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

Testicular tumor arising from an intra-abdominal undescended testis in a 1-year-old child: a case report and literature review

Objectives

Testicular tumors in the intra-abdominal undescended testis are rare in children, and their management remains challenging. The aim was to present a case report and review of the literature about diagnosis and treatment of testicular tumors arising from undescended intra-abdominal testis in children.

Methods

In this study, we retrospectively analyzed the clinical records of a 1-year-old male patient admitted to pediatric surgery in March 2022 with a testicular tumor originating in the intra-abdominal undescended testis. Furthermore, medical literature published in English during the last three decades was systematically searched through the databases of Medline, PubMed, and Google Scholar.

Results

The patient underwent laparoscopic orchiopexy and tumor excision. The operation was uneventful, and the patient recovered well without complications. An 8-month follow-up showed no recurrence of the teratoma after postoperative pathology. The literature search resulted in the retrieval of 16 non-duplicate articles, and 16 patients were included in this review. The cases included six cases of left cryptorchidism and 10 cases of right cryptorchidism, with an average age of 15.3 months. The largest transverse diameter of the tumors ranged from 1.8 to 12.5 cm, with an average tumor length of 6.7 cm. All patients underwent surgical treatment, including three cases of laparoscopic orchiectomy, a sole case of a conversion of inguinal incision to laparotomy and orchiectomy, and 12 cases of laparotomy and orchiectomy. Postoperative pathology revealed 12 cases of mature teratoma, two cases of immature teratoma, one case of yolk sac tumor, and a single case of embryonic carcinoma combined with yolk sac tumor. 11 patients were followed up, and one of them recurred.

Conclusion

Abdominal ultrasound (US) or abdominal computer tomography (CT) should be performed in cases of undescended testis suspected to have testicular tumors on clinical findings. The most common type of intra-abdominal testicular tumor is mature teratomas. Early diagnosis and prompt surgical intervention resulted in an excellent outcome.

Treatment at an Inexperienced Center Suggests Worse Prognosis of Metastatic Germ Cell Tumors

BACKGROUND/AIM

We evaluated the clinical outcomes of patients with metastatic germ cell tumors (GCT) treated at our hospital, which belongs to a regional cancer center.

PATIENTS AND METHODS

Data pertaining to patients with metastatic GCT were obtained between April 2007-October 2017 and was retrospectively analyzed. Key outcome measures included objective response rates and survival rates.

RESULTS

All 42 patients received chemotherapy [complete response: eight (19.0%); partial response: 21 (50.0%); stable disease (SD): nine (21.4%); progressive disease: four patients (9.5%)]. Post-chemotherapeutic surgery was performed for seven out of 21 cases of partial response and two out of nine of stable disease. The 5-year survival rates of patients with good, intermediate and poor prognosis (International Germ Cell Consensus Classification) were 100%, 100%, and 71.4%, respectively. Patients who received induction chemotherapy at other hospitals had significantly poorer prognosis than those at our hospital (p=0.0043).

CONCLUSION

Patients with metastatic GCT should preferably receive chemotherapy at an experienced institution.

Advanced Testis Cancer

Management of advanced testis cancer requires dedicated attention to the nuances of the disease to not only optimize cure but also ensure lifelong health. We are rapidly entering an era of precision medicine with novel biomarker discoveries that will undoubtedly change the treatment paradigm in both early- and late-stage disease.