Association of Torsion With Testicular Cancer: A Retrospective Study

Torsion of the spermatic cord revealing cystic dysplasia of the testicle

Cystic dysplasia of the testis is characterized by the presence of multiple cysts within the testicular parenchyma. It is a rare benign tumor. It is often accompanied by kidney malformations. There is no consensus on treatment. We report here the case of testicular dysplasia revealed by a torsion of the spermatic cord in an adult. The diagnosis of cystic dysplasia of the testis was made intraoperatively and confirmed by pathology. An orchiectomy was performed. Serum testicular cancer markers were normal postoperatively.

A rare cause of testicular torsion: Lymphocytic infiltration in an adolescent with recently diagnosed B-ALL

Testicular torsion is a commonly encountered medical emergency in children. A 10-year-old boy with diagnostically confirmed leukemia presented with new onset testis swelling. Scrotal ultrasound showed absent blood flow on the left, consistent with acute testicular torsion. The patient underwent left orchiectomy due to the testis being unsalvageable. Later pathology confirmed lymphoblastic infiltrates. A malignancy of the testicles is rarely associated with torsion and, in the setting of leukemia, suggests widespread disease. Due to the risk of scrotal violation, an inguinal approach is preferable for surgical exploration of the testicles in patients with a history of leukemia.

[A CASE OF TESTICULAR TUMOR DIAGNOSED DUE TO ACUTE SCROTUM]

A 32-year-old man visited the emergency department complaining of the right scrotal pain, which occurred suddenly during sexual intercourse. Palpation revealed induration and tenderness on the caudal side of the right testis. Ultrasonography revealed a mosaic-like mass on the caudal side of the testis and no difference in blood flow between the right and left testes. The patient underwent a thorough examination the next day. Although the blood test did not show elevated tumor marker levels, testicular MRI revealed a mass with heterogeneous signal in the right scrotum. Subsequently, the patient was referred to another hospital for surgery. The pathological examination revealed a mixed germ cell tumor: seminoma (60%), teratoma (20%), and embryonal carcinoma (20%). One year postoperatively, the patient has had no recurrence. Testicular tumors are rarely discovered in acute scrotum, and few such cases have been reported. Torsion of the tumor, hemorrhage, necrosis, rupture, and infection have been reported as mechanisms of occurrence. When acute scrotum is diagnosed, testicular tumor should be considered as a differential diagnosis.

Testicular Germ Cell Tumors: Classification, Pathologic Features, Imaging Findings, and Management

Testicular germ cell tumors (TGCTs) demonstrate a wide variety of histopathologic, genetic, pathogenetic, and immunocytochemical characteristics and various clinical-biologic profiles and prognoses. Most TGCTs arise from an intratubular precursor cell referred to as germ cell neoplasia in situ (GCNIS), which is an embryonic germ cell with the potential to differentiate into a plethora of embryonic and extraembryonic lineages. Advances in pathologic examination and genetics paved the way for the 2016 World Health Organization (WHO) classification system, which recognizes two pathogenetically distinct groups of TGCTs. Although postpubertal tumors originate from GCNIS, almost all prepubertal tumors belong to the non-GCNIS category. Molecular testing for chromosome 12p amplification helps to distinguish the two tumor categories. Imaging techniques such as US, CT, MRI, and fluorine 18 (¹⁸F)-fluorodeoxyglucose PET/CT are pivotal to the diagnosis and staging, evaluation of complications and treatment response, and long-term surveillance of TGCTs. In addition, select MRI findings may help to differentiate a seminoma from a nonseminomatous mixed TGCT. Accurate diagnosis of TGCTs has therapeutic and prognostic implications. Although seminomas show exquisite response to chemotherapy and radiation therapy, postpubertal teratomas are highly resistant to both. The 2016 WHO classification system introduced changes in the diagnosis and management of TGCTs, including the development of new treatment and follow-up guidelines. Radiologists play an essential role in the optimal treatment of patients with TGCTs. Online supplemental material is available for this article. ©RSNA, 2021.

Germ cells positive for PLAP and c-Kit in 11-16 year old normal boys with ongoing spermatogenesis

INTRODUCTION

Positive staining of testicular germ cells for PLAP and c-Kit beyond infancy may be associated with the presence of GCNIS (Germ Cell Neoplasia In Situ). We recently reported our findings of positive staining of normal, infantile germ cells for PLAP, and c-Kit up to 2 years of age, contrary to previous studies. The present study aims to elucidate whether otherwise normal testes of boys undergoing puberty express PLAP, c-Kit, Oct3/4, or D2-40.

