1
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Cazzaniga W, Pierorazio P, Heidenreich A. Review of Discordance Between American Urological Association and European Association of Urology Guideline Recommendations for Testicular Cancer. Eur Urol Focus 2024:S2405-4569(24)00079-8. [PMID: 38849277 DOI: 10.1016/j.euf.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 05/27/2024] [Indexed: 06/09/2024]
Abstract
We compared the American Urological Association and the European Association of Urology guidelines on testicular cancer. We identified a few differences, in particular for management of low-volume metastatic serum tumor marker-negative stage IIA/B seminoma and nonseminoma, and of advanced and relapsing disease. Overall the rate of concordance between the guidelines is high. PATIENT SUMMARY: We compared guidelines on testicular cancer published by the American Urological Association and the European Association of Urology. We found a high rate of agreement between the two guidelines, with some differences.
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Affiliation(s)
- Walter Cazzaniga
- Department of Urology, Royal Marsden NHS Foundation Trust, London, UK
| | - Phillip Pierorazio
- Section of Urology, Penn Presbyterian Medical Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Axel Heidenreich
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany; Department of Urology, Medical University Vienna, Vienna, Austria.
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2
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Gonzaga-Carlos N, Virgen-Gutierrez F, Angulo-Lozano JC, Virgen-Rivera MF, Maldonado-Avila M, Jaspersen Gastelum J. Association Between Testicular Microlithiasis and Histological Subtype in Testicular Cancer. Cureus 2022; 14:e29946. [DOI: 10.7759/cureus.29946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2022] [Indexed: 11/05/2022] Open
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3
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Nagaraj RV, Rao BV, Yoganarsimha J, Fonseca D, Kodandapani S, Giridhar A, Sharma R, Rajappa S, Rao TS, Sundaram C. Post-treatment Residual Clinicopathological Outcomes in Testicular Germ Cell Tumours. Indian J Surg Oncol 2022; 13:505-510. [PMID: 36187518 PMCID: PMC9515290 DOI: 10.1007/s13193-021-01491-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 12/16/2021] [Indexed: 10/19/2022] Open
Abstract
Surgical resection is a generally accepted treatment for residual masses after chemotherapy for metastatic testicular germ cell tumour (GCT). About half the patients have necrosis in post-chemotherapy residual masses, whereas rest have viable tumour and teratoma. The likelihood of leaving behind teratoma with its subsequent complications such as growing teratoma syndrome necessitates resection outweighing its surgical complications. Ours is a retrospective observational study and aims at assessing post-chemotherapy residual masses in testicular GCTs and to predict importance of teratomatous and non-seminomatous components. A total of 62 cases of testicular GCTs resected after chemotherapy between January 2012 and June 2019 were included. Demographic, clinical, biochemical and imageological findings were noted and categorised according to WHO classification (2016). They were divided into two groups - those who underwent retroperitoneal lymph node dissection (RPLND) post-high inguinal orchidectomy (HIO) and chemotherapy (CT) as group 1 (n = 40) and those who underwent HIO and/or RPLND post-chemotherapy as group 2 (n = 22). The gross and microscopic examination was carried out to assess response to chemotherapy in terms of residual viable tumour, necrosis and teratoma. Viable tumour, necrosis and teratoma were 10%, 62.5% and 35% respectively in group 1 and in group 2, the same were 15%, 70% and 25% respectively in HIO specimen and 7%, 50% and 21% respectively in RPLND specimen. All the cases with viable tumour were proven to be yolk sac tumours (YST) based on morphology and immunohistochemistry (IHC).Twenty cases had teratoma in the post-CT residual masses out of which 11 cases had teratoma despite reduction in size. At a median follow-up of 47.85 months, 5 cases in group 1 and 2 cases in group 2 showed relapse and it was observed that group 1 had a prolonged relapse-free survival over group 2. Our study re-emphasises the importance of performing resection of residual mass post-CT irrespective of the size, imageological or biochemical evidence of tumour regression. There does not appear to be reliable predictors of post-chemotherapy histology of residual masses indicating the continued need for surgical resection in specialised centres.
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Affiliation(s)
- Ranjitha Vodigenahalli Nagaraj
- Department of Pathology & Lab Medicine, Basavatarakam Indo American Cancer Hospital & Research Institute, Road No 14, Banjara Hills, Hyderabad, TS 500034 India
| | - B. Vishal Rao
- Department of Pathology & Lab Medicine, Basavatarakam Indo American Cancer Hospital & Research Institute, Road No 14, Banjara Hills, Hyderabad, TS 500034 India
| | - Jayakarthik Yoganarsimha
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, India
| | - Daphne Fonseca
- Department of Pathology & Lab Medicine, Basavatarakam Indo American Cancer Hospital & Research Institute, Road No 14, Banjara Hills, Hyderabad, TS 500034 India
| | - Suseela Kodandapani
- Department of Pathology & Lab Medicine, Basavatarakam Indo American Cancer Hospital & Research Institute, Road No 14, Banjara Hills, Hyderabad, TS 500034 India
| | - Ashwin Giridhar
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, India
| | - Rakesh Sharma
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, India
| | - Senthil Rajappa
- Department of Medical Oncology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, India
| | | | - Challa Sundaram
- Department of Pathology & Lab Medicine, Basavatarakam Indo American Cancer Hospital & Research Institute, Road No 14, Banjara Hills, Hyderabad, TS 500034 India
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4
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Barda S, Hauser R, Mano R, Savin Z, Molad-Hayo Y, Lehavi O, Kleiman SE, Azem F, Yossepowitch O, Dekalo S. Testicular microlithiasis defines a subgroup of azoospermic men with low rates of sperm retrieval. Int J Urol 2021; 29:65-68. [PMID: 34605564 DOI: 10.1111/iju.14717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 09/12/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the prevalence of testicular microlithiasis and its association with sperm retrieval rates and histopathology in men with non-obstructive azoospermia. METHODS A total of 120 men underwent scrotal ultrasonography prior to microsurgical testicular sperm extraction. Sperm retrieval rate, testicular histopathology, testicular size, reproductive hormones, karyotyping, Y chromosome microdeletion analyses, and presence of varicoceles and hydroceles were compared between men with and without testicular microlithiasis. RESULTS The total sperm retrieval rate was 40%. Ten men with normal spermatogenesis were excluded. The remaining 110 men with non-obstructive azoospermia were analyzed and testicular microlithiasis was detected in 16 of them (14.5%). The sperm retrieval rate in that subgroup was only 6.2% (1/16) as opposed to 39.4% (37/94) in men with non-obstructive azoospermia and no evidence of microlithiasis (P = 0.009). The mean right and left testicular diameters were significantly lower in the microlithiasis group (P = 0.04). On multivariate logistic regression analysis, the presence of mictolithiasis (odds ratio 7.4, 95% confidence interval 2.3, 12.2; P = 0.01) was the only independent predictor of unsuccessful sperm retrieval. The 15 patients with microlithiasis and without successful sperm extraction were diagnosed by histopathology as having Sertoli cells only. The 16th patient with successful sperm retrieval had a histopathology of mixed atrophy and was diagnosed with Klinefelter syndrome. CONCLUSION The presence of testicular microlithiasis is associated with low sperm retrieval rates among our cohort of men with non-obstructive azoospermia undergoing scrotal ultrasonography prior to microsurgical testicular sperm extraction. Larger, prospective studies should be conducted to confirm these findings.
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Affiliation(s)
- Shimi Barda
- Institute for the Study of Fertility, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Israel Academic College, Ramat Gan, Israel
| | - Ron Hauser
- Institute for the Study of Fertility, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Roy Mano
- Department of Urology, Tel Aviv Sourasky Medical Center, Israel
| | - Ziv Savin
- Department of Urology, Tel Aviv Sourasky Medical Center, Israel
| | | | - Ofer Lehavi
- Institute for the Study of Fertility, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Sandra E Kleiman
- Institute for the Study of Fertility, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Foad Azem
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Snir Dekalo
- Institute for the Study of Fertility, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Urology, Tel Aviv Sourasky Medical Center, Israel
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5
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Chaka A, Daassa AF, Hamdouni W, Ktari K, Laamiri R, Nouri A. Pediatric testicular microlithiasis through four clinical case studies: review of the literature and proposal of clinical guidelines. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00216-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Testicular microlithiasis in children was defined for the first time in 1961 based on histological criteria. There should be more than 5 calcifications per testicle in order to say that the patient has testicular microlithiasis. It has three different echographic grades depending on the number of calcifications. However, this disease is uncommon, with inaccurate prevalence and no certain information about its evolution or etiology.
