past few decades, is reviewed. We add to the existing literature our experience with six cases of familial testicular cancer encountered during a 10-year period, consisting of four father-and-son pairs, one pair of nontwin brothers, and a 23-year-old man who had a maternal uncle with a history of testicular cancer.

Familial cancer syndromes and clusters

Familial aggregation has been reported for virtually every form of cancer in humans. In general, close relatives of a cancer patient appear to have a twofold to threefold increase in risk for that tumor. Among cancer families, however, the level of excess risk is heterogeneous and ranges up to 1000-fold. Familial clusters of cancer are often due to inherited susceptibility, but environmental influences and chance association also must be considered. The effect of chance is large, due to the 50% lifetime risk of developing cancer that is present in the general U.S. population. Thus, a family history of cancer is the rule rather than the exception, and special studies are needed to distinguish predisposition from chance. An inherited susceptibility to cancer often becomes apparent through the occurrence of the same neoplasm among multiple blood relatives. These neoplasms tend to occur at earlier ages than usual, to appear bilaterally in paired organs, and to develop in multiple primary foci within the predisposed organ. Hereditary cancers can also develop as multiple primary tumors in organs that share the same embryological origins, as in the multiple endocrine neoplasia (MEN) syndromes. In addition, neoplasia occurs as a feature of diverse inherited diseases, such as neurofibromatosis types 1 and 2, which predispose to tumors of the peripheral nerves and brain. Recent advances in molecular biology have greatly enhanced the importance of studying cancer families. Newly developed molecular probes have been applied to map the loci of several human cancer genes. The studies have also revealed a new class of human oncogenes, the tumor suppressor genes. These genes normally function by suppressing the tumor phenotype. When inactivated or deleted in germinal cells, they can be transmitted to subsequent generations and predispose to cancer among carriers in the family. At the molecular level, these carriers have inherited a structural abnormality in one allele of a recessive oncogene, and loss of the second allele at the locus results in tumor development. The first tumor suppressor that has been isolated is the retinoblastoma gene on chromosome 13q14. Studies indicate that this gene is involved in the development of many more human cancers than had been appreciated previously on the basis of clinical observations. Presently, the identification of cancer families can be applied to genetic counseling, the in-utero diagnosis of carriers, and early disease detection. In familial cancers that are triggered by environmental carcinogens, patient education regarding the avoidance of harmful exposures can help prevent or delay the onset of neoplasia.

Are germ cell tumors part of the Li-Fraumeni cancer family syndrome?

The occurrence of six cases of germ cell tumors, five testicular and one ovarian, in relatives of children with bone or soft tissue sarcomas is described. It is proposed that germ cell tumors may be an uncommon manifestation of the genetic predisposition to cancer that exists in the Li-Fraumeni cancer family syndrome.

Testicular tumors in non-twin brothers from a consanguineous marriage

Malignant testicular tumors occurring in non-twin brothers are reported. Both of the brothers suffered from amentia and epilepsy and were the product of a consanguineous marriage. One brother presented with teratocarcinoma and the other seminoma. With a review of the literature, genetic roles in the etiology of testicular neoplasia are discussed.

Prenatal and familial associations of testicular cancer

In a case-control study of testis cancer 259 cases with testicular cancer, 238 controls treated at radiotherapy centres and 251 non-radiotherapy hospital in-patient controls were interviewed about some possible prenatal and familial risk factors for the tumour. For firstborn men, the risk of testis cancer increased significantly according to maternal age at the subject's birth, and this effect was most marked for seminoma. The association with maternal age was not apparent for cases other than firstborn. The risk of testis cancer was also significantly raised for men from small sibships and of early birth order. These results accord with the theory that raised maternal levels of available oestrogen during the early part of pregnancy are aetiological for testicular cancer in the son, although other explanations are possible; there is evidence that seminoma risk may particularly be affected.