MATERIALS AND METHODS

Biopsies were taken from 31 boys (11.5-16.5 years of age, mean and median of 13.5 years), who underwent surgery either for torsion of the testis (15) or a history suspicious of intermittent torsion of the testis (16). 21 were biopsied on both sides, making a total of 52 biopsies. Four testes were necrotic. The biopsies were fixed in Stieve's medium, cut into 2 μm sections, and mounted on coated slides. One slide was processed for H-E, and the others incubated with primary antibody for PLAP, c-Kit, D2-40, and Oct3/4.

RESULTS

87% of the boys stained positive for both PLAP and c-Kit. None were positive for either D2-40 or Oct3/4. None had any histological features characteristic of GCNIS. Only two boys showed no signs of having initiated spermatogenesis. Those positive for PLAP were likewise for c-Kit, and vice versa, except 2; one boy, 13 years, was positive for PLAP, but negative for c-KIT, another, 16 years, was negative for PLAP and positive for c-Kit. Three boys stained positive for PLAP and c-Kit on the right side, and negative on the left. One boy was negative for c-Kit on the right side, positive on the left, and positive for PLAP bilaterally.

CONCLUSION

Positive staining of testicular germ cells for PLAP and c-Kit seems to be a normal finding in boys not having completed puberty. Rather than indicating pre-malignant transformation, the positivity is indicative of an ongoing maturational process of the germ cells.

Testicular cavernous hemangioma associated with testicular torsion - case report and review of literature

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Testicular hemangioma is exceedingly rare and typically occurs in patients younger than 20 years.

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Hemangiomas of the testis have a similar sonographic and magnetic resonance imaging appearance to that of malignant tumors of the testis, especially seminoma.

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Clinicians and pathologists must be aware of the rare entity of testicular hemangiomas, as clinical examination and imaging studies do not often suffice to arrive at a correct diagnosis.

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The association of testicular torsion with testicular hemangioma is a rarity in children.

Introduction

Testicular neoplasms that are derived from connective tissue, blood vessels and musculature are uncommon and intra-testicular tumors of vascular origin are extremely rare; both are benign in nature. Testicular hemangioma is exceedingly rare and typically occurs in patients younger than 20 years, the age in which a primary germ cell tumor of the testis may present, necessitating a radical approach to management with orchidectomy, although potential conservative focal partial surgical excision is desirable. Hemangiomas of the testis have a similar sonographic and magnetic resonance imaging appearance to that of malignant tumors of the testis, especially seminoma.

The work has been reported in line with the SCARE criteria.

Presentation of case

We present a case of testicular torsion in a 15-year-old male patient who had a painful left testis for 6 days, no vomiting, no fever or dysuria.

With clinical suspicion of an old testicular torsion the patient was examined by ultrasound which confirmed the clinical diagnosis.

The patient underwent emergency surgical exploration. The left testis was found to be necrotic after a 360° testicular torsion and an orchiectomy was performed.

Results

The postoperative course was uneventful. The patient was discharged on day 4 after surgery. Histology showed a complete ischemic infarction of the testicular parenchyma as part of a ruptured intratesticular cavernous hemangioma.

Discussion and conclusion

Cavernous hemangioma is a rare tumor of the testicle in either childhood or adult period. The particularity of the presented case is the possible association of a cavernous intratesticular hemangioma with the torsion of the testis in a teenager. Clinicians and pathologists must be aware of the rare entity of testicular hemangiomas, as clinical examination and imaging studies do not often suffice to arrive at a correct diagnosis.

Intra-scrotal testicular torsion of a classical seminoma in an elderly patient: a case report and literature review

Intra-scrotal testicular torsion of a seminoma is extremely rare and has been reported scarcely in literature. On the other hand testicular torsion by itself is rare in old age as well. We report a 63-year-old male who was presented to our Emergency Department with a right scrotal swelling and pain for 1 week. The patient had intra-scrotal testicular torsion of a seminoma which was overlooked initially by Doppler ultrasound, progression of symptoms led to a computed tmomgraphy scan which showed a testicular torsion. Intra-operative findings showed a torsed right testis with completely engorged cord. Right radical orchiectomy was done and indecently histopathology revealed a classical seminoma. Urologist should be aware and more vigilant of testicular torsion as a presentation of malignancy in old age especially with the presence of diagnostic limitations.