1
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Ando T, Naito M. First case of synchronous Leydig cell tumor and spermatocytic tumor in the unilateral testis. Urol Case Rep 2024; 53:102648. [PMID: 38229735 PMCID: PMC10788787 DOI: 10.1016/j.eucr.2024.102648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/01/2024] [Accepted: 01/04/2024] [Indexed: 01/18/2024] Open
Abstract
Both Leydig cell tumor (LCT), which is a sex cord-stromal tumor, and spermatocytic tumor (ST), which is a germ cell tumor, are rare testicular tumors. Synchronous LCT and ST in the unilateral testis are extremely rare because of their different origins. Herein, we report the case of an 84-year-old male patient with right scrotal swelling due to a testicular tumor. His age was out of the onset peak age of LCT but within ST. To the best of our knowledge, this is the first case with synchronous LCT and ST in the unilateral testis.
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Affiliation(s)
- Takashi Ando
- Department of Urology, JA Niigata Kouseiren Murakami General Hospital, Midorimachi 5-8-1, Murakamishi, Niigata, 958-8533, Japan
| | - Makoto Naito
- Department of Pathology, Niigata Medical Center, Kobari 3-27-11, Nishi-ku, Niigata, 950-2022, Japan
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2
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Dieckmann KP, Dumlupinar C, Grobelny F, Utschig J, Klemke M, Ahmed Saad EM, Wülfing C, Pichlmeier U, Isbarn H, Belge G. Testicular neoplasms: the interrelationships of serum levels of microRNA-371a-3p (M371) and classical tumor markers with histology, clinical staging, and age-a statistical analysis. J Cancer Res Clin Oncol 2023; 149:7079-7090. [PMID: 36869885 PMCID: PMC9985438 DOI: 10.1007/s00432-023-04664-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/22/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE In testicular neoplasms, the interrelationship of elevations of the novel serum tumor marker microRNA-371a-3p (M371) and traditional markers with other clinical features is still incompletely understood. The present study evaluated marker expression rates in relation to various other clinical parameters. METHODS The following data were retrospectively registered from 641 consecutive patients with testicular neoplasms: histology, such as seminoma (n = 365), nonseminoma (n = 179), benign tumor (n = 79), other malignant tumor (n = 18); patients age (years); clinical stage (CS1, CS2a/b, CS2c, CS3); and preoperative elevation of beta HCG, AFP, LDH, M371 (yes/no). Descriptive statistical methods were employed with comparisons of various subgroups to disclose associations of marker expression rates with age, histology and CS, and of age with histology. RESULTS The histologic subgroups revealed significantly different expression rates of tumor markers. M371 performed best with expression rates of 82.69% and 93.58% in seminoma and in nonseminoma, respectively. In germ cell tumors, all markers had significantly higher expression rates in metastasized stages than in localized disease. All markers except LDH have significantly higher expression rates in younger than in older patients. Nonseminoma is most prevalent in the youngest age category, seminoma predominates in patients > 40 years, other malignancies were restricted to patients > 50 years. CONCLUSION The study documented significant associations of serum marker expression rates with histology, age and clinical staging, with highest rates in nonseminomas, young age and advanced clinical stages. M371 showed significantly higher expression rates than other markers suggesting its superior clinical usefulness.
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Affiliation(s)
| | - Cansu Dumlupinar
- Department of Tumour Genetics, Faculty of Biology and Chemistry, University of Bremen, Leobener Strasse 2/FVG, 28359, Bremen, Germany
| | - Francesca Grobelny
- Department of Tumour Genetics, Faculty of Biology and Chemistry, University of Bremen, Leobener Strasse 2/FVG, 28359, Bremen, Germany
- Faculty of Medicine, University of Hamburg, Hamburg, Germany
| | - Julia Utschig
- Department of Urology, Asklepios Klinik Altona, 22763, Hamburg, Germany
| | - Markus Klemke
- Department of Tumour Genetics, Faculty of Biology and Chemistry, University of Bremen, Leobener Strasse 2/FVG, 28359, Bremen, Germany
| | | | - Christian Wülfing
- Department of Urology, Asklepios Klinik Altona, 22763, Hamburg, Germany
| | - Uwe Pichlmeier
- Institute of Medical Biometry and Epidemiology, Universitätsklinikum Eppendorf, 20251, Hamburg, Germany
| | - Hendrik Isbarn
- Martini Klinik, Universitätsklinikum Eppendorf, 20251, Hamburg, Germany
| | - Gazanfer Belge
- Department of Tumour Genetics, Faculty of Biology and Chemistry, University of Bremen, Leobener Strasse 2/FVG, 28359, Bremen, Germany.