Main body
We studied 4 clinical cases of children diagnosed with testicular microlithiasis, in light of the conducted review of the literature, and we defined the characteristics of this disease and proposed a management and monitoring framework based on the clinical observations.
Conclusion
There is a link between testicular microlithiasis and testicular cancer. Therefore, it is recommended to make a regular follow-up of children who present testicular microlithiasis with the presence of risk factors.
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Yu CJ, Lu JD, Zhao J, Wei Y, Zhao TX, Lin T, He DW, Wu SD, Wei GH. Incidence characteristics of testicular microlithiasis and its association with risk of primary testicular tumors in children: a systematic review and meta-analysis. World J Pediatr 2020; 16:585-597. [PMID: 31853884 DOI: 10.1007/s12519-019-00328-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 11/28/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND To systematically evaluate the incidence characteristics of testicular microlithiasis (TM) in children and its association with primary testicular tumors (PTT). METHODS A systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. A priori protocol was registered in the PROSPERO database (CRD42018111119), and a literature search of all relevant studies published until February 2019 was performed. Prospective, retrospective cohort, or cross-sectional studies containing ultrasonography (US) data on the incidence of TM or the association between TM and PTT were eligible for inclusion. RESULTS Of the 102 identified articles, 18 studies involving 58,195 children were included in the final analysis. The overall incidence of TM in children with additional risk factors for PTT was 2.7%. In children, the proportion of left TM in unilateral cases was 55.7%, the frequency of bilateral TM was 69.0%, and proportion of classic TM was 71.8% [95% confidence interval (CI) 62.4-81.1%, P = 0.0, I2 = 0.0%]. About 93.5% of TM remained unchanged, and newly detected PTT rate was very low (4/296) during follow-up. The overall risk ratio of TM in children with a concurrent diagnosis of PTT was 15.46 (95% CI 6.93-34.47, P < 0.00001). CONCLUSIONS The incidence of TM in children is highly variable. Nonetheless, TM is usually bilateral, of the classic type, and remains stable or unchanged at follow-up. Pediatric patients with TM and contributing factors for PTT have an increased risk for PTT; however, there is no evidence to support mandatory US surveillance of children with TM.
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Affiliation(s)
- Cheng-Jun Yu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Jian-Dong Lu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Jie Zhao
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Yi Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics Chongqing, Room 806, Kejiao Building (No. 6), No. 136, Zhongshan 2nd Road, Yuzhong District, Chongqing, China
| | - Tian-Xin Zhao
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics Chongqing, Room 806, Kejiao Building (No. 6), No. 136, Zhongshan 2nd Road, Yuzhong District, Chongqing, China
| | - Tao Lin
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics Chongqing, Room 806, Kejiao Building (No. 6), No. 136, Zhongshan 2nd Road, Yuzhong District, Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Da-Wei He
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics Chongqing, Room 806, Kejiao Building (No. 6), No. 136, Zhongshan 2nd Road, Yuzhong District, Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Sheng-De Wu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China. .,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China. .,National Clinical Research Center for Child Health and Disorders, Chongqing, China. .,Chongqing Key Laboratory of Pediatrics Chongqing, Room 806, Kejiao Building (No. 6), No. 136, Zhongshan 2nd Road, Yuzhong District, Chongqing, China. .,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China. .,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.
| | - Guang-Hui Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics Chongqing, Room 806, Kejiao Building (No. 6), No. 136, Zhongshan 2nd Road, Yuzhong District, Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
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7
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Liu MY, Gray E, Hahn ME, Shiehmorteza M. Scrotal Ultrasound: Updates on Testicular Microlithiasis, Incidental Non-Palpable Lesions, Varicoceles and Testicular Infarction. CURRENT RADIOLOGY REPORTS 2020. [DOI: 10.1007/s40134-020-00372-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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8
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Vasta LM, McMaster ML, Harney LA, Ling A, Kim J, Harris AK, Carr AG, Damrauer SM, Rader DJ, Kember RL, Kanetsky PA, Nathanson KL, Pyle LC, Greene MH, Schultz KA, Stewart DR. Lack of pathogenic germline DICER1 variants in males with testicular germ-cell tumors. Cancer Genet 2020; 248-249:49-56. [PMID: 33158809 DOI: 10.1016/j.cancergen.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several studies have reported conflicting evidence on the inclusion of testicular germ cell tumors (TGCT) in the DICER1 tumor-predisposition phenotype. We evaluated the relationship between DICER1 and TGCT by reviewing scrotal ultrasounds of males with pathogenic germline variants in DICER1 and queried exome data from TGCT-affected men for DICER1 variants. METHODOLOGY Fifty-four male DICER1-carriers and family controls (n=41) enrolled in the National Cancer Institute (NCI) DICER1 Natural History Study were offered scrotal ultrasounds. These studies were examined by a single radiologist for abnormalities. In parallel, DICER1 variants from two large exome-sequenced TGCT cohorts were extracted. We used previously published AMG-AMP criteria to characterize rare DICER1 variants. RESULTS There was no observed difference in frequency of testicular cystic structures in DICER1-carriers versus controls. DICER1 variation was not associated with TGCT in the NCI DICER1-carriers. In 1,264 exome-sequenced men with TGCT, none harbored ClinVar- or InterVar-determined pathogenic or likely pathogenic variants in DICER1. Three DICER1 variants of uncertain significance (one case and two controls) were predicted "damaging" based on a priori criteria. CONCLUSION Using two complementary approaches, we found no evidence of an association between pathogenic DICER1 variants and TGCT.
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Affiliation(s)
- Lauren M Vasta
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, MD, USA; National Capital Consortium, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Mary L McMaster
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, MD, USA; Commissioned Corps of the United States Public Health Service
| | | | - Alexander Ling
- Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Jung Kim
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, MD, USA
| | - Anne K Harris
- International Pleuropulmonary Blastoma/DICER1 Registry, Minneapolis, MN, USA
| | - Ann G Carr
- Commissioned Corps of the United States Public Health Service
| | - Scott M Damrauer
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Corporal Michael Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Daniel J Rader
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Rachel L Kember
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter A Kanetsky
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Katherine L Nathanson
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Louise C Pyle
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mark H Greene
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, MD, USA
| | - Kris Ann Schultz
- International Pleuropulmonary Blastoma/DICER1 Registry, Minneapolis, MN, USA; Cancer and Blood Disorders, Children's Minnesota, International Pleuropulmonary Blastoma/DICER1 Registry, Minneapolis, MN, USA; International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, MN, USA
| | - Douglas R Stewart
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, MD, USA.
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9
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Davis JT, Wagner LM. Imaging of childhood urologic cancers: current approaches and new advances. Transl Androl Urol 2020; 9:2348-2357. [PMID: 33209708 PMCID: PMC7658153 DOI: 10.21037/tau-19-839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Urologic tumors make up approximately 10% of all pediatric cancers, and include a variety of different histologies and imaging considerations. In this review, we discuss standard radiologic approaches for children with tumors arising in the genitourinary system, and identify important ways in which imaging affects the differential diagnosis, preoperative planning, and staging of these tumors. In addition, we provide an update on strategies to reduce the time of imaging, which may obviate the need for sedation in younger patients. Efforts to reduce a patient’s overall radiation exposure and subsequent risk of second malignancy are also detailed, including recent work on surveillance imaging following completion of therapy. Finally, we highlight new techniques such as radiomics that are now being investigated for patients with these malignancies.