Simultaneous cloacogenic carcinoma in dizygotic twins

Dizygotic twins developed cloacogenic carcinoma of the anus almost simultaneously. The patients, although separated from the time they were 20-years-old, had very similar life styles. There are several reports in the medical literature of synchronous tumors in mono and dizygotic twins. It is recommended that if a cancer diagnosis is made in one twin, the other undergo workup to exclude the presence of a tumor with similar histology. The establishment of state or national twin registries would provide valuable information regarding the role of genetic and environmental factors in the development of not only cancer but also of various nonmalignant disorders.

Testicular malignancy in father and son. A case report

The etiology of testicular cancer is unknown, but both environmental and genetic factors have to be considered. The recognition of the tumour in more than one member of a family, a rare occurrence, adds further material to the research of the etiology and might, therefore, be of general interest. To the few cases of testicular cancer occurring both in father and son reported in the literature, the present presentation adds another instance of embryonal metastasizing cancer.

A case of simultaneous bilateral germ cell tumors arising from cryptorchid testes

We report a rare case of simultaneous bilateral testicular germ cell tumors arising from uncorrected cryptorchid testes. Each side had a different histological type, which consisted of pure high grade seminoma on the left side, and teratocarcinoma with choriocarcinoma and yolk sac tumor elements in addition to seminoma on the right side. Patients with cryptorchidism are known to have a higher risk of germ cell tumors. Genetic factors also may have a role in the oncogenesis in our patient, since his older brother had had a seminoma in the left cryptorchid testis previously. Both patients had the HLA-Aw24 antigen. The characteristics of familial testicular tumors are discussed.

Identical laryngeal cancers in two non-twin sibling pairs: case reports and a review of the literature

The occurrence of identical laryngeal cancers in two nontwin sibling pairs is reported for the first time. To understand the relative importance of genetic and environmental factors in the etiology of laryngeal cancer, the evidence in the literature for the development of identical cancers in genetically unrelated and related pairs sharing the same environments was examined.

Familial embryonal carcinoma in a cancer-prone kindred

Familial testicular cancer is rare. This report describes a family with an unusual cancer spectrum that included the infantile form of embryonal carcinoma of the testis in the son of a cancer-free but putative obligate gene carrier mother, and the adult form of embryonal carcinoma in this women's maternal half-brother (their mutual mother had malignant melanoma and urinary bladder carcinoma). Hereditary syndrome designation remains elusive. Priority attention to biomarker research in families of this type for elucidation of cause and control is discussed.

Familial testicular cancer and urogenital developmental anomalies

In a case-control study of testicular cancer, 6 of 269 cases (2.2%) reported a first-degree relative with testicular cancer, compared to 1 of 259 controls (0.4%). Fathers and brothers of testicular cancer cases had a six-fold elevated risk of developing a testicular malignancy compared to men in the general population. Cryptorchidism was reported in a first-degree relative in 1 (17%) of the familial cases versus 7 of 259 (2.7%) controls and 14 of 263 (5.3%) cases with a negative family history for testicular cancer. One half of the 6 familial cases reported a first-degree relative with a groin hernia (all surgically repaired before age 12), compared to 12.7% of 259 controls and 10.3% of 263 nonfamilial cases. Three familial clusters identified through the case-control study were selected for clinical evaluation. One of the 6 surviving males with testicular cancer in these 3 families had undergone orchiopexy and inguinal herniorrhaphy at age 6 years, and one had a hydrocele associated with his testicular tumor. Of the 12 living fathers and brothers of these 6 men, 3 reported childhood inguinal hernias, two with coexisting hydroceles. One additional hernia and two additional hydroceles were detected during urologic evaluation of these healthy relatives. The high prevalence of cryptorchidism, inguinal hernias, and hydroceles among men in these families suggests that an underlying alteration in urogenital embryogenesis may be associated with the familial predisposition to testicular neoplasia.

Testicular neoplasms in Hispanic brothers

Two hispanic brothers developed nonconcordant testicular malignancies in an interval of 11 months. They represent the 36th report of familial testicular neoplasia. The problems deriving from poor patient compliance are documented.