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3
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Huang Y, Chen B, Cao D, Chen Z, Li J, Guo J, Dong Q, Wei Q, Liu L. Sex Cord-Stromal Tumors of Testis: A Clinicopathologic and Follow-Up Study of 15 Cases in a High-Volume Institute of China. Front Med (Lausanne) 2022; 9:816012. [PMID: 35712094 PMCID: PMC9197338 DOI: 10.3389/fmed.2022.816012] [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] [Received: 11/16/2021] [Accepted: 04/21/2022] [Indexed: 02/05/2023] Open
Abstract
Objectives To report the first series of testicular sex cord-stromal tumors (TSCSTs) with detailed clinicopathologic findings and long-term follow-up in the Chinese population. Patients and Methods From 2008 to 2018, 15 patients with TSCST were included in our study. The tumors were analyzed for epidemiological parameters, clinical characteristics, tumor markers, therapy, and follow-up data. Results The median age of the patients was 28 years (range, 13–80 years). Para-aortic lymph node metastases were detected in 2 patients after radiological evaluation. Orchiectomy was performed in all patients, and the median diameter of the tumor was 1.5 cm (range, 0.5–5.0 cm). Nine Leydig cell tumors (LCTs), 5 Sertoli cell tumors (SCTs), and 1 unclassified type were confirmed after pathologic evaluation. Thirteen patients (86.7%) were categorized as stage I, and 2 patients (13.3%) were categorized as stage II. The median clinical follow-up was 39.0 months (range, 5–97 months), which showed 10 alive patients, such as 1 patient with progression at 40 months after orchiectomy. The 3- and 5-year progression-free survivals were 100 and 90.0%, respectively. Conclusion Testicular sex cord-stromal tumor at stages I and II is a rare subtype with benign behavior and a favorable prognosis in the Chinese population. However, lymph node metastases may be the dominant risk factor for patients with TSCST.
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Affiliation(s)
- Yin Huang
- Department of Urology, West China Hospital, Institute of Urology, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Bo Chen
- Department of Urology, West China Hospital, Institute of Urology, Sichuan University, Chengdu, China
| | - Dehong Cao
- Department of Urology, West China Hospital, Institute of Urology, Sichuan University, Chengdu, China
| | - Zeyu Chen
- Department of Urology, West China Hospital, Institute of Urology, Sichuan University, Chengdu, China
| | - Jin Li
- Department of Urology, West China Hospital, Institute of Urology, Sichuan University, Chengdu, China
| | - Jianbing Guo
- Department of Urology, West China Hospital, Institute of Urology, Sichuan University, Chengdu, China
| | - Qiang Dong
- Department of Urology, West China Hospital, Institute of Urology, Sichuan University, Chengdu, China
| | - Qiang Wei
- Department of Urology, West China Hospital, Institute of Urology, Sichuan University, Chengdu, China
| | - Liangren Liu
- Department of Urology, West China Hospital, Institute of Urology, Sichuan University, Chengdu, China
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4
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Zuniga KB, Washington SL, Porten SP, Meng MV. A comparison of stage-specific all-cause mortality between testicular sex cord stromal tumors and germ cell tumors: results from the National Cancer Database. BMC Urol 2020; 20:40. [PMID: 32303266 PMCID: PMC7164279 DOI: 10.1186/s12894-020-00609-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 04/03/2020] [Indexed: 12/01/2022] Open
Abstract
Background Testicular sex cord stromal tumors (SCSTs) are managed similarly to germ cell tumors (GCTs); however, few studies have directly compared outcomes between these tumor types. Using the National Cancer Database (NCDB), we sought to compare overall and stage-specific all-cause mortality (ACM) between SCSTs versus GCTs. Methods NCDB was queried for patients diagnosed with SCSTs and GCTs between 2004 and 2013. Descriptive statistics were used to compare sociodemographic and clinical characteristics between groups. Univariable and multivariable Cox proportional hazards regression analyses were used to assess associations with ACM. Results We identified 42,192 patients diagnosed with testicular cancer between 2004 and 2013, with 280 having SCSTs and 41,912 patients having GCTs. Median age for SCSTs and GCTs was 45 (interquartile range [IQR] 34–59) and 34 (IQR 27–43), respectively (p < 0.001). Median follow-up was 39 and 52 months, respectively. Overall, patients with SCSTs had greater risk of ACM compared to those with GCTs (HR 1.69, 95% CI 1.14–2.50). Private insurance, greater education, and fewer comorbidities were associated with reduced risk of ACM (p < 0.05 for all). Among those with stage I disease, tumor type was not associated with ACM on multivariable analysis. Among those with stage II/III disease, patients with SCSTs had increased risk of ACM compared to patients with GCTs (HR 3.29, 95% CI 1.89–5.72). Conclusions Patients with advanced SCSTs had worse survival outcomes compared to those with advanced GCTs. These data suggest a need for further investigation to ascertain effective management recommendations for SCSTs.
