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Valentino Torry SR, Warli SM, Taher A, Rahman F, Lisnawati. Metachronous bilateral testicular germ cell tumors with different histopathology: A case report. Urol Case Rep 2023; 51:102612. [PMID: 38046261 PMCID: PMC10690550 DOI: 10.1016/j.eucr.2023.102612] [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: 09/10/2023] [Revised: 10/19/2023] [Accepted: 11/06/2023] [Indexed: 12/05/2023] Open
Abstract
Background Testicular cancer is the most common solid tumor affecting men aged 20-39 years old. About 95% of all testicular tumor is testicular germ cell tumor. Bilateral testicular tumor is a rare incident and has similar histopathology only in less than 5% of all testicular cancer patients. Besides oncological issues, bilateral testicular tumors could lead to further consequences, such as psychosocial and hormonal issues. This article shows a case of different histopathology in the metachronous bilateral testicular tumors. Case presentation A 34-years-old male came with right radical orchiectomy due to testicular pure seminoma pT1N0M0S0 three and half years ago. He underwent bleomycin, etoposide phosphate (BEP) chemotherapy for progressive multiple lymphadenopathies in paracaval and interaortacaval region from positron emission tomography (PET)/computerized tomography (CT) scan a year later. Sperm banking was done before initiated chemotherapy. High metabolic activity was detected in contralateral testis from follow up PET-scan. Left testicle enlargement with hard consistency was found on physical examination and there is an elevation of alpha-feto protein (AFP) and β-hCG. Intraoperatively, the frozen section identified a malignant tumor and the patient was decided to undergo radical left orchiectomy. Postoperative pathological results showed a mixed germ cell tumor of 3.5 × 2.5 × 2 cm consisting of immature teratoma, yolk sac tumor and embryonic carcinoma without lympho-vascular invasion and involvement of the spermatic cord. Post-operative imaging and testicular tumor marker did not identify any metastases. BEP chemotherapy, testosterone replacement therapy was planned for further management in this patient with complete blood count, prostate serum antigen (PSA) and digital rectal examination should be measured three to six weeks after initiation. Conclusion Metachronous bilateral TGCT with different histopathology is a rare disease. The treatment depends on histology of second tumor and its stage. TRT is mandatory for patient undergoing bilateral orchidectomy to address lack if testosterone.
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Affiliation(s)
- Stivano Rizky Valentino Torry
- Department of Urology, Faculty of Medicine, Universitas Indonesia – Haji Adam Malik General Hospital, Medan, Indonesia
| | - Syah Mirsya Warli
- Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara - Haji Adam Malik General Hospital, Medan, Indonesia
- Department of Urology, Universitas Sumatera Utara Hospital, Universitas Sumatera Utara, Medan, Indonesia
| | - Akmal Taher
- Department of Urology, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Fakhri Rahman
- Department of Urology, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Lisnawati
- Department of Anatomical Pathology, Universitas Indonesia–Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Küronya Z, Fröhlich G, Ladányi A, Martin T, Géczi L, Gyergyai F, Horváth O, Kiszner G, Kovács Á, Dienes T, Lénárt E, Nagyiványi K, Szarvas T, Szőnyi M, Tóth A, Biró K. Low socioeconomic position is a risk factor for delay to treatment and mortality of testicular cancer patients in Hungary, a prospective study. BMC Public Health 2021; 21:1707. [PMID: 34538241 PMCID: PMC8451119 DOI: 10.1186/s12889-021-11720-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 09/02/2021] [Indexed: 01/03/2023] Open
Abstract
Background In Hungary, the mortality rate for testicular germ cell cancer (TGCC) is 0,9/100000 which is significantly higher than the EU average. We prospectively evaluated the effect of socioeconomic position on patient delay and therapy outcomes. Methods Questionnaires on subjective social status (MacArthur Subjective Status Scale), objective socioeconomic position (wealth, education, and housing data), and on patient’s delay were completed by newly diagnosed TGCC patients. Results Patients belonged to a relatively high socioeconomic class, a university degree was double the Hungarian average, Cancer-specific mortality in the highest social quartile was 1.56% while in the lowest social quartile 13.09% (p = 0.02). In terms of patient delay, 57.2% of deceased patients waited more than a year before seeking help, while this number for the surviving patients was 8.0% (p = 0.0000). Longer patient delay was associated with a more advanced stage in non-seminoma but not in seminoma, the correlation coefficient for non-seminoma was 0.321 (p < 0.001). For patient delay, the most important variables were the mother’s and patient’s education levels (r = − 0.21, p = 0.0003, and r = − 0.20, p = 0.0005), respectively. Since the patient delay was correlated with the social quartile and resulted in a more advanced stage in non-seminoma, the lower social quartile resulted in higher mortality in non-seminoma patients (p = 0.005) but not in seminoma patients (p = 0.36) where the patient delay was not associated with a more advanced stage. Conclusions Based on our result, we conclude that to improve survival, we should promote testicular cancer awareness, especially among the most deprived populations, and their health care providers. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11720-w.
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Affiliation(s)
- Zsófia Küronya
- Department of Genitourinary Medical Oncology and Clinical Pharmacology, National Institute of Oncology, Ráth György u. 7-9, Budapest, H-1122, Hungary.