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Affiliation(s)
- Joseph T Davis
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Lars M Wagner
- Division of Pediatric Hematology/Oncology, Duke University Medical Center, Durham, NC, USA
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10
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Pedersen MR, Møller H, Rafaelsen SR, Møller JK, Osther PJS, Vedsted P. Association between risk factors and testicular microlithiasis. Acta Radiol Open 2019; 8:2058460119870297. [PMID: 31588363 PMCID: PMC6740053 DOI: 10.1177/2058460119870297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 07/26/2019] [Indexed: 11/16/2022] Open
Abstract
Background Testicular microlithiasis and its clinical significance are not fully understood. Testicular microlithiasis and risk factors have been associated with testicular cancer. The role of testicular microlithiasis is investigated. Purpose To investigate the association between testicular microlithiasis and socioeconomic and other pre-diagnostic factors. Material and Methods All men who had a scrotal ultrasound examination at the Department of Radiology, Vejle Hospital, during 2001–2013 were included. They were categorized as patients with and without testicular microlithiasis and compared with pre-diagnostic data from a nationwide registry. A total of 2404 men (283 [11.8%] with testicular microlithiasis and 2121 [88.2%] without testicular microlithiasis) were included. The association between testicular microlithiasis and pre-diagnostic conditions was investigated with logistic regression. Results Overall, we found no statistically significant differences in demographics, socioeconomic characteristics, or testicular diseases in men with and without testicular microlithiasis. Men with testicular microlithiasis had more often been treated for infertility (odds ratio [OR] 2.09, 95% confidence interval [CI] 0.84–5.24) and testicular torsion (OR 1.58, 95% CI 0.34–7.36) compared to men without testicular microlithiasis. We found no association between sexually transmitted diseases and testicular microlithiasis. Conclusion Treatment for infertility and torsion was non-significantly associated with testicular microlithiasis and no other association was found. These data do not suggest early exposure is related to testicular microlithiasis.
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Affiliation(s)
- Malene Roland Pedersen
- Department of Radiology, Vejle Hospital, Vejle, Denmark.,Urological Research Centre, Department of Urology, Vejle Hospital, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Henrik Møller
- Cancer Epidemiology and Population Health, King's College London, London, United Kingdom.,Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Søren Rafael Rafaelsen
- Department of Radiology, Vejle Hospital, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Jens Kjølseth Møller
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Clinical Microbiology, Clinical Cancer Center, Vejle Hospital, Vejle, Denmark
| | - Palle Jørn Sloth Osther
- Urological Research Centre, Department of Urology, Vejle Hospital, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Peter Vedsted
- Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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11
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Aoun F, Slaoui A, Naoum E, Hassan T, Albisinni S, Azzo JM, Kallas-Chemaly A, Assenmacher G, Peltier A, Roumeguère T. Testicular microlithiasis: Systematic review and Clinical guidelines. Prog Urol 2019; 29:465-473. [DOI: 10.1016/j.purol.2019.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/24/2019] [Accepted: 07/02/2019] [Indexed: 12/22/2022]
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12
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Pedersen MR, Bartlett EC, Brown C, Rafaelsen SR, Sellars ME, Sidhu PS. Is Testicular Macrocalcification a Risk for Malignancy?: Tumor Development on Ultrasonographic Follow-up of Preexisting Intratesticular Macrocalcification. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2949-2953. [PMID: 29665033 DOI: 10.1002/jum.14657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/20/2018] [Accepted: 03/22/2018] [Indexed: 06/08/2023]
Abstract
Testicular macrocalcification is an uncommon finding when imaging the scrotum with ultrasonography (US). It is not normally a recognized risk factor for development of testicular malignancy, and patients are not usually offered follow-up US examinations or counseled for self-examination. This aspect is in distinction to patients with testicular microlithiasis (usually with an additional risk factor), who are offered follow-up on the assumption that microlithiasis is associated with malignancy. We report a series of 6 patients with predetermined testicular macrocalcification, with development of a malignancy on follow-up US. We encourage US follow-up examinations for patients with macrocalcification, potentially in a similar manner as for those with testicular microlithiasis.
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Affiliation(s)
- Malene R Pedersen
- University of Southern Denmark, Institute of Regional Health Research, Odense, Denmark
- Department of Radiology, Vejle Hospital, Vejle, Denmark
| | - Emily C Bartlett
- Department of Radiology, King's College Hospital, King's College London, London, England
| | - Christian Brown
- Department of Urology, King's College Hospital, King's College London, London, England
| | - Søren R Rafaelsen
- University of Southern Denmark, Institute of Regional Health Research, Odense, Denmark
- Department of Radiology, Vejle Hospital, Vejle, Denmark
| | - Maria E Sellars
- Department of Radiology, King's College Hospital, King's College London, London, England
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital, King's College London, London, England
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Balawender K, Orkisz S, Wisz P. Testicular microlithiasis: what urologists should know. A review of the current literature. Cent European J Urol 2018; 71:310-314. [PMID: 30386652 PMCID: PMC6202617 DOI: 10.5173/ceju.2018.1728] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 07/12/2018] [Accepted: 08/21/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction Testicular microlithiasis is a finding incidental to the ultrasound examination of the scrotum. This article presents some new data regarding the etiopathology of testicular microliths. As there is a growing body of literature available, which associates testicular microlithiasis with a testicular germ cell tumor or male infertility, our review focuses on these relations (based on a new meta-analysis and retrospective follow-up programs). The purpose of this review is to summarize the knowledge about testicular microlithiasis and discuss the latest recommendations. Material and methods A comprehensive literature review was performed using Science Direct and Scopus with MeSH terms and keywords 'testicular microlithiasis', testicular tumor', male infertility'. Results The clinical consequences of testicular microlithiasis depend on the co-occurrence of specific risk factors. The presence of testicular microlithiasis alone in the absence of risk factors is not an indication for further investigation. Conclusions A link between testicular microlithiasis and testicular cancer as well as male infertility has been analyzed. Follow-up is only recommended where risk factors of testicular cancer other than testicular microlithiasis are present.
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Affiliation(s)
- Krzysztof Balawender
- Morphological Science Department of Human Anatomy, Medical Faculty University of Rzeszów, Poland.,Urological Department of Pope John Paul II Regional Hospital in Zamość, Poland
| | - Stanisław Orkisz
- Morphological Science Department of Human Anatomy, Medical Faculty University of Rzeszów, Poland
| | - Paweł Wisz
- Department of Physiology, Medical Faculty University of Rzeszów, Poland
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14
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Leblanc L, Lagrange F, Lecoanet P, Marçon B, Eschwege P, Hubert J. Testicular microlithiasis and testicular tumor: a review of the literature. Basic Clin Androl 2018; 28:8. [PMID: 30002831 PMCID: PMC6036676 DOI: 10.1186/s12610-018-0073-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 04/24/2018] [Indexed: 11/15/2022] Open
Abstract
Introduction There are numerous scientific publications on testicular microlithiasis (TML) detected during ultrasound (US) examination. We wished to update the data. Methods PubMed was used to identify original articles published between 1998 and May 2017 describing the association between TML and testicular tumor. Studies were only included if TML was diagnosed by US. Studies were then classified into subgroups according to the following criteria: asymptomatic, symptomatic, infertility, cryptorchidism, family or personal history of testicular cancer, and “no given reason for US”. A Z-Test was used to identify differences within these subgroups. In addition, we identified prospective cohorts of TML patients. Numbers, duration of follow-up, and occurrence of the “testicular tumor” event were recorded for each of them. Results One hundred and seventy-five articles were identified, 40 of which were included. Our review has not showed a clear evidence that cryptorchidism associated with TML is a risk factor for testicular tumor. However, there seems to be a correlation between infertility associated with TML and a higher tumor risk. There were not enough studies to confirm a relationship between family or personal history associated with TML and the tumor risk. There was also a correlation with a higher tumor risk for symptomatic associated with TML and “no given reason for US” plus TML groups. However, these groups are assumed to contain bias and caution must be taken regarding conclusions. Regarding the prospective cohort studies, 16 testicular tumors appeared in the follow-up of patients with TML, 13 patients had risk factors. Conclusion In cases of TML incidental finding by US with the presence of risk factors (personal history of testicular cancer, testicular atrophy, infertility, cryptorchidism) a consultation with a specialist should be considered. In the absence of risk factors, the occurrence of testicular cancer in patients with TML is similar to the risk of the general population.