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Affiliation(s)
- Kyle B Zuniga
- Department of Urology, University of California, San Francisco, 550 16th Street, 6th Floor, San Francisco, CA, 94158, USA. .,Osher Center for Integrative Medicine, University of California, San Francisco, 1545 Divisadero Street, Suite 301, San Francisco, CA, 94143, USA. .,Vagelos College of Physicians and Surgeons, Columbia University Medical Center, 630 West 168th Street, New York, NY, 10032, USA.
| | - Samuel L Washington
- Department of Urology, University of California, San Francisco, 550 16th Street, 6th Floor, San Francisco, CA, 94158, USA
| | - Sima P Porten
- Department of Urology, University of California, San Francisco, 550 16th Street, 6th Floor, San Francisco, CA, 94158, USA
| | - Maxwell V Meng
- Department of Urology, University of California, San Francisco, 550 16th Street, 6th Floor, San Francisco, CA, 94158, USA
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5
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Azizi M, Aydin AM, Cheriyan SK, Peyton CC, Montanarella M, Gilbert SM, Sexton WJ. Therapeutic strategies for uncommon testis cancer histologies: teratoma with malignant transformation and malignant testicular sex cord stromal tumors. Transl Androl Urol 2020; 9:S91-S103. [PMID: 32055490 DOI: 10.21037/tau.2019.09.08] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Testicular cancer is the most common solid malignancy in male adolescents and young adults, with germ cell derived seminomas and non-seminomas being by far the most common histologies. Teratoma with somatic-type malignancy is a rare chemo-resistant phenotype of testis cancer associated with poor prognosis in patients with advanced stage disease. Malignant gonadal-stromal tumors comprise 5% of testicular neoplasms and approximately 10% are malignant and considered chemo-radiation resistant. Prognostic factors and treatment strategies for these uncommon histologies are lacking.
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Affiliation(s)
- Mounsif Azizi
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Ahmet M Aydin
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Salim K Cheriyan
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Charles C Peyton
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Matthew Montanarella
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Scott M Gilbert
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Wade J Sexton
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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6
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Genomic Features of Metastatic Testicular Sex Cord Stromal Tumors. Eur Urol Focus 2019; 5:748-755. [DOI: 10.1016/j.euf.2019.05.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/01/2019] [Accepted: 05/16/2019] [Indexed: 12/28/2022]
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7
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Adult Granulosa Cell Tumor of the Testis: A Case Report with a Review of the Literature. Case Rep Urol 2019; 2019:7156154. [PMID: 31236304 PMCID: PMC6545753 DOI: 10.1155/2019/7156154] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 05/07/2019] [Indexed: 12/28/2022] Open
Abstract
Adult granulosa cell tumor (AGCT) of the testis represents a very rare testicular neoplasm that is poorly understood clinically. Here we report the case of a 22-year-old male who presented with unspecific scrotal symptoms. Scrotal sonography disclosed a 6 mm hypoechoic intratesticular lesion. Histological examination after orchiectomy revealed a homogeneous and well demarcated neoplasm with monomorphic cells with nuclear grooving and microfollicular formation of the so-called Call-Exner bodies. Immunohistology showed positive stainings of vimentin, calretinin, and inhibin with negative stainings of the typical germ cell tumor markers. Thus, the diagnosis of a benign AGCT was made. The patient is well one year after surgery. A total of 91 previous AGCT cases were identified in the literature. Median age of the cases reported to date is 44 years, median tumor size 3.2 cm. 54.3% of the AGCT cases were located on the left side. 12 cases (13.2%) were of malignant nature. Testis-sparing surgery would be the treatment of choice, but only two of all cases had received that procedure. The present report aims to increase the clinical knowledge of AGCT and specifically to increase the clinician's vigilance with respect to testis-sparing surgery in probably benign testicular masses.