| | - Georgina Fröhlich
- Faculty of Science, Eötvös Loránd University, Budapest, Hungary.,Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
| | - Andrea Ladányi
- Department of Surgical and Molecular Pathology, National Institute of Oncology, Budapest, Hungary
| | - Tamás Martin
- Department of Genitourinary Medical Oncology and Clinical Pharmacology, National Institute of Oncology, Ráth György u. 7-9, Budapest, H-1122, Hungary
| | - Lajos Géczi
- Department of Genitourinary Medical Oncology and Clinical Pharmacology, National Institute of Oncology, Ráth György u. 7-9, Budapest, H-1122, Hungary
| | - Fruzsina Gyergyai
- Department of Genitourinary Medical Oncology and Clinical Pharmacology, National Institute of Oncology, Ráth György u. 7-9, Budapest, H-1122, Hungary
| | - Orsolya Horváth
- Department of Genitourinary Medical Oncology and Clinical Pharmacology, National Institute of Oncology, Ráth György u. 7-9, Budapest, H-1122, Hungary
| | - Gergő Kiszner
- Department of Genitourinary Medical Oncology and Clinical Pharmacology, National Institute of Oncology, Ráth György u. 7-9, Budapest, H-1122, Hungary
| | - Ágnes Kovács
- Boehringer Ingelheim RCV GmbH & Co. KG Branch Office Budapest, Budapest, Hungary
| | - Tamás Dienes
- Department of Genitourinary Medical Oncology and Clinical Pharmacology, National Institute of Oncology, Ráth György u. 7-9, Budapest, H-1122, Hungary
| | - Enikő Lénárt
- Department of Genitourinary Medical Oncology and Clinical Pharmacology, National Institute of Oncology, Ráth György u. 7-9, Budapest, H-1122, Hungary
| | - Krisztián Nagyiványi
- Department of Genitourinary Medical Oncology and Clinical Pharmacology, National Institute of Oncology, Ráth György u. 7-9, Budapest, H-1122, Hungary
| | - Tibor Szarvas
- Department of Urology, Semmelweis University Budapest, Budapest, Hungary
| | - Mihály Szőnyi
- Semmelweis University Faculty of Medicine, Budapest, Hungary
| | | | - Krisztina Biró
- Department of Genitourinary Medical Oncology and Clinical Pharmacology, National Institute of Oncology, Ráth György u. 7-9, Budapest, H-1122, Hungary
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Camacho-Moll ME, Macdonald J, Looijenga LHJ, Rimmer MP, Donat R, Marwick JA, Shukla CJ, Carragher N, Jørgensen A, Mitchell RT. The oncogene Gankyrin is expressed in testicular cancer and contributes to cisplatin sensitivity in embryonal carcinoma cells. BMC Cancer 2019; 19:1124. [PMID: 31744479 PMCID: PMC6862764 DOI: 10.1186/s12885-019-6340-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 11/06/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Testicular germ cell cancer (TGCC) develops from pre-malignant germ neoplasia in situ (GCNIS) cells. GCNIS originates from fetal gonocytes (POU5F1+/MAGE-A4-), which fail to differentiate to pre-spermatogonia (POU5F1-/MAGE-A4+) and undergo malignant transformation. Gankyrin is an oncogene which has been shown to prevent POU5F1 degradation and specifically interact with MAGE-A4 in hepatocellular carcinoma (HCC) cells. We aimed to investigate the role of Gankyrin in progression from gonocyte to pre-invasive GCNIS and subsequent invasive TGCC. METHODS We determined Gankyrin expression in human fetal testicular tissue (gestational weeks 9-20; n = 38), human adult testicular tissue with active spermatogenesis (n = 9), human testicular tissue with germ cell maturation delay (n = 4), testicular tissue from patients with pre-invasive GCNIS (n = 6), and invasive TGCC including seminoma (n = 6) and teratoma (n = 7). Functional analysis was performed in-vitro by siRNA knock-down of Gankyrin in the NTera2 cells (derived from embryonal carcinoma). RESULTS Germ cell expression of Gankyrin was restricted to a sub-population of prespermatogonia in human fetal testes. Nuclear Gankyrin was also expressed in GCNIS cells of childhood and adult pre-invasive TGCC patients, and in GCNIS from seminoma and non-seminoma patients. Cytoplasmic expression was observed in seminoma tumour cells and NTera2 cells. Gankyrin knock-down in NTera2 cells resulted in an increase in apoptosis mediated via the TP53 pathway, whilst POU5F1 expression was unaffected. Furthermore, Gankyrin knock-down in NTera2 cells increased cisplatin sensitivity with an increase in cell death (13%, p < 0.05) following Gankyrin knock-down, when compared to cisplatin treatment alone, likely via BAX and FAS. Our results demonstrate that Gankyrin expression changes in germ cells during normal transition from gonocyte to prespermatogonia. In addition, changes in Gankyrin localisation are associated with progression of pre-invasive GCNIS to invasive TGCC. Furthermore, we found that Gankyrin is involved in the regulation of NTera2 cell survival and that a reduction in Gankyrin expression can modulate cisplatin sensitivity. CONCLUSIONS These results suggest that manipulation of Gankyrin expression may reduce the cisplatin dose required for the treatment of TGCC, with benefits in reducing dose-dependent side effects of chemotherapy. Further studies are required in order to assess the effects of modulating Gankyrin on GCNIS/TGCC using in vivo models.
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Affiliation(s)
- Maria E. Camacho-Moll
- Departamento de Biología Molecular, Centro de Investigación Biomédica del Noreste, Delegación Nuevo León, Instituto Mexicano del Seguro Social, Calle 2 de abril 501, esq. San Luis Potosí, Col. Independencia, CP, 64720 Monterrey, Nuevo León Mexico
- Centro de Diagnóstico Molecular y Medicina Personalizada, División Ciencias de la Salud, Universidad de Monterrey, Av. Ignacio Morones Prieto 4500 Pte, N. L, 66238 San Pedro Garza García, Mexico
| | - Joni Macdonald
- MRC Centre for Reproductive Health, The University of Edinburgh, Queen’s Medical Research Institute, 47 Little France Crescent, Edinburgh, Scotland, EH16 4TJ UK
| | - L. H. J. Looijenga
- Department of Pathology, Erasmus University, Medical Center, Cancer Center, Josephine Nefkens Institute, Wytemaweg 80, 3015 Rotterdam, CN Netherlands
- Princess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands
| | - Michael P. Rimmer
- MRC Centre for Reproductive Health, The University of Edinburgh, Queen’s Medical Research Institute, 47 Little France Crescent, Edinburgh, Scotland, EH16 4TJ UK
| | - Roland Donat
- Department of Urology, Western General Hospital, Crewe Road, Edinburgh, Scotland, EH4 2XU UK
| | - John A. Marwick
- The MRC Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ UK
| | - C. J. Shukla
- Department of Urology, Western General Hospital, Crewe Road, Edinburgh, Scotland, EH4 2XU UK
| | - Neil Carragher
- Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Anne Jørgensen
- Department of Growth and Reproduction, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9 2100 KBH Ø, Copenhagen, UK
| | - Rod T. Mitchell
- MRC Centre for Reproductive Health, The University of Edinburgh, Queen’s Medical Research Institute, 47 Little France Crescent, Edinburgh, Scotland, EH16 4TJ UK
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Hom M, Sriprasert I, Ihenacho U, Castelao JE, Siegmund K, Bernstein L, Cortessis VK. Systematic Review and Meta-analysis of Testicular Germ Cell Tumors Following In Utero Exposure to Diethylstilbestrol. JNCI Cancer Spectr 2019; 3:pkz045. [PMID: 31555759 PMCID: PMC6748667 DOI: 10.1093/jncics/pkz045] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/06/2019] [Accepted: 06/19/2019] [Indexed: 11/15/2022] Open
Abstract
Background Early exposure to estrogen-like compounds has been implicated in the etiology of testicular cancer, but individual level epidemiologic data addressing this hypothesis are scarce. The synthetic estrogen diethylstilbestrol (DES) was administered during pregnancy from 1948 to 1971, but sequelae of in utero exposure have been more extensively characterized in females than in males. Methods By systematic review, we sought to identify all epidemiologic research relating testicular cancer to a history of in utero exposure to diethylstilbestrol. Identified studies were critically appraised to assemble a set of nonredundant data in which any in utero exposure to DES was compared between men with incident testicular cancer and cancer-free men. These data were synthesized using random effects meta-analysis to estimate the summary association between in utero DES exposure and testicular cancer. Results By meta-analysis of data from the six qualifying studies, the summary odds ratio estimate of the in utero DES-testicular cancer association was 2.98 (95% confidence interval = 1.15 to 7.67). Conclusions Results of this comprehensive meta-analysis accord with a threefold increase in testicular cancer risk among men who were exposed in utero to DES, implicating early hormonal exposures in etiology of testicular cancer. Because use of DES ceased in 1971, this work may provide the most comprehensive estimate of this association that will be made.