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Affiliation(s)
| | | | | | | | - Pascal Eschwege
- 1Department of Urology, CHRU Nancy, Nancy, France.,2CNRS UMR 7039 CRAN, Lorraine University, Nancy, France
| | - Jacques Hubert
- 1Department of Urology, CHRU Nancy, Nancy, France.,3IADI-UL-Inserm (U947), Lorraine University, Nancy, France
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Adolescent testicular microlithiasis: A case-based, multinational survey of clinical management practices. J Pediatr Urol 2018; 14:151.e1-151.e8. [PMID: 29428360 DOI: 10.1016/j.jpurol.2017.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 12/13/2017] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Testicular microlithiasis (TM) is a condition characterized by calcium deposits within the testis, usually detected incidentally during ultrasonography of the scrotum. TM has been associated with the presence of, and possibly the development of, testicular malignancy. Our aim was to document international clinical management practices for TM and to analyze what factors and perception of risk influence conservative versus active management and follow-up. METHODS European Society for Paediatric Urology (ESPU) and Society for Pediatric Urology (SPU) members were invited to complete an online case-based survey of clinical management practices of TM. Eight cases had a single variable changed each time (classic versus limited TM, unilateral versus bilateral, prior cryptorchidism versus no cryptorchidism) to ascertain the provider's perception of risk. The respondents completed multiple choice questions on initial management, follow-up plan, length and interval of follow-up. Multivariate logistic regression was performed to determine factors associated with decisions on management and follow-up. RESULTS There were 265 respondents to the survey from 35 countries (Table). Median time in practice was 13 years. Factors that were significantly associated with more aggressive initial management (more than counseling on self-examination) included: not yet in independent practice, low volume TM cases per year, those practicing pediatric and adult urology, classic appearance of TM and cryptorchidism. Factors that were significantly associated with urologist follow-up and active investigation included: European practitioners, low TM case volume per year, those practicing both pediatric urology and pediatric surgery, classic TM appearance and a case history of cryptorchidism. Interval and length of follow-up was wide-ranging, with most respondents favoring annual follow-up. CONCLUSION Management of TM varies and a mix of surgeon and case factors significantly influences management strategies. This baseline understanding of the lack of systematic management suggests the need for the development of consensus guidelines and prospective study.
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Kola B. Pediatric Testicular Microlithiasis: To Refer or Not to Refer? Glob Pediatr Health 2017; 4:2333794X17731854. [PMID: 29051915 PMCID: PMC5637960 DOI: 10.1177/2333794x17731854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 07/18/2017] [Indexed: 11/20/2022] Open
Affiliation(s)
- Bhargavi Kola
- Texas Tech University Health Sciences Center, Odessa, TX, USA
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17
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Pedersen MR, Møller H, Rafaelsen SR, Jørgensen MMB, Osther PJ, Vedsted P. Characteristics of symptomatic men with testicular microlithiasis - A Danish cross-sectional questionnaire study. Andrology 2017; 5:556-561. [PMID: 28267895 PMCID: PMC6088230 DOI: 10.1111/andr.12326] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/09/2016] [Accepted: 12/05/2016] [Indexed: 12/02/2022]
Abstract
Testicular microlithiasis (TML) is an incidental finding at ultrasonography of the scrotum. A link between testicular microlithiasis and testicular cancer has been suggested. However, the majority of studies are retrospective using ultrasonography with minor data on health status and life style characteristics. Our objective was to investigate if lifestyle and health are associated with TML. In 2014, we conducted a self‐administered questionnaire survey including 1538 men, who all due to testicular/scrotal symptoms had an ultrasound investigation of the scrotum during 2004–2013. The men were divided into men with TML and men without. The 23‐items questionnaire included items on age, height, weight, lifestyle (alcohol consumptions, smoking habits, workload, exercise and food), previous diseases in the testicles, pain and consumption of analgesics. The prevalence of TML was 12.8%. Overall, lifestyle factors did not vary between men with or without TML. However, men with TML did consume more crisp than men without. Development of TML was not associated to classic life style factors such as alcohol consumption, smoking habits, or mothers smoking during pregnancy. Also, age and height could not be linked to presence of TML. We did find, however, that men with TML experienced less physical activity and consumed more crisp than men without TML. Since ingestion of crisps has potential carcinogenic effect (acrylamide), this finding needs confirmation in a separate study.
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Affiliation(s)
- M R Pedersen
- Department of Radiology, Vejle Hospital, Part of Lillebaelt Hospital, Vejle, Denmark.,Urological Research Centre, Vejle Hospital, Part of Lillebaelt Hospital, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - H Møller
- Cancer Epidemiology and Population Health, King's College London, London, UK.,Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - S R Rafaelsen
- Department of Radiology, Vejle Hospital, Part of Lillebaelt Hospital, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - M M B Jørgensen
- Department of Radiology, Vejle Hospital, Part of Lillebaelt Hospital, Vejle, Denmark
| | - P J Osther
- Urological Research Centre, Vejle Hospital, Part of Lillebaelt Hospital, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - P Vedsted
- Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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18
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Fedder J. Prevalence of small testicular hyperechogenic foci in subgroups of 382 non-vasectomized, azoospermic men: a retrospective cohort study. Andrology 2017; 5:248-255. [PMID: 28061524 PMCID: PMC5363684 DOI: 10.1111/andr.12291] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 08/20/2016] [Accepted: 09/01/2016] [Indexed: 12/03/2022]
Abstract
Testicular hyperechogenic foci (THF) are associated with Klinefelter's syndrome, cryptorchidism, infertility, and testicular germ cell neoplasia. The aims of the study were to evaluate THF in relation to etiology of azoospermia and to Sertoli cell dysfunction. The structures inside the scrotum of consecutive non‐vasectomized, azoospermic were examined by ultrasonography, and hormone (FSH, LH, testosterone, and prolactin), and genetic analyses (karyotype, Y microdeletions, and CFTR mutations) were performed. At testicular ultrasonography, patients were graduated into: pronounced THF (>7 THF per transducer field), distributed universally (uTHF) or collected in plaques (pTHF), borderline THF (bTHF; 3–7 THF per transducer field), or no THF (<3 THF per transducer field). Diagnostic testicular biopsy was taken open or with TruCut needle (14G). THF status was sufficiently described in 382 of 449 potential participants, and testicular histology was available in 300 cases. Presence of ultrasonographically detectable THF was compared to presence of testicular microlithiasis (TM) detected histologically. Sertoli cell dysfunction was investigated in a subgroup using a three‐stage immunoperoxidase technique for detection of cytokeratin‐18 (CK‐18). The prevalence of THF was 13.4%. uTHF was found in 11 men (2.9%), the pattern was bilateral in four while other four had bTHF in the other testis. pTHF was detected in eight cases (2.1%), and except for one case with Klinefelter's syndrome, pTHF was in all cases occurring unilaterally. bTHF was detected in 32 cases (8.4%), bilaterally in 17 (53%). Pronounced THF was significantly associated with testicular malignancy. CK‐18 was detected in more azoospermic men with sperm production in ≤50% seminiferous tubules than in azoospermic men with spermatogenesis in ≥90% of seminiferous tubules and normal controls (p < 0.05). Unfortunately, TM detected histologically was not detected in any patient expressing THF, and neither THF nor TM was detected in any of the patients examined for CK‐18. Sertoli cell dysfunction was not associated with testicular microlithiasis or hyperechogenic foci.
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Affiliation(s)
- J Fedder
- Centre of Andrology and Fertility Clinic, Odense University Hospital, Odense, Denmark
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19
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Pedersen MR, Osther PJS, Soerensen FB, Rafaelsen SR. Testicular Microlithiasis: Patient Compliance in a Two-Year Follow-Up Program. Ultrasound Int Open 2016; 2:E113-E116. [PMID: 27921092 DOI: 10.1055/s-0042-113776] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 07/21/2016] [Indexed: 10/21/2022] Open
Abstract
Introduction: We present a retrospective 2-year follow-up cohort of 103 men with testicular microlithiasis (TML) and discuss patient compliance and the value of surveillance. Methods: A retrospective analysis of patients examined with scrotal ultrasonography (US) in the period from 2008 through 2010 was performed. A total of 103 men with TML were diagnosed and offered US follow-up every 6 months for 2 years. They were retrospectively analyzed regarding demographics and follow-up details, including the development of any kind of malignancy until March 2015, using the Danish Electronic Pathology Registry. Results: The prevalence of TML was 10.3%. Of the 103 men with TML, 23 (22.3%) had TML in the left testicle, 38 (36.9%) in the right (p=0.002), and 42 (40.8%) had bilateral TML. Patient compliance was low with 11.7% participating in all US follow-up examinations. 5 men presented risk factors (testicular atrophy (N=1) and previous testicular cancer (N=4)), but no cases of testicular malignancy were found in the follow-up period. Conclusion: The low patient compliance conflicts with the ESUR Scrotal Imaging Subcommittee guidelines that recommend scrotal US follow-up annually for TML until the age of 55 years. The fact that no cancers were found during follow-up using the pathology registry calls the value of follow-up into question.