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8
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Calaway AC, Tachibana I, Masterson TA, Foster RS, Einhorn LH, Cary C. Oncologic Outcomes Following Surgical Management of Clinical Stage II Sex Cord Stromal Tumors. Urology 2019; 127:74-79. [PMID: 30807775 DOI: 10.1016/j.urology.2019.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/09/2019] [Accepted: 02/15/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To investigate the clinical history of patients with clinical stage II sex cord stromal tumors who underwent retroperitoneal lymph node dissection (RPLND) at our institution. METHODS Our prospectively maintained testicular cancer database was queried to identify patients who presented with or developed clinical stage II sex cord stromal tumors and underwent RPLND at our institution between 1980 and 2018. Demographic, clinical, and pathologic characteristics were reviewed. Kaplan-Meier curves were graphed to assess recurrence-free and overall survival. RESULTS Fourteen patients were included in the study with a median age of 44.2years. Four patients presented with clinical stage II disease and 10 patients developed metastatic disease during follow-up of initial clinical stage I disease with a median time to metastasis of 2.7years (range: 0.4-19.5 years). Of the 10 patients with orchiectomy pathology data available, all patients had at least 1 risk factor on testis pathology (mean: 2.9 risk factors). Nine patients received treatment prior to referral to our institution. All patients recurred post-RPLND at Indiana University. Median recurrence-free survival was 9.8 months. Twelve patients died of disease with a median overall survival of 14.4 months. CONCLUSION Metastatic sex cord stromal tumors are rare and are more resistant to standard treatment modalities than metastatic germ cell tumors. Patients presenting with sex cord stromal tumors should consider prophylactic primary RPLND in the setting of 1 or more pathologic predictor of malignancy.
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Affiliation(s)
- Adam C Calaway
- Indiana University School of Medicine, Department of Urology, Indianapolis, IN.
| | - Isamu Tachibana
- Indiana University School of Medicine, Department of Urology, Indianapolis, IN
| | - Timothy A Masterson
- Indiana University School of Medicine, Department of Urology, Indianapolis, IN
| | - Richard S Foster
- Indiana University School of Medicine, Department of Urology, Indianapolis, IN
| | - Lawrence H Einhorn
- Indiana University School of Medicine, Department of Oncology, Indianapolis, IN
| | - Clint Cary
- Indiana University School of Medicine, Department of Urology, Indianapolis, IN
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9
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Current controversies on the role of lymphadenectomy for testicular cancer for the journal: Urologic Oncology: Seminars and Original Investigations for the special seminars section on the role of lymphadenectomy for urologic cancers. Urol Oncol 2019; 39:698-703. [PMID: 30630731 DOI: 10.1016/j.urolonc.2018.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 12/04/2018] [Accepted: 12/22/2018] [Indexed: 11/22/2022]
Abstract
The role of surgery in the locoregional management of many solid tumors has long been established. For testicular cancer, the incorporation of lymphadenectomy has played an important part in generating long-term survival outcomes in excess of 90% for germ cell tumor patients. In this review, we address several clinical scenarios in which lymphadenectomy at times is underutilized, and others ill advised.
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10
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Hale GR, Teplitsky S, Truong H, Gold SA, Bloom JB, Agarwal PK. Lymph node imaging in testicular cancer. Transl Androl Urol 2018; 7:864-874. [PMID: 30456189 PMCID: PMC6212624 DOI: 10.21037/tau.2018.07.18] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Testicular cancer is a rare malignancy mainly affecting young men. Survival for testicular cancer remains high due to the effectiveness of multimodal treatment options. Accurate imaging is imperative to both treatment and follow-up. Both computed tomography (CT) and magnetic resonance imaging (MRI) suffer from size cut-offs as the only distinguishing characteristic of benign vs. malignant lymph nodes and may miss up to 30% of micro-metastatic disease. While functional [positron emission tomography (PET)] imaging may rule out disease in patients with seminoma who have undergone chemotherapy, there is insufficient evidence to recommend its use in other settings. This review highlights the uses and pitfalls of conventional imaging during staging, active surveillance, and post-treatment phases of both seminomatous and non-seminomatous germ cell tumors (NSGCT).