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Affiliation(s)
- Marianne Hom
- See the Notes section for the full list of authors' affiliations
| | | | - Ugonna Ihenacho
- See the Notes section for the full list of authors' affiliations
| | | | | | - Leslie Bernstein
- See the Notes section for the full list of authors' affiliations
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Shah A, Feustel PJ, Knuth J, Welliver C. An updated mortality risk analysis of the post-pubertal undescended testis. Can Urol Assoc J 2019; 13:E1-E6. [PMID: 30059286 PMCID: PMC6314858 DOI: 10.5489/cuaj.5296] [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 The undescended testicle (UDT) presents a problem in post-pubertal (PP) men, as it carries an increased risk of developing a germ cell tumour (GCT). Management of the PP patient with an UDT must weigh the relative risk (RR) of perioperative mortality (POM) from orchiectomy against the lifetime risk of death from a GCT. METHODS The most recent data on GCT mortality were obtained from the National Centre for Health Statistics. Standard life tables were used to calculate the cumulative risk over a man's lifetime based on age. The increased RR of GCT in men with UDT was determined by weighing the observed and expected rates from literature review. Life table data was then multiplied by the RR to define the risk of GCT in men with UDT. Data from patients undergoing similar risk surgical procedures stratified by American Society of Anesthesiologists (ASA) class was used to determine POM. RESULTS Lifetime risk of dying from GCT decreases with increasing age. POM exceeded risks of death from GCT for men after age 50.2 for ASA class 1 and age 35.4 for ASA class 2. Men with an ASA class higher than 2 have a higher risk of POM compared to GCT for all ages. CONCLUSIONS We found different ages from previous reports at which observation is advised. We consider prophylactic orchiectomy only in men who are under 50.2 years if ASA class 1 and under 35.4 years if ASA class 2. Men with an ASA class 3 or higher should always undergo observation.
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Affiliation(s)
- Ankur Shah
- Department of Surgery, Division of Urology, Albany Medical College, Albany, NY, United States
| | - Paul J. Feustel
- Center for Neuropharmacology and Neuroscience, Albany Medical College, Albany, NY, United States
| | - Jennifer Knuth
- Department of Anesthesiology, Albany Medical College, Albany, NY, United States
| | - Charles Welliver
- Department of Surgery, Division of Urology, Albany Medical College, Albany, NY, United States
- Albany Stratton VA Medical Center, Albany, NY, United States
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Marcotte EL, Pankratz N, Amatruda JF, Frazier AL, Krailo M, Davies S, Starr JR, Lau CC, Roesler M, Langer E, Hallstrom C, Hooten AJ, Poynter JN. Variants in BAK1, SPRY4, and GAB2 are associated with pediatric germ cell tumors: A report from the children's oncology group. Genes Chromosomes Cancer 2017; 56:548-558. [PMID: 28295819 DOI: 10.1002/gcc.22457] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 03/07/2017] [Accepted: 03/07/2017] [Indexed: 12/18/2022] Open
Abstract
Germ cell tumors (GCT) are a rare form of childhood cancer that originate from the primordial germ cell. Recent genome-wide association studies (GWAS) have identified susceptibility alleles for adult testicular GCT (TGCT). We test whether these SNPs are associated with GCT in pediatric and adolescent populations. This case-parent triad study includes individuals with GCT diagnosed between ages 0 and 19. We evaluated 26 SNPs from GWAS of adult TGCT and estimated main effects for pediatric GCT within complete trios (N = 366) using the transmission disequilibrium test. We used Estimation of Maternal, Imprinting and interaction effects using Multinomial modelling to evaluate maternal effects in non-Hispanic white trios and dyads (N = 244). We accounted for multiple comparisons using a Bonferroni correction. A variant in SPRY4 (rs4624820) was associated with reduced risk of GCT (OR [95% CI]: 0.70 [0.57, 0.86]). A variant in BAK1 (rs210138) was positively associated with GCT (OR [95% CI]: 1.70 [1.32, 2.18]), with a strong estimated effect for testis tumors (OR [95% CI]: 3.31 [1.89, 5.79]). Finally, a SNP in GAB2 (rs948662) was associated with increased risk for GCT (OR [95% CI]: 1.56 [1.20, 2.03]). Nominal associations (P < 0.05) were noted for eight additional loci. A maternal effect was observed for KITLG SNP rs4474514 (OR [95% CI]: 1.66 [1.21, 2.28]) and a paternal parent-of-origin effect was observed for rs7221274 (P = 0.00007), near TEX14, RAD51C, and PPM1E. We observed associations between SNPs in SPRY4, BAK1, and GAB2 and GCTs. This analysis suggests there may be common genetic risk factors for GCT in all age groups.
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Affiliation(s)
- Erin L Marcotte
- Division of Epidemiology & Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Nathan Pankratz
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - James F Amatruda
- Departments of Pediatrics, Molecular Biology and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Mark Krailo
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Stella Davies
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Ching C Lau
- Texas Children's Cancer and Hematology Centers, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Michelle Roesler
- Division of Epidemiology & Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Erica Langer
- Division of Epidemiology & Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Caroline Hallstrom
- Division of Epidemiology & Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Anthony J Hooten
- Division of Epidemiology & Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Jenny N Poynter
- Division of Epidemiology & Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
- Masonic Cancer Center, Minneapolis, Minnesota
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Abstract
Lactitol is a disaccharide sugar alcohol (polyol) which is derived from lactose by catalytic hydrogenation and which may be used as a noncariogenic, reduced calorie sugar substitute in different foods. In the context of the safety evaluation of lactitol, a chronic carcinogenicity/toxicity study was conducted in a Wistar-derived strain of rats. In addition to effects that occur commonly in rats fed high doses of polyols, an increased incidence of Leydig cell tumors was observed in rats fed a diet with 10% lactitol for their lifetime. A comparison group receiving a diet with 20% lactose exhibited the same effect. At the 5% dose level of lactitol, no testicular changes were seen. Although lactitol is not genotoxic in standard in vitro tests and was also not associated with tumor formation in female rats and mice of either sex, it was necessary to assess the relevance of the testicular neoplastic growth for human safety. A comparative evaluation of the spontaneous and chemically induced formation of Leydig cell tumors in rats and humans demonstrates that the spontaneous occurrence is extremely low in humans but rather high in rats. Chemical agents or experimental conditions that in rats are associated with interstitial cell hyperplasia or neoplasia have not been associated with similar effects in humans. This is also true for lactose which, in Western countries, is consumed regularly and in substantial amounts with dairy products. Since lactitol is essentially not hydrolyzed in the small intestine, it gains access to the metabolism only after fermentation by the intestinal flora. It is therefore reasonable to assume that the testicular effects of lactitol and lactose were mediated by changes in the digestive tract such as by the known increase of calcium absorption which occurs in lactitol- and lactose-fed rats but not in humans or by effects of these compounds on the enterohepatic cycling of steroid hormones. Although these mechanisms are not yet elucidated, the available data on Leydig cell tumors indicate that the effects seen in male rats are not relevant to humans. The major lines of evidence supporting the human safety of lactitol and lactose are: (1) the lack of genotoxicity of lactitol, (2) the rat specificity of the testicular effects of lactose and lactitol, (3) the long history of safe consumption of lactose in humans, (4) the insensitivity of the human Leydig cells to agents and conditions that are known to cause neoplastic growth of Leydig cells in rats, (5) the generally very low spontaneous incidence of Leydig cell tumors in the human population, and (6) the absence of any epidemiological evidence establishing a link between nutritional factors and the occurrence of Leydig cell tumors in humans.