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Affiliation(s)
- M R Pedersen
- Radiology, Vejle Hospital - Part of Sygehus Lillebaelt, Vejle, Denmark
| | - P J S Osther
- Urological Research Centre, Fredercia Hospital - Part of Sygehus Lillebaelt, Fredericia, Denmark
| | - F B Soerensen
- Clinical Pathology, Sygehus Lillebalt Vejle Sygehus, Vejle, Denmark
| | - S R Rafaelsen
- Department of Radiology, DCCG South Vejle Hospital, Vejle, Denmark
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20
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Pedersen MR, Graumann O, Hørlyck A, Duus LA, Jørgensen MMB, Vagn-Hansen C, Holst R, Rafaelsen SR. Inter- and intraobserver agreement in detection of testicular microlithiasis with ultrasonography. Acta Radiol 2016; 57:767-72. [PMID: 26419255 DOI: 10.1177/0284185115604516] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 08/12/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ultrasonography of the testis is a well-established diagnostic tool in detection of testicular microlithiasis (TML). Operator-dependent diagnostic variation related to skill, knowledge, and operator consistency are factors that influence detection of TML. PURPOSE To determine inter- and intraobserver agreement for detection of TML using ultrasonography for a group of physicians with no or limited experience compared to a group of experience senior radiologists. MATERIAL AND METHODS Between May and September 2014 a total of six observers evaluated 34 patients scrotal ultrasonography recorded from September to December 2013. The observers were blinded to patient history and previous ultrasonography. Three of the observers had no or limited experience with detection of TML, and three of the observers had more than 15 years of experience. Each observer reviewed all the scrotal ultrasonography recordings twice with a time interval of 3 months. RESULTS The inter-observer agreement showed substantial agreement and up to almost perfect agreement (κ = 0.86). Both the experienced and less experienced observers had a higher agreement in detecting and grading TML in their second reading. CONCLUSION The ultrasonography grading system of TML in this study showed to be reproducible, with an inter- and intraobserver agreement ranging between substantial agreement and up to almost perfect agreement with many years of experience not necessarily being essential.
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Affiliation(s)
- Malene Roland Pedersen
- Department of Radiology, Lillebaelt Hospital, Vejle, Denmark
- Urological Research Center, Department of Urology, Lillebaelt Hospital, Fredericia, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Denmark
| | - Ole Graumann
- Department of Radiology, Aarhus University Hospital, Skejby, Denmark
- CECLUS, Center of Clinical Ultrasound, Aarhus University, Denmark
| | - Arne Hørlyck
- Department of Radiology, Aarhus University Hospital, Skejby, Denmark
- CECLUS, Center of Clinical Ultrasound, Aarhus University, Denmark
| | | | | | | | - René Holst
- Institute of Regional Health Research, University of Southern Denmark, Denmark
| | - Søren Rafael Rafaelsen
- Department of Radiology, Lillebaelt Hospital, Vejle, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Denmark
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22
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Kühn AL, Scortegagna E, Nowitzki KM, Kim YH. Ultrasonography of the scrotum in adults. Ultrasonography 2016; 35:180-97. [PMID: 26983766 PMCID: PMC4939719 DOI: 10.14366/usg.15075] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 02/21/2016] [Accepted: 02/24/2016] [Indexed: 11/30/2022] Open
Abstract
Ultrasonography is the ideal noninvasive imaging modality for evaluation of scrotal abnormalities. It is capable of differentiating the most important etiologies of acute scrotal pain and swelling, including epididymitis and testicular torsion, and is the imaging modality of choice in acute scrotal trauma. In patients presenting with palpable abnormality or scrotal swelling, ultrasonography can detect, locate, and characterize both intratesticular and extratesticular masses and other abnormalities. A 12-17 MHz high frequency linear array transducer provides excellent anatomic detail of the testicles and surrounding structures. In addition, vascular perfusion can be easily assessed using color and spectral Doppler analysis. In most cases of scrotal disease, the combination of clinical history, physical examination, and information obtained with ultrasonography is sufficient for diagnostic decision-making. This review covers the normal scrotal anatomy as well as various testicular and scrotal lesions.
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Affiliation(s)
- Anna L Kühn
- Department of Radiology, UMass Memorial Medical Center, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Eduardo Scortegagna
- Department of Radiology, UMass Memorial Medical Center, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Kristina M Nowitzki
- Department of Radiology, UMass Memorial Medical Center, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Young H Kim
- Department of Radiology, UMass Memorial Medical Center, University of Massachusetts Medical Center, Worcester, MA, USA
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24
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McMaster ML, Heimdal KR, Loud JT, Bracci JS, Rosenberg PS, Greene MH. Nontesticular cancers in relatives of testicular germ cell tumor (TGCT) patients from multiple-case TGCT families. Cancer Med 2015; 4:1069-78. [PMID: 25882629 PMCID: PMC4529345 DOI: 10.1002/cam4.450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/20/2015] [Accepted: 02/23/2015] [Indexed: 12/20/2022] Open
Abstract
Testicular germ cell tumors (TGCT) exhibit striking familial aggregation that remains incompletely explained. To improve the phenotypic definition of familial TGCT (FTGCT), we studied an international cohort of multiple-case TGCT families to determine whether first-degree relatives of FTGCT cases are at increased risk of other types of cancer. We identified 1041 first-degree relatives of TGCT cases in 66 multiple-case TGCT families from Norway and 64 from the United States (combined follow-up of 31,556 person-years). We collected data on all cancers (except nonmelanoma skin cancers) reported by the family informant in these relatives, and we attempted to verify all reported cancer diagnoses through medical or cancer registry records. We calculated observed-to-expected (O/E) standardized incidence ratios, together with 95% confidence intervals (CI), for invasive cancers other than TGCT. We found no increase in risk of cancer overall (Norway O/E = 0.8; 95% CI: 0.6–1.1 and United States O/E = 0.9; 95% CI: 0.7–1.3). Site-specific analyses pooled across the two countries revealed a leukemia excess (O/E = 6.5; 95% CI: 3.0–12.3), deficit of female breast cancer (O/E = 0.0; 95% CI: 0.0–0.6) and increased risk of soft tissue sarcoma (O/E = 7.2; 95% CI: 2.0–18.4); in all instances, these results were based on small case numbers and statistically significant only in Norway. While limited by sample size and potential issues relating to completeness of cancer reporting, this study in multiple-case TGCT families does not support the hypothesis that cancers other than testis cancer contribute to the FTGCT phenotype.