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Affiliation(s)
- Graham R Hale
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Seth Teplitsky
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Hong Truong
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Samuel A Gold
- SUNY Downstate College of Medicine, Downstate Medical Center, Brooklyn, NY, USA
| | - Jonathan B Bloom
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Piyush K Agarwal
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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11
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Synchronous Leydig Cell Tumor and Seminoma in the Ipsilateral Testis. Case Rep Urol 2018; 2018:8747131. [PMID: 29670803 PMCID: PMC5836420 DOI: 10.1155/2018/8747131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/17/2018] [Accepted: 01/23/2018] [Indexed: 11/29/2022] Open
Abstract
Leydig cell tumor is a rare sex cord tumor that accounts for 1–3% of all testicular neoplasms. Seminomas are more common and occur in 30–40% of testicular tumors. Leydig cell tumors are derived from undifferentiated gonadal mesenchyme and the concurrent development of the tumor and a seminoma which are derived from germinal epithelium in an ipsilateral testis is extremely rare. Here we report a case of ipsilateral Leydig cell tumor and seminoma occurring in a 38-year-old man with a left testicular mass. The key to diagnosis is dependent on histopathology and immunohistochemistry. To our knowledge, this is the first diagnosis of the two disease entities in a unilateral testis using immunohistochemistry. Increased awareness of the entity is important in order to distinguish Leydig cell tumor and seminomas from other malignancies due to difference in therapeutic management.
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12
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Yuh LM, Lara PN, Wagenaar RM, Evans CP, Dall'era MA, Cress R, Yap SA. A contemporary population-based study of testicular sex cord stromal tumours: Presentation, treatment patterns, and predictors of outcome. Can Urol Assoc J 2018; 11:E344-E349. [PMID: 29382456 DOI: 10.5489/cuaj.4402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We aimed to characterize demographic distribution, patient outcomes, and prognostic features of testicular sex cord stromal tumours (SCST) using a large statewide database. METHODS Adult male patients diagnosed with SCST between 1988 and 2010 were identified within the California Cancer Registry (CCR). Baseline demographic variables and disease characteristics were reported. Primary outcome measures were cancer-specific survival (CSS) and overall survival (OS). Bivariate and multivariate Cox proportional hazards models were employed to identify predictors of survival. RESULTS A total of 67 patients with SCST were identified, of which 45 (67%) had Leydig cell and 19 (28%) had Sertoli cell tumours. Median age was 40 years and the majority of patients (84%) presented with localized disease. Following orchiectomy, nine patients (15%) underwent retroperitoneal lymph node dissection (RPLND), whereas 54 patients (80%) had no further treatment. With a median followup of 75 months, two-year OS and CSS was 91% and 95%, respectively, for those presenting with stage I disease. For those presenting with stage II disease, two-year OS and CSS was 30%. Predictors of worse OS included age >60 (hazard ratio [HR] 5.64; p<0.01) and metastatic disease (HR 8.56; p<0.01). Presentation with metastatic disease was the only variable associated with worse CSS (HR 13.36; p<0.01). Histology was not found to be a significant predictor of either CSS or OS. CONCLUSIONS We present the largest reported series to date for this rare tumour and provide contemporary epidemiological and treatment data. The primary driver of prognosis in patients with SCST is disease stage, emphasizing the importance of early detection and intervention.