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Affiliation(s)
- Albert Bär
- Bioresco Ltd. Hauptstrasse 63 CH-4102 Binningen, Switzerland
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Elzinga-Tinke JE, Dohle GR, Looijenga LH. Etiology and early pathogenesis of malignant testicular germ cell tumors: towards possibilities for preinvasive diagnosis. Asian J Androl 2016; 17:381-93. [PMID: 25791729 PMCID: PMC4430936 DOI: 10.4103/1008-682x.148079] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Malignant testicular germ cell tumors (TGCT) are the most frequent cancers in Caucasian males (20-40 years) with an 70% increasing incidence the last 20 years, probably due to combined action of (epi)genetic and (micro)environmental factors. It is expected that TGCT have carcinoma in situ(CIS) as their common precursor, originating from an embryonic germ cell blocked in its maturation process. The overall cure rate of TGCT is more than 90%, however, men surviving TGCT can present long-term side effects of systemic cancer treatment. In contrast, men diagnosed and treated for CIS only continue to live without these long-term side effects. Therefore, early detection of CIS has great health benefits, which will require an informative screening method. This review described the etiology and early pathogenesis of TGCT, as well as the possibilities of early detection and future potential of screening men at risk for TGCT. For screening, a well-defined risk profile based on both genetic and environmental risk factors is needed. Since 2009, several genome wide association studies (GWAS) have been published, reporting on single-nucleotide polymorphisms (SNPs) with significant associations in or near the genes KITLG, SPRY4, BAK1, DMRT1, TERT, ATF7IP, HPGDS, MAD1L1, RFWD3, TEX14, and PPM1E, likely to be related to TGCT development. Prenatal, perinatal, and postnatal environmental factors also influence the onset of CIS. A noninvasive early detection method for CIS would be highly beneficial in a clinical setting, for which specific miRNA detection in semen seems to be very promising. Further research is needed to develop a well-defined TGCT risk profile, based on gene-environment interactions, combined with noninvasive detection method for CIS.
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Affiliation(s)
| | | | - Leendert Hj Looijenga
- Department of Pathology, Laboratory of Experimental Patho-Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
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Steinman KJ, Robeck TR, O'Brien JK. Characterization of estrogens, testosterone, and cortisol in normal bottlenose dolphin (Tursiops truncatus) pregnancy. Gen Comp Endocrinol 2016; 226:102-12. [PMID: 26718081 DOI: 10.1016/j.ygcen.2015.12.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 12/04/2015] [Accepted: 12/19/2015] [Indexed: 11/30/2022]
Abstract
The goal of this study was to describe profiles of serum estrogens, testosterone and cortisol during normal pregnancy in bottlenose dolphins. Predominant estrogens in all categories of dolphin sera pools during estrus and pregnancy (EARLY: Days 0-120; MID: Days 121-240; LATE: Days 241 to parturition; Day 0=day of conception) were estrone/estrone conjugates (E1-C) and estriol (E3). Serum samples collected throughout 101 normal pregnancies were analyzed for E1-C, E3, testosterone (T) and cortisol (CORT). E1-C was higher (P<0.05) during LATE compared to EARLY and MID, and higher (P<0.05) in nulliparous than multiparous females. E1-C concentrations were also inversely associated with maternal age (P=0.05). E3 was higher (P<0.05) in EARLY than MID and LATE, and higher overall for nulliparous than multiparous females, but concentrations were similar among gestational stages when parity was excluded from analyses. Analysis by indexed month post-conception (IMPC) demonstrated that E1-C increased from IMPC 9 and peaked at IMPC 11. E3 was significantly elevated during IMPC 1, decreased until IMPC 6 and peaked at IMPC 11. T increased (P<0.05) at IMPC 3 and continued to increase throughout gestation (P<0.05). CORT was higher (P<0.05) during LATE compared to EARLY and MID (P<0.05), peaked during IMPC 12, and was not affected by parity. Hormone profiles were not influenced by fetal sex.
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Affiliation(s)
- Karen J Steinman
- SeaWorld Parks and Entertainment, Inc., SeaWorld and Busch Gardens Reproductive Research Center, San Diego, CA 92109, USA.
| | - Todd R Robeck
- SeaWorld Parks and Entertainment, Inc., SeaWorld and Busch Gardens Reproductive Research Center, San Diego, CA 92109, USA
| | - Justine K O'Brien
- SeaWorld Parks and Entertainment, Inc., SeaWorld and Busch Gardens Reproductive Research Center, San Diego, CA 92109, USA
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10
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Sarıcı H, Telli O, Eroğlu M. Bilateral testicular germ cell tumors. Turk J Urol 2015; 39:249-52. [PMID: 26328119 DOI: 10.5152/tud.2013.062] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 05/15/2013] [Indexed: 11/22/2022]
Abstract
Testicular cancer represents 1% to 1.5% of neoplasias in males and 5% of urologic tumors in general. The incidence of bilateral testicular tumors is 1-5%. Approximately one third of the cases are diagnosed as synchronous, while the other two thirds are diagnosed as metachronous tumors. Additionally, 5% of all patients diagnosed with testicular cancer may have contralateral intratubular germ cell neoplasia and may develop a contralateral germ cell tumor. However, few data are available regarding bilateral testicular germ cell tumors (BTGCTs). In this review, we aim to provide an overview of the incidence, pathological features and clinical outcomes.of BTGCTs.
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Affiliation(s)
- Haşmet Sarıcı
- Clinic of Urology, Ankara Research and Training Hospital, Ankara, Turkey
| | - Onur Telli
- Clinic of Urology, Ankara Research and Training Hospital, Ankara, Turkey
| | - Muzaffer Eroğlu
- Clinic of Urology, Ankara Research and Training Hospital, Ankara, Turkey
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11
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Leydig Cell Tumour and Giant Adrenal Myelolipoma Associated with Adrenogenital Syndrome: A Case Report with a Review of the Literature. Urologia 2015; 83:43-8. [DOI: 10.5301/uro.5000162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2015] [Indexed: 11/20/2022]
Abstract
Context Male patients with congenital adrenal hyperplasia (CAH) may develop bilateral testicular adrenal rest tumours (TARTs). These tumours, in most cases, regress with glucocorticoid therapy and their histological differentiation from Leydig-cell tumors is quite difficult. Objective The aim of this study was to differentiate the histological and clinical features of the TARTs from those of the Leydig-cell tumours. Methods The authors report a case of bilateral Leydig-cell tumour associated with giant bilateral adrenal myelolipoma in a male with adrenogenital syndrome who was submitted to a bilateral orchiectomy. Results Testicular neoplasia continue to grow despite adequate hormonal treatment and a bilateral orchiectomy was performed. The histopathological examination of the specimen ultimately confirmed the diagnosis of bilateral Leydig-cell tumour. Conclusions This case shows the importance of all the relevant examinations, blood chemistry analysis, and instrumental tests in the differential diagnosis of TARTs and other testicular tumours.