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Affiliation(s)
- Mary L McMaster
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, 20892-9769.,Commissioned Corps of the U.S. Public Health Service, U.S. Department of Health and Human Services, Washington, District of Columbia
| | - Ketil R Heimdal
- Section for Clinical Genetics, Department of Medical Genetics, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Jennifer T Loud
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, 20892-9769
| | | | - Philip S Rosenberg
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, 20892-9769
| | - Mark H Greene
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, 20892-9769
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Coursey Moreno C, Small WC, Camacho JC, Master V, Kokabi N, Lewis M, Hartman M, Mittal PK. Testicular Tumors: What Radiologists Need to Know—Differential Diagnosis, Staging, and Management. Radiographics 2015; 35:400-415. [DOI: 10.1148/rg.352140097] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Richenberg J, Belfield J, Ramchandani P, Rocher L, Freeman S, Tsili AC, Cuthbert F, Studniarek M, Bertolotto M, Turgut AT, Dogra V, Derchi LE. Testicular microlithiasis imaging and follow-up: guidelines of the ESUR scrotal imaging subcommittee. Eur Radiol 2014; 25:323-30. [DOI: 10.1007/s00330-014-3437-x] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 08/25/2014] [Accepted: 09/08/2014] [Indexed: 11/28/2022]
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27
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Heller HT, Oliff MC, Doubilet PM, O'Leary MP, Benson CB. Testicular microlithiasis: prevalence and association with primary testicular neoplasm. JOURNAL OF CLINICAL ULTRASOUND : JCU 2014; 42:423-426. [PMID: 24585495 DOI: 10.1002/jcu.22144] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 08/12/2013] [Accepted: 01/31/2014] [Indexed: 06/03/2023]
Abstract
PURPOSE To assess the prevalence of testicular microlithiasis and its association with primary testicular neoplasm. METHODS Evaluated were 6,002 patients undergoing scrotal ultrasound at our institution. Data recorded included age, ultrasound date, presence of microlithiasis, presence of testicular mass on ultrasound, and pathologic diagnosis for those who had subsequent orchiectomy. RESULTS Four hundred fifty-six of 6,002 patients (7.6%) demonstrated testicular microlithiasis. The prevalence increased from 4.6% for those examined before 2001 to 9.02% for those examined since 2001 (p < 0.001). The prevalence of primary testicular neoplasm in patients without microlithiasis was 1.5% (84/5,546), whereas in those with microlithiasis it was 12% (53/456) (p < 0.001). The prevalence of pure seminoma was 39% (33/84) in the nonmicrolithiasis group with tumor versus 64% (34/53) in the microlithiasis group with tumor (p < 0.001). Germ cell tumors made up 98% of neoplasms in patients with microlithiasis, but only 85% in patients without microlithiasis (p = 0.009). CONCLUSIONS Advances in ultrasound technology have led to an increased detection of testicular microlithiasis. We observed an eight-fold increased prevalence of primary testicular neoplasm in patients with microlithiasis than in those without as well as an increased prevalence of germ cell tumors, particularly pure seminoma. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 42:423-426, 2014.
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Affiliation(s)
- Howard T Heller
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115
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28
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Shetty D, Bailey AG, Freeman SJ. Testicular microlithiasis an ultrasound dilemma: survey of opinions regarding significance and management amongst UK ultrasound practitioners. Br J Radiol 2014; 87:20130603. [PMID: 24311562 PMCID: PMC4064550 DOI: 10.1259/bjr.20130603] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 11/13/2013] [Accepted: 12/02/2013] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To establish whether there is a consensus regarding the significance of testicular microlithiasis and a strategy for managing patients with this condition, amongst ultrasound practitioners in the UK. METHODS An electronic questionnaire was distributed to 1482 members of the British Medical Ultrasound Society (BMUS), requesting information from ultrasound practitioners involved in scrotal ultrasound about their interpretation of the risk associated with testicular microlithiasis and their departmental or personal recommendations for managing patients with this condition. RESULTS Responses were obtained from 221 BMUS members. Analysis demonstrated a wide variation in the significance attributed to the discovery of testicular microlithiasis and the risk of subsequent development of testicular germ cell tumours. There was also great variation in strategies for management of patients with testicular microlithiasis, including the need for surveillance ultrasound, amongst ultrasound practitioners regardless of their job description. CONCLUSION Lack of consensus shown by this study highlights significant differences across the UK in managing patients with testicular microlithiasis and validates the importance of guidance currently being formulated by the European Society of Urogenital Radiology. ADVANCES IN KNOWLEDGE We believe that this is the first survey to be conducted amongst imaging specialists in the UK regarding testicular microlithiasis and demonstrates that there is currently no uniform practice in managing patients with this condition.
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Affiliation(s)
- D Shetty
- Imaging Directorate, Level 6, Derriford Hospital, Plymouth, UK
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Mullooly C, Hickerton B, Weston R, Woolley PD. Testicular microlithiasis: is it significant? Int J STD AIDS 2013; 23:620-2. [PMID: 23033512 DOI: 10.1258/ijsa.2012.011444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Previously considered to be a benign finding on scrotal ultrasonography, testicular microlithiasis (TM) is now recognized as a condition associated with the development of testicular neoplasia. Despite this the management of TM remains unclear. We review the evidence for this association and suggested management strategies.
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Affiliation(s)
- C Mullooly
- Department of Sexual Medicine and HIV, University Hospitals of South Manchester, West Didsbury, Manchester, UK.
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30
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De Zordo T, Stronegger D, Pallwein-Prettner L, Harvey CJ, Pinggera G, Jaschke W, Aigner F, Frauscher F. Multiparametric ultrasonography of the testicles. Nat Rev Urol 2013; 10:135-48. [DOI: 10.1038/nrurol.2012.255] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Bozzini G, Lunelli L, Berlingheri M, Groppali E, Carmignani L. Epididymis microlithiasis and semen abnormalities in young adult kidney transplant recipients. Andrologia 2012; 45:357-60. [DOI: 10.1111/and.12036] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2012] [Indexed: 11/30/2022] Open
Affiliation(s)
- G. Bozzini
- Academic Division of Urology; IRCCS Policlinico San Donato; University of Milan; Milan; Italy
| | - L. Lunelli
- Academic Division of Urology; IRCCS Policlinico San Donato; University of Milan; Milan; Italy
| | - M. Berlingheri
- Pediatric Nephrology Unit; Foundation IRCCS Ca' Granda; Ospedale Maggiore Policlinico; Milan; Italy
| | - E. Groppali
- Pediatric Nephrology Unit; Foundation IRCCS Ca' Granda; Ospedale Maggiore Policlinico; Milan; Italy
| | - L. Carmignani
- Academic Division of Urology; IRCCS Policlinico San Donato; University of Milan; Milan; Italy
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Clinical aspects of testicular microlithiasis in boys: a review. J Pediatr Urol 2012; 8:459-69. [PMID: 21856234 DOI: 10.1016/j.jpurol.2011.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 07/07/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE After review of the pediatric literature, we report on the prevalence of testicular microlithiasis and its relation with benign and malign entities. We provide a guideline for the management of boys with testicular microlithiasis. MATERIALS AND METHODS The databases searched were Medline, Web of Science, Embase and the Cochrane Library. Data on the rates of testicular microlithiasis were collected and from each study information was extracted on the study population according to country, study design, diagnostic method, type of patient, number of patients, age, associated anomalies, additional diagnostic methods and follow-up information. From the 472 articles, we selected 126 articles as potentially relevant, of which 57 were included. RESULTS In asymptomatic boys, the prevalence of testicular microlithiasis is 4.2% and in symptomatic referrals it is 1.6%. The development of a testicular malignancy is occasionally reported after diagnosis of testicular microlithiasis. The management of boys with testicular microlithiasis varies widely. Most authors recommend regular self-examination, and some perform testicular ultrasound and/or screen tumor markers. CONCLUSION The prevalence of testicular microlithiasis in boys varies between 1.1% and 4.2%. For follow-up, regular self-examination is advised from the age of 15 years.
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Eiss D, Cornud F, Thiounn N, Wolf JP, Amar E, Ghouadni M, Hélénon O. Imagerie de l’hypofertilité masculine : technique et résultats. ACTA ACUST UNITED AC 2012; 40:481-9. [DOI: 10.1016/j.gyobfe.2012.07.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 07/05/2012] [Indexed: 10/28/2022]
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Testicular microlithiasis: is there a need for surveillance in the absence of other risk factors? Eur Radiol 2012; 22:2540-6. [PMID: 22710430 DOI: 10.1007/s00330-012-2520-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 04/15/2012] [Accepted: 04/25/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Ultrasound surveillance of patients with testicular microlithiasis (TM) has been advocated following the reported association with testicular cancer. The aim of this study was to assess the evidence base supporting such surveillance. METHODS Formal literature review identified cohort studies comprising at least 15 patients followed up for at least 24 months. Combining an institutional audit with the identified studies in a pooled analysis the incidence of new cancers during the surveillance period was evaluated. RESULTS Literature review identified eight studies. Our institutional audit comprised 2,656 men referred for scrotal ultrasound. Fifty-one men (1.92 %) with TM were identified, none of whom developed testicular cancer (mean follow-up: 33.3 months). In a combined population of 389 men testicular cancer developed in 4. Excluding 3 who had additional risk factors, only 1 of 386 developed testicular cancer during follow-up (95 % CI 0.05-1.45 %). CONCLUSIONS Ultrasound surveillance is unlikely to benefit patients with TM in the absence of other risk factors. In the presence of additional risk factors (previous testicular cancer, a history of maldescent or testicular atrophy) patients are likely to be under surveillance; nonetheless monthly self-examination should be encouraged, and open access to ultrasound and formal annual surveillance should be offered. KEY POINTS • The literature reports a high association between testicular microlithiasis and testicular cancer. • Our study and meta-analysis suggest no causal link between microlithiasis and cancer. • In the absence of additional risk factors surveillance is not advocated. • In the presence of additional risk factors surveillance is recommended. • Such surveillance is primarily aimed at engaging patients in regular follow-up.