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Affiliation(s)
- Lindsay M Yuh
- Department of Urology, University of California Davis, Sacramento, CA; United States.,University of California Davis Comprehensive Cancer Center, Sacramento, CA; United States
| | - Primo N Lara
- Division of Hematology Oncology, Department of Internal Medicine, University of California Davis, Sacramento, CA; United States.,University of California Davis Comprehensive Cancer Center, Sacramento, CA; United States
| | - Rebecca M Wagenaar
- Department of Urology, University of California Davis, Sacramento, CA; United States.,University of California Davis Comprehensive Cancer Center, Sacramento, CA; United States
| | - Christopher P Evans
- Department of Urology, University of California Davis, Sacramento, CA; United States.,University of California Davis Comprehensive Cancer Center, Sacramento, CA; United States
| | - Marc A Dall'era
- Department of Urology, University of California Davis, Sacramento, CA; United States.,University of California Davis Comprehensive Cancer Center, Sacramento, CA; United States
| | - Rosemary Cress
- Cancer Registry of Greater California, Public Health Institute, Sacramento, CA; United States.,Department of Public Health Sciences, UC Davis School of Medicine, Davis, CA; United States.,University of California Davis Comprehensive Cancer Center, Sacramento, CA; United States
| | - Stanley A Yap
- Department of Urology, University of California Davis, Sacramento, CA; United States.,University of California Davis Comprehensive Cancer Center, Sacramento, CA; United States.,Division of Urology, Department of Surgery, VA Northern California Health Care System, Sacramento, CA; United States
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13
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Muheilan MM, Shomaf M, Tarawneh E, Murshidi MM, Al-Sayyed MR, Murshidi MM. Leydig cell tumor in grey zone: A case report. Int J Surg Case Rep 2017; 35:12-16. [PMID: 28419904 PMCID: PMC5394201 DOI: 10.1016/j.ijscr.2017.03.043] [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: 01/14/2017] [Revised: 03/31/2017] [Accepted: 03/31/2017] [Indexed: 11/12/2022] Open
Abstract
Leydig cell tumor is a testicular tumor with a low incidence accounting for 1–3% of testicular neoplasms. Only about 10% of them show malignant behavior in the form of metastatic disease. When diagnosed and treated early, long-term favorable outcomes are seen even with its potential metastatic behavior.
Introduction Leydig cell tumor constitutes only about 1–3% of testicular neoplasms. There is apparently increased incidence in the last few years; one possible explanation for this phenomenon is the widespread use of ultrasound technology and the subsequent increased early detection of smaller lesions that have not been found in historical series. Case presentation We report a case of Leydig cell tumor of testis in a patient presenting with painless long standing slowly growing left scrotal mass who found to have intrapulmonary nodule and multiple enlarged retroperitoneal lymph nodes on staging work up. The mass was managed by radical orchiectomy. Pathological diagnosis was Leydig cell tumor. Discussion Orchiectomy is the accepted mode of treatment but follow-up every 3–6 months with physical examination, hormone assays, scrotal and abdominal ultrasonography, chest radiography, and CT scans is essential in such a case with a potential for malignant behavior. Conclusion Inguinal orchiectomy is the therapeutic decision of choice and long-term follow-up is necessary to exclude recurrence or metastasis. Cases which fall in the grey zone like ours need to be followed up carefully for metastasis instead of rushing into an early retroperitoneal lymph node dissection, with its potential risks and complications.
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Affiliation(s)
- Muheilan Mustafa Muheilan
- Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Jordan.
| | - Maha Shomaf
- Department of Pathology and Microbiology and Forensic Medicine, Jordan University Hospital, The University of Jordan, Jordan.
| | - Emad Tarawneh
- Department of Radiology, Jordan University Hospital, The University of Jordan, Jordan.
| | | | - Manar Rizik Al-Sayyed
- Department of Pathology and Microbiology and Forensic Medicine, Jordan University Hospital, The University of Jordan, Jordan.
| | - Mujalli Mhailan Murshidi
- Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Jordan.