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12
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Grassetti D, Giannandrea F, Paoli D, Masciandaro P, Figura V, Carlini T, Rizzo F, Lombardo F, Lenzi A, Gandini L. Androgen receptor polymorphisms and testicular cancer risk. Andrology 2014; 3:27-33. [PMID: 25180665 DOI: 10.1111/j.2047-2927.2014.00252.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 06/30/2014] [Accepted: 07/05/2014] [Indexed: 11/29/2022]
Abstract
Testicular cancer (TC) is currently the most common malignant solid tumour in Caucasian males aged 15-39 years. Epidemiological evidence suggests that its onset may be due to an imbalance in the action of steroidal sex hormones and their receptors. A faulty androgen receptor signalling pathway can, in fact, cause various male reproductive disorders. The androgen receptor (AR) gene has two polymorphic segments consisting of CAG and GGC repeats. The length of CAG repeats has been shown to affect the regulation of AR activity. In our study, we used fragment analysis to evaluate the AR gene repeats of 302 TC patients and 322 controls, to establish if there is any association between repeat number and TC. This study of the largest Italian caseload investigated to date highlighted three particularly significant aspects. First, a CAG repeat number of ≥25 may be considered a risk factor for the onset of TC, given its greater frequency in patients in comparison with controls. This difference became significant for the non-seminoma group. Second, men with CAG repeats below 21 or above 24 were found to have a, respectively, 50 and 76% higher risk of TC than those with CAG 21-24, suggesting that these too can be considered a risk factor for TC. Finally, stage II patients were more likely to have a CAG repeat number <21 or >24 than stage I patients.
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Affiliation(s)
- D Grassetti
- Laboratory of Seminology-Sperm Bank, Department of Experimental Medicine, University of Rome "La Sapienza", Rome, Italy
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13
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Goodman S, Zhang L, Cheng L, Jiang Z. Differential expression of IMP3 between male and female mature teratomas-immunohistochemical evidence of malignant nature. Histopathology 2014; 65:483-9. [DOI: 10.1111/his.12409] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 03/04/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Steven Goodman
- Department of Pathology; University of Massachusetts Medical School; Worcester MA USA
| | - Liping Zhang
- Department of Pathology; University of Massachusetts Medical School; Worcester MA USA
| | - Liang Cheng
- Department of Pathology; Indiana University School of Medicine; Indianapolis IN USA
| | - Zhong Jiang
- Department of Pathology; University of Massachusetts Medical School; Worcester MA USA
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14
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A case of gastrointestinal bleeding due to duodenal metastasis from a testicular choriocarcinoma. J Gastrointest Cancer 2013; 44:234-7. [PMID: 22961707 DOI: 10.1007/s12029-012-9433-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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15
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Sarma D, Barua SK, Rajeev TP, Baruah SJ. Role of primary chemotherapy in management of large tumors of undescended testis: Our experience. Urol Ann 2013; 5:179-82. [PMID: 24049381 PMCID: PMC3764899 DOI: 10.4103/0974-7796.115742] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 06/12/2012] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study aimed to share our experience with tumors of undescended testis (UDT) and to assess the impact of primary cisplatin-based chemotherapy on such tumors. MATERIALS AND METHODS This study included the cases of tumor in UDT from February 2005 to December 2011. Evaluation of the cases was done with proper clinical examination and laboratory investigations along with tumor markers (alfa-feto protein, beta-human chorionic gonadotropin, lactate dehydrogenase) and contrast-enhanced computed tomography abdomen. Fine needle aspiration cytologywas done in all cases. Primary chemotherapy with three cycles of bleomycin, etoposide, and cisplatin regimen at three weekly intervals started in all cases. Response to treatment was seen after four weeks of the third cycle. RESULTS Fourteen cases (12.5%) of germ cell tumor in UDT out of 112 cases of germ cell tumor of the testis were included. The age ranged from 16-60 years. Histological diagnosis was pure seminoma in all cases. After three cycles of BEP regime, complete response was seen in 11 cases and partial response in three cases where the residual tumor was excised along with retroperitoneal lymph node dissection RPLND. Of the 14 cases, 13 were in regular follow-up and one was lost to follow-up. All on follow-up were doing well without recurrence till now. CONCLUSION Surgical removal of the primary tumor in UDT with or without bulky metastasis is complicated. Primary chemotherapy with cisplatin-based regimen is a good option in such cases.
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Affiliation(s)
- Debanga Sarma
- Department of Urology, Gauhati Medical College, Bhangagarh, Guwahati, Assam, India
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16
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Mitchell RT, Sharpe RM, Anderson RA, McKinnell C, Macpherson S, Smith LB, Wallace WHB, Kelnar CJH, van den Driesche S. Diethylstilboestrol exposure does not reduce testosterone production in human fetal testis xenografts. PLoS One 2013; 8:e61726. [PMID: 23620786 PMCID: PMC3631175 DOI: 10.1371/journal.pone.0061726] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 03/11/2013] [Indexed: 01/27/2023] Open
Abstract
In rodents, in utero exposure to exogenous estrogens including diethylstilboestrol (DES) results in major suppression of steroidogenesis in fetal testes. Whether similar effects occur in the human fetal testis is equivocal. Based on the results of the rodent studies, we hypothesised that exposure of human fetal testes to DES would result in a reduction in testosterone production. We show, using a xenograft approach, that testosterone production is not reduced in human fetal testis following DES exposure. Human fetal testes (15–19 weeks’ gestation, n = 6) were xenografted into castrate male nude mice which were then treated for 35 days with vehicle or 100 µg/kg DES three times a week. For comparison, similar treatment was applied to pregnant rats from e13.5–e20.5 and effects on fetal testes evaluated at e21.5. Xenograft testosterone production was assessed by measuring host seminal vesicle (SV) weights as an indirect measure over the entire grafting period, and single measurement of serum testosterone at termination. Human fetal testis xenografts showed similar survival in DES and vehicle-exposed hosts. SV weight (44.3 v 26.6 mg, p = 0.01) was significantly increased in DES compared to vehicle-exposed hosts, respectively, indicating an overall increase in xenograft testosterone production over the grafting period, whilst serum testosterone at termination was unchanged. In contrast intra-testicular testosterone levels were reduced by 89%, in fetal rats exposed to DES. In rats, DES effects are mediated via Estrogen Receptor α (ESR1). We determined ESR1 protein and mRNA expression in human and rat fetal testis. ESR1 was expressed in rat, but not in human, fetal Leydig cells. We conclude that human fetal testis exposure to DES does not impair testosterone production as it does in rats, probably because ESR1 is not expressed in human fetal Leydig cells. This indicates that DES exposure is likely to pose minimal risk to masculinization of the human fetus.
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Affiliation(s)
- Rod T Mitchell
- MRC Centre for Reproductive Health, Edinburgh University, Edinburgh, Scotland, UK.