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Mohamed GH, Gelfond JAL, Nicolas MM, Brand TC, Sarvis JA, Leach RJ, Johnson-Pais TL. Genomic characterization of testis cancer: association of alterations with outcome of clinical stage 1 mixed germ cell nonseminomatous germ cell tumor of the testis. Urology 2012; 80:485.e1-5. [PMID: 22503760 DOI: 10.1016/j.urology.2012.02.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 01/27/2012] [Accepted: 02/14/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To identify genomic markers that are reliable in predicting lymph node metastases in clinical stage 1 non-seminomatous germ cell tumors (NSGCTs). METHODS Comparative genomic array technology was used to identify regions of genomic amplification or deletion in clinical stage 1 NSGCTs. Twelve stage 1 mixed germ cell testicular tumors were analyzed, which were obtained from 8 patients who had no evidence of nodal metastasis when retroperitoneal lymph node dissection (RPLND) had been performed (ie, were RPLND negative) and 4 patients who had nodal metastases (ie, were RPLND positive). RESULTS Differences between the genomic alterations associated with the two classes of tumors were identified. Genomic alterations previously reported in other subtypes of testicular tumors were observed in both metastatic and nonmetastatic cases. Statistically suggestive differences in mean copy number of the Y chromosome were found between metastatic and nonmetastatic cases (P = .0142). CONCLUSION This finding suggests the presence of chromosome Y deletions to be a potential genetic marker for prediction of mixed germ cell tumor progression. This is a first step toward identifying chromosomal markers of progression in testicular cancer in clinical stage 1 mixed germ cell NSGCT.
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Affiliation(s)
- Gihan H Mohamed
- Department of Pathology, University of Texas Health Science Center, San Antonio, TX 78229, USA
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Chiang LW, Yap TL, Asiri MM, Phaik Ong CC, Low Y, Jacobsen AS. Implications of incidental finding of testicular microlithiasis in paediatric patients. J Pediatr Urol 2012; 8:162-5. [PMID: 21546312 DOI: 10.1016/j.jpurol.2011.03.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 03/07/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To improve understanding of the implications of testicular microlithiasis (TM) in paediatric patients diagnosed incidentally on scrotal ultrasonography (US). PATIENTS AND METHODS 31 boys aged 4-14 years diagnosed with TM based on US between February 2000 and September 2007 were retrospectively reviewed. Demographic data, indications for US, associated inguino-scrotal pathologies and follow-up data were collated. RESULTS A total of 59 testes were evaluated. Fifty-four had TM at US. The most common indication for US was scrotal swelling (n = 17). Twenty patients (65%) had at least one associated inguino-scrotal pathology related to patent processus vaginalis, with cryptorchidism being the most frequently observed (39%). On follow up (mean 39.6 months), 6 patients documented decrease or resolution of TM, while 2 showed increase in TM density. No testicular malignancy was observed during follow up. CONCLUSIONS TM is commonly diagnosed incidentally on US in paediatric patients. A literature review revealed few case reports on its association with testicular malignancy and a prevalence of 4.2% among asymptomatic boys. The spontaneous resolution of TM supports degeneration of seminiferous tubules as the possible cause and further questions its malignant implication. An appropriate surveillance scheme would require involvement of a well-informed patient and parent with good compliance on testicular self-examination.
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Affiliation(s)
- Li Wei Chiang
- Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Jalan Bukit Timah, Singapore 229899, Singapore.
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37
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Prevalence of Testicular Microlithiasis in Males Aged 0 to 18 Years Referred for Scrotal Sonography. Nephrourol Mon 2011. [DOI: 10.5812/numonthly.1898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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38
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La Vignera S, Condorelli R, Vicari E, D’Agata R, Calogero AE. Testicular microlithiasis: analysis of prevalence and associated testicular cancer in central-eastern Sicilian andrological patients. Andrologia 2011; 44 Suppl 1:295-9. [DOI: 10.1111/j.1439-0272.2011.01180.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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39
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Risk MC, Masterson TA. Intratubular germ cell neoplasms of the testis and bilateral testicular tumors: clinical significance and management options. Indian J Urol 2011; 26:64-71. [PMID: 20535289 PMCID: PMC2878442 DOI: 10.4103/0970-1591.60454] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objectives: Intratubular germ cell neoplasia (ITGCN) is the precursor lesion for invasive testicular germ cell tumors (TGCTs) of adolescents and young adults. The rising incidence of these tumors has prompted a rigorous investigation of the etiology, diagnosis and management of ITGCN. Bilateral testicular cancer is closely linked with ITGCN, as patients with unilateral testicular cancer are at the highest risk for a future malignancy in the contralateral testicle. Methods: A literature review directed at ITGCN and bilateral testis cancer was performed using the Medline/PubMed database. Our review focused on the pathogenesis, risk factors, diagnosis and treatment regimens utilized. Results: Major advances have been made in the understanding of ITGCN over the past 30 years. There is evidence that TGCTs arise from ITGCN, ITGCN is closely related to fetal gonocytes, and that events in pre- and perinatal period may result in abnormal persistence of fetal gonocytes leading to ITGCN and subsequent TGCT. Controversy exists regarding the need to biopsy men at increased risk of TGCT, as well as the best approach to managing patients with known ITGCN. Bilateral testicular cancer has excellent outcomes in the current era of platinum-based chemotherapy. Conclusion: The optimal management of patients at risk for ITGCN and future TGCT is still a matter of debate. Individualization of management, including biopsy and treatment, should be based on risk factors for TGCT, compliance with potential surveillance, and patient preferences particularly with regard to fertility.
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Affiliation(s)
- Michael C Risk
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
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40
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Bigot P, Durand X. [Management of testicular microlithiasis]. Prog Urol 2011; 21 Suppl 2:S46-9. [PMID: 21397828 DOI: 10.1016/s1166-7087(11)70010-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Testicular microlithiases are calcite concretions in the convoluted seminiferous tubules lumen. Their ultrasound aspect is a hyper-echogenous area without any shadow in the testicular parenchyma. Their size is smaller than 2mm and there are more than 5. The surface of the gland is respected. Their incidence is about 5% which more important than the incidence of TGT. The association between testicular microlithiasis and TGT has been initially established by retrospective studies but has never been confirmed by recent prospective studies. Their rate is higher for patients with TGT risk factors (cryptorchidism, intratubular germ cell neoplasia and family history). There are not any official guidelines about the management of testicular microlithiasis. An individual screening depending on the clinical situation can be performed: it could be a simple self examination, ultrasound, or testicular biopsies.
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Affiliation(s)
- P Bigot
- Service d'Urologie, CHU d'Angers, 4 rue Larrey, 49933 Angers Cedex, France.
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42
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Abstract
BACKGROUND Testicular cancer commonly affects men aged between 20 and 35 years. Screening for testicular cancer may reduce both morbidity and mortality, yet the effectiveness of any method is unknown. Equally, screening may also promote treatment procedures that are unwarranted or may adversely affect the health outcomes of the patient with no net benefit. Additionally, many organisations recommend against screening for testicular cancer due to the low incidence of testicular cancer and favourable outcomes in the absence of screening. OBJECTIVES The primary objective of this review is to determine whether screening for testicular cancer (physician or patient self-examination) reduces testicular cancer-specific mortality. The secondary objective of this review is to determine impact of screening for testicular cancer on quality of life and adverse outcomes. SEARCH STRATEGY Electronic searches were conducted across MEDLINE, CINAHL, the Cochrane Central Register of Controlled Trials (CENTRAL) and PsychINFO. SELECTION CRITERIA All published randomised controlled trials (RCTs) of screening versus no screening for testicular cancer were eligible for inclusion in this review. DATA COLLECTION AND ANALYSIS The search identified 19 potentially relevant articles, which were selected for full text review. None of the articles that were reviewed were evaluated as eligible for inclusion in this review. MAIN RESULTS There are no published RCTs evaluating the effectiveness of screening for testicular cancer. AUTHORS' CONCLUSIONS Patients with increased clinical risk factors for testicular cancer, including a family history of testicular cancer, undescended testis (cryptorchidism) or testicular atrophy should be informed by their physicians of their potential increased risk of testicular cancer, along with potential benefits and harms associated with screening.