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14
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Banerji JS, Odem-Davis K, Wolff EM, Nichols CR, Porter CR. Patterns of Care and Survival Outcomes for Malignant Sex Cord Stromal Testicular Cancer: Results from the National Cancer Data Base. J Urol 2016; 196:1117-22. [DOI: 10.1016/j.juro.2016.03.143] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2016] [Indexed: 10/22/2022]
Affiliation(s)
- John S. Banerji
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington
| | | | - Erika M. Wolff
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington
- Surgical Outcomes Research Center, University of Washington, Seattle, Washington
| | - Craig R. Nichols
- Testicular Cancer Multidisciplinary Clinic, Virginia Mason Medical Center, Seattle, Washington
| | - Christopher R. Porter
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington
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15
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Compérat E, Culine S. Tumeurs rares du testicule et de ses annexes de l’adulte. ONCOLOGIE 2014. [DOI: 10.1007/s10269-014-2382-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Silberstein JL, Bazzi WM, Vertosick E, Carver BS, Bosl GJ, Feldman DR, Bajorin DF, Motzer RJ, Al-Ahmadie H, Reuter VE, Sheinfeld J. Clinical outcomes of local and metastatic testicular sex cord-stromal tumors. J Urol 2014; 192:415-9. [PMID: 24518791 DOI: 10.1016/j.juro.2014.01.104] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE We evaluated pathological variables of testicular sex cord-stromal tumors, management options and clinical outcomes. MATERIALS AND METHODS We retrospectively reviewed the records of 48 patients with testicular sex cord-stromal tumors treated at Memorial Sloan-Kettering Cancer Center between 1997 and 2012. Clinical outcomes were compared based on treatment and previously described pathological factors associated with metastatic potential. RESULTS Of the 48 patients 37 underwent surveillance without retroperitoneal lymph node dissection, including 34 with no high risk feature and 3 with 1. Median followup was 14.5 months (IQR 6.9-32.5). No patient experienced recurrence. Retroperitoneal lymph node dissection was performed in 11 patients, including 6 with clinical stage I disease and 2 or more high risk features who underwent early dissection, 2 with clinical stage IIa disease at diagnosis who underwent early dissection and 3 with clinical stage I disease and 2 or more high risk features who were observed elsewhere but referred to our institution due to retroperitoneal disease. Six patients with clinical stage I disease underwent early dissection, 4 had no evidence of disease at a median followup of 6.6 years and 2 experienced recurrence and died of disease. Neither of the 2 patients with IIa disease at diagnosis experienced relapse. All 3 patients with delayed dissection experienced relapse and 1 died of disease. CONCLUSIONS Patients with testicular sex cord-stromal tumors and 1 or no high risk feature can be safely observed without retroperitoneal lymph node dissection but longer followup is needed. Given the lack of effective alternative treatments, early retroperitoneal lymph node dissection may be beneficial in those with 2 or more high risk features, or clinical stage IIa disease.
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Affiliation(s)
| | - Wassim M Bazzi
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Emily Vertosick
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Brett S Carver
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - George J Bosl
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Darren R Feldman
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Dean F Bajorin
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Robert J Motzer
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Hikmat Al-Ahmadie
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Victor E Reuter
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Joel Sheinfeld
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
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Lima JF, Jin L, de Araujo ARC, Erikson-Johnson MR, Oliveira AM, Sebo TJ, Keeney GL, Medeiros F. FOXL2 mutations in granulosa cell tumors occurring in males. Arch Pathol Lab Med 2012; 136:825-8. [PMID: 22742556 DOI: 10.5858/arpa.2011-0355-oa] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Granulosa cell tumors comprise less than 5% of ovarian tumors in women and are much rarer in men, with only about 20 cases reported, to our knowledge. Recently, a somatic mutation of FOXL2 was reported in virtually all adult-type granulosa cell tumors in women. OBJECTIVE To investigate FOXL2 mutations in granulosa cell tumors occurring in males. DESIGN Five cases of an adult-type granulosa cell tumor from males were selected from the files of the Mayo Clinic. Nine other testicular tumors (1 juvenile granulosa cell tumor, 5 Leydig cell tumors, and 3 Sertoli-Leydig cell tumors) were evaluated for comparison. Inhibin immunostain was performed in all cases. DNA was extracted from formalin-fixed, paraffin-embedded tissue, followed by polymerase chain reaction and direct sequencing of FOXL2. RESULTS All 5 cases had classic histopathologic features of the adult-type granulosa cell tumor. Inhibin was diffusely positive in all cases. FOXL2 402C→G (C134W) was identified in 40% (2 of 5) of the male, adult-type granulosa cell tumors. Of the 2 tumors positive for the mutation, 1 occurred in the testis of a man, and the other one affected the abdominal ovaries of a phenotypically male patient. All other testicular tumors were negative for the mutation. CONCLUSIONS The FOXL2 402C→G (C134W) mutation is also present in adult-type granulosa cell tumors occurring in men, although in a smaller proportion when compared with the rates reported in women. FOXL2 mutational analysis can be a helpful in the diagnosis of granulosa cell tumors of the testis.
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Affiliation(s)
- Joema F Lima
- Division of Anatomic Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.
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Wheater M, Simmonds P. REPLY. BJU Int 2011. [DOI: 10.1111/j.1464-410x.2011.10672_2.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jiménez J, Cebrián J, Guarch R, Hualde A. Tumor testicular de células de Sertoli con marcadores neuroendocrinos positivos. Actas Urol Esp 2010. [DOI: 10.1016/j.acuro.2010.01.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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