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17
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Marty PJ, McDermott RJ. Effects of Two Testicular Cancer Education Programs on Self-Examination Knowledge and Attitudes among College-Aged Men. HEALTH EDUCATION 2013. [DOI: 10.1080/00970050.1985.10614468] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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18
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Shin YS, Kim HJ. Current management of testicular cancer. Korean J Urol 2013; 54:2-10. [PMID: 23362440 PMCID: PMC3556548 DOI: 10.4111/kju.2013.54.1.2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 12/24/2012] [Indexed: 11/18/2022] Open
Abstract
Germ cell tumors (GCTs) of the testis are rare, but are the most common cancer in young men. GCTs may consist of one predominant histologic pattern or may represent a mixture of multiple histologic types. For treatment purposes, two broad categories are recognized: 1) pure seminoma and 2) others, which together are termed nonseminomatous GCTs (NSGCTs). In general, seminoma tends to be less aggressive, to be diagnosed at an earlier stage, and to spread predictably along lymphatic channels to the retroperitoneum before spreading hematogenously to the lung or other organs. Compared with NSGCTs, seminoma is exquisitely sensitive to radiation therapy and platinum-based chemotherapy. NSGCTs are usually mixed tumors and teratoma often exists at the sites of metastasis with other GCT elements; cure often requires chemotherapy to kill the chemosensitive-components and surgery to remove the teratomatous components. The main factors contributing to excellent cure rates of GCTs are careful staging at diagnosis; adequate early treatment using chemotherapeutic combinations, with or without radiotherapy and surgery; and very strict follow-up and salvage therapy. We review several clinical studies and summarize the current trends in the management of GCTs.
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Affiliation(s)
- Yu Seob Shin
- Department of Urology, Chonbuk National University Medical School, Institute for Medical Sciences of Chonbuk National University, Jeonju, Korea
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Worster A, Sharma S, Mookadam F, Opie J. Acute presentation of choriocarcinoma: a case study and review of the literature. CAN J EMERG MED 2012; 4:111-4. [PMID: 17612431 DOI: 10.1017/s1481803500006230] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We report an unusual case of a 27-year-old male with an acute presentation of choriocarcinoma. The patient presented with unstable vital signs, severe anemia and a widened arterial pulse pressure following a several day history of testicular pain. He was subsequently diagnosed as having testicular choriocarcinoma with multiple hepatic metastases and large hemorrhagic para-aortic lymph nodes. The widened pulse pressure persisted during fluid resuscitation and correction of both the anemia and hypotension, and only narrowed after the initiation of chemotherapy. A literature review indicates that metastatic testicular choriocarcinoma is a rare but aggressive malignancy that often presents with acute symptoms and signs that cause patients to seek emergency care. We summarize the reported cases of "acute" testicular choriocarcinoma presentation and briefly discuss its relationship to widened arterial pulse pressure.
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Affiliation(s)
- Andrew Worster
- Department of Emergency Medicine, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
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Li J, Vestergaard M, Obel C, Cnattingus S, Gissler M, Ahrensberg J, Olsen J. Antenatal maternal bereavement and childhood cancer in the offspring: a population-based cohort study in 6 million children. Br J Cancer 2012; 107:544-8. [PMID: 22759879 PMCID: PMC3405225 DOI: 10.1038/bjc.2012.288] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: Prenatal stress may increase the susceptibility to childhood cancer by affecting immune responses and hormonal balance. We examined whether antenatal stress following maternal bereavement increased the risk of childhood cancer. Methods: All children born in Denmark from 1968 to 2007 (N=2 743 560) and in Sweden from 1973 to 2006 (N=3 400 212) were included in this study. We compared cancer risks in children born to women who lost a first-degree relative (a child, spouse, a parent, or a sibling) the year before pregnancy or during pregnancy with cancer risks in children of women who did not experience such bereavement. Results: A total of 9795 childhood cancer cases were observed during follow-up of 68 360 707 person years. Children born to women who lost a child or a spouse, but not those who lost other relatives, had an average 30% increased risk of any cancer (hazard ratio (HR) 1.30, 95% confidence interval (CI) 0.96–1.77). The HRs were the highest for non-Hodgkin disease (512 cases in total, HR 3.40, 95% CI 1.51–7.65), hepatic cancer (125 cases in total, HR 5.51, 95% CI 1.34–22.64), and testicular cancer (86 cases in total, HR 8.52, 95% CI 2.03–37.73). Conclusion: Our data suggest that severe antenatal stress following maternal bereavement, especially due to loss of a child or a spouse, is associated with an increased risk of certain childhood cancers in the offspring, such as hepatic cancer and non-Hodgkin disease, but not with childhood cancer in general.
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Affiliation(s)
- J Li
- Section for Epidemiology, Department of Public Health, Aarhus University, Bartholins Alle 2, DK 8000 Aarhus C, Denmark.
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Steroid profiles as potential biomarkers in patients with urogenital tract cancer for diagnostic investigations analyzed by liquid chromatography coupled to mass spectrometry. J Pharm Biomed Anal 2012; 73:108-15. [PMID: 22475516 DOI: 10.1016/j.jpba.2012.03.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 03/08/2012] [Indexed: 11/20/2022]
Abstract
Large discrepancy remains for the hormone-responsible cancers with regards to the conditions generating the optimal opportunity for cancerogenesis. In the research, altered steroid profiles were observed in patients with urogenital tract cancer diseases, namely bladder, kidney, prostate and testis ones. The presented steroid profiles from 154 subjects, including 77 urogenital tract cancer patient and 77 healthy controls were determined by liquid chromatography coupled to mass spectrometry method. Because the original experimental data obtained as a result of analytical experiment in order to interpret them in better way required the appropriate pre-treatment, the data were standardized by scaling and centering. In order to determine which samples form a collection for a high-capacity predictive model, Kennard-Stone's algorithm was used. A principal component analysis of preprocessed data provided better consistency of the steroid profiles with health status of subjects than PCA profiles without data preprocessing and showed a tendency to separate clusters of cancer patients from healthy subjects. The discriminant analysis was also performed and the percent of correct classification of cancer patients and control group was calculated. Finally, detailed studies examined the role of steroid profiles measured in urine, and considered as potential biomarkers related to urogenital cancer and associated renal dysfunctions.
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Albers P, Albrecht W, Algaba F, Bokemeyer C, Cohn-Cedermark G, Fizazi K, Horwich A, Laguna M. [EAU guidelines on testicular cancer: 2011 update. European Association of Urology]. Actas Urol Esp 2012; 36:127-45. [PMID: 22188753 DOI: 10.1016/j.acuro.2011.06.017] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 06/28/2011] [Indexed: 12/31/2022]
Abstract
CONTEXT On behalf of the European Association of Urology (EAU), guidelines for the diagnosis, therapy, and follow-up of testicular cancer were established. OBJECTIVE This article is a short version of the EAU testicular cancer guidelines and summarises the main conclusions from the guidelines on the management of testicular cancer. EVIDENCE ACQUISITION Guidelines were compiled by a multidisciplinary guidelines working group. A systematic review was carried out using Medline and Embase, also taking Cochrane evidence and data from the European Germ Cell Cancer Consensus Group into consideration. A panel of experts weighted the references, and a level of evidence and grade of recommendation were assigned. RESULTS There is a paucity of literature especially regarding longer term follow-up, and results from a number of ongoing trials are awaited. The choice of treatment centre is of the utmost importance, and treatment in reference centres within clinical trials, especially for poor-prognosis nonseminomatous germ cell tumours, provides better outcomes. For patients with clinical stage I seminoma, based on recently published data on long-term toxicity, adjuvant radiotherapy is no longer recommended as first-line adjuvant treatment. The TNM classification 2009 is recommended. CONCLUSIONS These guidelines contain information for the standardised management of patients with testicular cancer based on the latest scientific insights. Cure rates are generally excellent, but because testicular cancer mainly affects men in their third or fourth decade of life, treatment effects on fertility require careful counselling of patients, and treatment must be tailored taking individual circumstances and patient preferences into account. TAKE HOME MESSAGE Although testicular cancer has excellent cure rates, the choice of treatment centre is of the utmost importance. Expert centres achieve better results for both early stage testicular cancer (lower relapse rates) and overall survival (higher stages within clinical trials). For patients with clinical stage I seminoma, adjuvant radiotherapy is no longer recommended as first-line adjuvant treatment.