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Affiliation(s)
- Dragan Ilic
- School of Public Health & Preventive Medicine, Monash University, The Alfred Centre, Level 6, 99 Commercial Rd, Melbourne, Victoria, Australia, 3004
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43
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Self-examination behaviors for syphilis symptoms among HIV-infected men. J Acquir Immune Defic Syndr 2010; 55:284-5. [PMID: 20859086 DOI: 10.1097/qai.0b013e3181e13ed9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Valadares D, Nery F, Marques F. Twelve Years of Experience in the Management of Testicular Germ Cell Tumors at a Referral Center in Portugal. World J Oncol 2010; 1:187-193. [PMID: 29147205 PMCID: PMC5649796 DOI: 10.4021/wjon245w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2010] [Indexed: 11/21/2022] Open
Abstract
Background Testicular germ cell tumors (TGCT) are generally rare but quite frequent in young males. Guidelines are well established for their management. Methods We present the first report from Portugal on clinical, histological, treatment modalities and outcomes of a population with TGCT. Data was retrospectively analyzed for the 1996 through 2008 period, applying a previous internally validated protocol. Results Seventy nine patients with TGCT were identified, 40.5% had seminomatous and 59.5% nonseminomatous tumors. Incidence rates were higher among males in their twenties and thirties. Pain and swelling testis were the most common symptoms and microlithiasis was detected in 20.3% of patients. Lower stages were more frequent in seminomatous tumors. Orchiectomy was done in all patients and further therapy was performed by guidelines recommendations in 86.1% of them. Hematological toxicity was found in 44.3% of the population studied and free disease survival rates were at 88.6%. Conclusions This retrospective study corroborates the European Western country trends concerning TGCT. Mortality was only seen in nonseminomatous TGCT group. Good risk and lower TGCT stages have no deaths reported. Public health campaigns should be undertaken to guide patients to seek medical advice earlier in the course of the disease.
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Affiliation(s)
- Diana Valadares
- Department of Internal Medicine, Centro Hospitalar do Porto - Hospital Santo Antonio, Porto, Portugal
| | - Filipe Nery
- Department of Internal Medicine, Centro Hospitalar do Porto - Hospital Santo Antonio, Porto, Portugal
| | - Franklim Marques
- Department of Internal Medicine, Centro Hospitalar do Porto - Hospital Santo Antonio, Porto, Portugal.,Director of Oncology Services, Centro Hospitalar do Porto - Hospital Santo Antonio, Porto, Portugal
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45
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[Germ cell cancer--an update]. Urologe A 2010; 49 Suppl 1:166-8. [PMID: 20812045 DOI: 10.1007/s00120-010-2375-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Recently a rise in the incidence of testicular germ cell cancer (TGCC) has been repeatedly reported in Germany (18% during the period 2000-2006). Future investigations are needed to examine causes for this increase in TGCT. The mortality rates in the western and eastern parts of Germany converge, but there is still a significantly higher mortality rate in the eastern part. Again future investigations are needed to examine causes for this phenomenon. In cases of testicular microlithiasis, testicular biopsies should be considered if further factors representing testicular dysgenesis syndrome are present, such as infertility, atrophic testes, and undescended testes. One course of adjuvant BEP reduces the risk of relapse by approximately 90% and may be a new option as the initial treatment for all CS1 NSGCT. Patients obtaining a CR (<1 cm) after first-line chemotherapy can be safely observed without PC-RPLND. Relapses are rare and potentially curable with further treatment.
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46
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Tan IB, Ang KK, Ching BC, Mohan C, Toh CK, Tan MH. Testicular microlithiasis predicts concurrent testicular germ cell tumors and intratubular germ cell neoplasia of unclassified type in adults. Cancer 2010; 116:4520-32. [DOI: 10.1002/cncr.25231] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Zuniga A, Lawrentschuk N, Jewett MAS. Organ-sparing approaches for testicular masses. Nat Rev Urol 2010; 7:454-64. [DOI: 10.1038/nrurol.2010.100] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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48
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Chen JL, Chou YH, Tiu CM, Chiou HJ, Wang HK, Chiou SY, Liang IP, Lee CH, Chang CY. Testicular microlithiasis: analysis of prevalence and associated testicular cancer in Taiwanese men. JOURNAL OF CLINICAL ULTRASOUND : JCU 2010; 38:309-313. [PMID: 20544867 DOI: 10.1002/jcu.20694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
PURPOSE To determine the incidence of testicular microlithiasis (TM) in Taiwanese males who were referred for scrotal sonography (US) and to evaluate the association between TM and cancer, with state-of-the-art equipment. METHODS This retrospective study included 513 males who underwent scrotal US in a period of 7 months. The US images and charts of each patient were reviewed to determine the presence of TM and note relevant clinical information. RESULTS The data for all 513 patients were analyzed. Their age was 0-91 years (mean, 54.3 years). The overall incidence of TM was 14.4% (74/513); 6.2% (32/513) had classic TM, and 8.2% had limited TM. The incidence of testicular cancer in this population was 1.6% (8/513). Six of eight (75%) patients who had testicular cancer at presentation had classic TM or limited TM. There was a significant difference (P < 0.01) between the rate of malignancy in subjects with TM (6/74) and that in subjects without TM (2/439). CONCLUSION The incidence of TM in Taiwanese people may be higher than previously reported, which may be due to the difference in methodology and increased awareness of the US findings. Although there was a significant difference in the rate of malignancy in males with TM compared with those without TM, the question remains whether TM independently increases the risk of testicular malignancy.
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Affiliation(s)
- Jian-Ling Chen
- Department of Radiology, Veterans General Hospital-Taipei, and National Yang-Ming University, School of Medicine, Taipei, Taiwan
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49
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Rapley EA, Nathanson KL. Predisposition alleles for testicular germ cell tumour. Curr Opin Genet Dev 2010; 20:225-30. [DOI: 10.1016/j.gde.2010.02.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Revised: 02/18/2010] [Accepted: 02/19/2010] [Indexed: 01/21/2023]
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50
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Greene MH, Kratz CP, Mai PL, Mueller C, Peters JA, Bratslavsky G, Ling A, Choyke PM, Premkumar A, Bracci J, Watkins RJ, McMaster ML, Korde LA. Familial testicular germ cell tumors in adults: 2010 summary of genetic risk factors and clinical phenotype. Endocr Relat Cancer 2010; 17:R109-21. [PMID: 20228134 PMCID: PMC3101798 DOI: 10.1677/erc-09-0254] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Familial aggregations of testicular germ cell tumor (FTGCT) have been well described, suggesting the existence of a hereditary TGCT subset. Approximately 1.4% of newly diagnosed TGCT patients report a positive family history of TGCT. Sons and siblings of TGCT patients have four- to sixfold and eight- to tenfold increases in TGCT risk respectively. Segregation analyses suggest an autosomal recessive mode of inheritance. Linkage analyses have identified several genomic regions of modest interest, although no high-penetrance cancer susceptibility gene has been mapped yet. These data suggest that the combined effects of multiple common alleles, each conferring modest risk, might underlie familial testicular cancer. Families display a mild phenotype: the most common number of affected families is 2. Age at diagnosis is 2-3 years younger for familial versus sporadic cases. The ratio of familial seminoma to nonseminoma is 1.0. FTGCT is more likely to be bilateral than sporadic TGCT. This syndrome is cancer site specific. Testicular microlithiasis is a newly recognized FTGCT component. Candidate gene-association studies have implicated the Y chromosome gr/gr deletion and PDE11A gene mutations as genetic modifiers of FTGCT risk. Two genomewide association studies of predominantly sporadic but also familial cases of TGCT have implicated the KIT-ligand, SPRY4, and BAK1 genes as TGCT risk modifiers. All five loci are involved in normal testicular development and/or male infertility. These genetic data provide a novel insight into the genetic basis of FTGCT, and an invaluable guide to future TGCT research.
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Affiliation(s)
- Mark H Greene
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland 20852, USA.
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