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Banks K, Tuazon E, Berhane K, Koh CJ, De Filippo RE, Chang A, Kim SS, Daneshmand S, Davis-Dao C, Lewinger JP, Bernstein L, Cortessis VK. Cryptorchidism and testicular germ cell tumors: comprehensive meta-analysis reveals that association between these conditions diminished over time and is modified by clinical characteristics. Front Endocrinol (Lausanne) 2012; 3:182. [PMID: 23423470 PMCID: PMC3574983 DOI: 10.3389/fendo.2012.00182] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Accepted: 12/20/2012] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Risk of testicular germ cell tumors (TGCT) is consistently associated with a history of cryptorchidism (CO) in epidemiologic studies. Factors modifying the association may provide insights regarding etiology of TGCT and suggest a basis for individualized care of CO. To identify modifiers of the CO-TGCT association, we conducted a comprehensive, quantitative evaluation of epidemiologic data. MATERIALS AND METHODS Human studies cited in PubMed or ISI Web of Science indices through December 2011 and selected unpublished epidemiologic data were reviewed to identify 35 articles and one unpublished dataset with high-quality data on the CO-TGCT association. Association data were extracted as point and 95% confidence interval estimates of odds ratio (OR) or standardized incidence ratio (SIR), or as tabulated data. Values were recorded for each study population, and for subgroups defined by features of study design, CO and TGCT. Extracted data were used to estimate summary risk ratios (sRR) and evaluate heterogeneity of the CO-TGCT association between subgroups. RESULTS The overall meta-analysis showed that history of CO is associated with four-fold increased TGCT risk [RR = 4.1(95% CI = 3.6-4.7)]. Subgroup analyses identified five determinants of stronger association: bilateral CO, unilateral CO ipsilateral to TGCT, delayed CO treatment, TGCT diagnosed before 1970, and seminoma histology. CONCLUSIONS Modifying factors may provide insight into TGCT etiology and suggest improved approaches to managing CO. Based on available data, CO patients and their parents or caregivers should be made aware of elevated TGCT risk following orchidopexy, regardless of age at repair, unilateral vs. bilateral non-descent, or position of undescended testes.
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Affiliation(s)
- Kimberly Banks
- Keck School of Medicine, University of Southern CaliforniaLos Angeles, CA, USA
- City of Hope National Medical CenterDuarte, CA, USA
- St. Joseph HospitalOrange, CA, USA
| | - Ellenie Tuazon
- Keck School of Medicine, University of Southern CaliforniaLos Angeles, CA, USA
| | - Kiros Berhane
- Keck School of Medicine, University of Southern CaliforniaLos Angeles, CA, USA
| | - Chester J. Koh
- Keck School of Medicine, University of Southern CaliforniaLos Angeles, CA, USA
- Children's Hospital Los AngelesLos Angeles, CA, USA
| | - Roger E. De Filippo
- Keck School of Medicine, University of Southern CaliforniaLos Angeles, CA, USA
- Children's Hospital Los AngelesLos Angeles, CA, USA
| | - Andy Chang
- Keck School of Medicine, University of Southern CaliforniaLos Angeles, CA, USA
- Children's Hospital Los AngelesLos Angeles, CA, USA
| | - Steve S. Kim
- Keck School of Medicine, University of Southern CaliforniaLos Angeles, CA, USA
- Children's Hospital Los AngelesLos Angeles, CA, USA
| | - Siamak Daneshmand
- Keck School of Medicine, University of Southern CaliforniaLos Angeles, CA, USA
| | - Carol Davis-Dao
- Keck School of Medicine, University of Southern CaliforniaLos Angeles, CA, USA
| | - Juan P. Lewinger
- Keck School of Medicine, University of Southern CaliforniaLos Angeles, CA, USA
| | - Leslie Bernstein
- Keck School of Medicine, University of Southern CaliforniaLos Angeles, CA, USA
- City of Hope National Medical CenterDuarte, CA, USA
| | - Victoria K. Cortessis
- Keck School of Medicine, University of Southern CaliforniaLos Angeles, CA, USA
- *Correspondence: Victoria K. Cortessis, Department of Preventive Medicine, University of Southern California, 1441 Eastlake Avenue, MC-9175, Los Angeles, CA 90089-9175, USA. e-mail:
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Albers P, Algaba F, Cohn-Cedermark G, DeSantis M, Kliesch S, Moul JW. Diagnosis, Staging, and Risk Factors: SIU/ICUD Consensus Meeting on Germ Cell Tumors (GCT), Shanghai 2009. Urology 2011; 78:S427-34. [DOI: 10.1016/j.urology.2011.03.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 03/29/2011] [Accepted: 03/29/2011] [Indexed: 11/28/2022]
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Abstract
CONTEXT On behalf of the European Association of Urology (EAU), guidelines for the diagnosis, therapy, and follow-up of testicular cancer were established. OBJECTIVE This article is a short version of the EAU testicular cancer guidelines and summarises the main conclusions from the guidelines on the management of testicular cancer. EVIDENCE ACQUISITION Guidelines were compiled by a multidisciplinary guidelines working group. A systematic review was carried out using Medline and Embase, also taking Cochrane evidence and data from the European Germ Cell Cancer Consensus Group into consideration. A panel of experts weighted the references, and a level of evidence and grade of recommendation were assigned. RESULTS There is a paucity of literature especially regarding longer term follow-up, and results from a number of ongoing trials are awaited. The choice of treatment centre is of the utmost importance, and treatment in reference centres within clinical trials, especially for poor-prognosis nonseminomatous germ cell tumours, provides better outcomes. For patients with clinical stage I seminoma, based on recently published data on long-term toxicity, adjuvant radiotherapy is no longer recommended as first-line adjuvant treatment. The TNM classification 2009 is recommended. CONCLUSIONS These guidelines contain information for the standardised management of patients with testicular cancer based on the latest scientific insights. Cure rates are generally excellent, but because testicular cancer mainly affects men in their third or fourth decade of life, treatment effects on fertility require careful counselling of patients, and treatment must be tailored taking individual circumstances and patient preferences into account.
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Passos-Coelho J, Castro Ribeiro M, Santos E, Sousa Pontes C, Brito B, Miranda A. Suboptimal survival of male germ-cell tumors in southern Portugal—a population-based retrospective study for cases diagnosed in 1999 and 2000. Ann Oncol 2011; 22:1215-1220. [DOI: 10.1093/annonc/mdq551] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cook MB, Akre O, Forman D, Madigan MP, Richiardi L, McGlynn KA. A systematic review and meta-analysis of perinatal variables in relation to the risk of testicular cancer--experiences of the son. Int J Epidemiol 2010; 39:1605-18. [PMID: 20660640 PMCID: PMC2992627 DOI: 10.1093/ije/dyq120] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2010] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We undertook a systematic review and meta-analysis of perinatal variables in relation to testicular cancer risk, with a specific focus upon characteristics of the son. METHODS Literature databases Scopus, EMBASE, PubMed and Web of Science were searched using highly sensitive search strategies. Of 5865 references retrieved, 67 articles met the inclusion criteria, each of which was included in at least one perinatal analysis. RESULTS Random effects meta-analysis produced the following results for association with testicular cancer risk: birth weight [per kilogram, odds ratio (OR) = 0.94, 95% confidence interval (CI) 0.88-1.01, I(2)= 12%], low birth weight (OR = 1.34, 95% CI 1.08-1.67, I(2)= 51%), high birth weight (OR = 1.05, 95% CI 0.96-1.14, I(2)= 0%), gestational age (per week, OR = 0.95, 95% CI 0.92-0.98, I(2)= 38%; low vs not, OR = 1.31, 95% CI 1.07-1.59, I(2)= 49%), cryptorchidism (OR = 4.30, 95% CI 3.62-5.11, I(2)= 44%), inguinal hernia (OR = 1.63, 95% CI 1.37-1.94, I(2)= 38%) and twinning (OR = 1.22, 95% CI 1.03-1.44, I(2)= 22%). Meta-analyses of the variables birth length, breastfeeding and neonatal jaundice did not provide evidence for an association with testicular cancer risk. When low birth weight was stratified by data ascertainment (record/registry vs self-report), only the category of self-report was indicative of an association. Meta-regression of data ascertainment (record/registry vs self-report) inferred that record-/registry-based studies were less supportive of an association with gestational age (per week = 0.97, 95% CI 0.94-1.00, I(2)( )= 29%; low vs not = 1.08, 95% CI 0.91-1.28, I(2)= 32%). CONCLUSION In conclusion, this systematic review and meta-analysis finds evidence that cryptorchidism, inguinal hernia and twinning, and tentative evidence that birth weight and gestational age, are associated with risk of testicular cancer.
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Affiliation(s)
- Michael B Cook
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD 20852-7234, USA.
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Poynter JN, Amatruda JF, Ross JA. Trends in incidence and survival of pediatric and adolescent patients with germ cell tumors in the United States, 1975 to 2006. Cancer 2010; 116:4882-91. [PMID: 20597129 DOI: 10.1002/cncr.25454] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pediatric germ cell tumors (GCTs) are rare and heterogeneous tumors with uncertain etiology. In the current study, data from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program were used to evaluate trends in incidence and survival of GCTs in boys and girls ages ≤19 years. To the authors' knowledge, few studies to date have evaluated trends in pediatric GCTs. Results from these analyses may provide clues to the etiology of GCTs. METHODS Frequencies, incidence rates, and 5-year relative survival rates stratified by sex were evaluated overall and by demographic subgroups based on age (birth to 9 years and 10-19 years), race (white, black, and other), and ethnicity (non-Hispanic and Hispanic) as sample size permitted. RESULTS In whites, the incidence of GCTs was lower for females than males in the 10-year to 19-year age group (rate ratio [RR], 0.47; 95% confidence interval [95% CI], 0.42-0.53), whereas the rates were similar in the age group for birth to 9 years. In contrast, incidence rates were higher in black females than in black males in both age groups (RR, 2.01 [95%CI, 1.08-3.84] in those ages birth to 9 years; RR, 3.30 [95% CI, 2.13-5.28] in those ages 10-19 years). The incidence of ovarian GCT was significantly higher in Hispanic compared with non-Hispanic girls in the groups aged 10 to 19 years. Incidence rates increased during the study period in boys ages 10 to 19 years (annual percentage change [APC], 1.2; 95% CI, 0.4-2.1) and girls ages birth to 9 years (APC, 1.9; 95% CI, 0.3-2.5). CONCLUSIONS The incidence of pediatric GCTs in the United States appears to be increasing only in certain subgroups, suggesting that the etiology is not completely overlapping in all age groups. Differences in incidence patterns by race and ethnicity merit further investigation.
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Affiliation(s)
- Jenny N Poynter
- Division of Pediatric Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota 55455, USA.
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Family history of cancer and malignant germ cell tumors in children: a report from the Children's Oncology Group. Cancer Causes Control 2009; 21:181-9. [PMID: 19842050 DOI: 10.1007/s10552-009-9448-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Accepted: 10/01/2009] [Indexed: 10/20/2022]
Abstract
Family history of testicular cancer is an established risk factor for adult testicular germ cell tumors (GCT). We evaluated the association between family history of cancer and pediatric GCT in a Children's Oncology Group case-control study that included 274 GCT cases (195 female and 79 male) diagnosed < age 15 years and 418 controls frequency matched to cases on sex and age. Family history data were collected through telephone interviews with biological mothers and fathers and unconditional logistic regression was used to evaluate associations with GCT adjusting for potential confounders. A family history of cancer with onset < age 40 years was associated with a reduced risk of GCT among female cases (Odds Ratio (OR) = 0.50, 95% Confidence Interval (CI) 0.28-0.89) and an increased risk among male cases (OR = 2.56, 95% CI 1.02-6.44). Male cases were more likely to report family history of melanoma compared with male controls (OR = 4.65, 95% CI 1.40-15.4). There was an inverse association between family history of ovarian or uterine cancers and GCT in girls (OR = 0.46, 95% CI 0.22-0.96). These sex and cancer site specific associations should be confirmed in additional studies as they may provide clues to the etiology of pediatric GCT.
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Cook MB, Akre O, Forman D, Madigan MP, Richiardi L, McGlynn KA. A systematic review and meta-analysis of perinatal variables in relation to the risk of testicular cancer--experiences of the mother. Int J Epidemiol 2009; 38:1532-42. [PMID: 19776243 DOI: 10.1093/ije/dyp287] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We undertook a systematic review and meta-analysis of perinatal variables in relation to testicular cancer risk, with a specific focus upon characteristics of the mother. METHODS EMBASE, PubMed, Scopus and Web of Science databases were searched using sensitive search strategies. Meta-analysis was undertaken using STATA 10. RESULTS A total of 5865 references were retrieved, of which 67 met the inclusion criteria and contributed data to at least one perinatal analysis. Random effects meta-analysis found maternal bleeding during pregnancy [odds ratio (OR) 1.33, 95% confidence interval (CI) 1.02-1.73], birth order (primiparous vs not, 1.08, 95% CI 1.01-1.16; second vs first, OR 0.94, 95% CI 0.88-0.99; third vs first, OR 0.91, 95% CI 0.83-1.01; fourth vs first, OR 0.80, 95% CI 0.69-0.94) and sibship size (2 vs 1, OR 0.93, 95% CI 0.75-1.15; 3 vs 1, OR 0.89, 95% CI 0.74-1.07; 4 vs 1, OR 0.75, 95% CI 0.62-0.90) to be associated with testicular cancer risk. Meta-analyses that produced summary estimates which indicated no association included maternal age, maternal nausea, maternal hypertension, pre-eclampsia, breech delivery and caesarean section. Meta-regression provided evidence that continent of study is important in the relationship between caesarean section and testicular cancer (P = 0.035), and a meta-analysis restricted to the three studies from the USA was suggestive of association (OR 1.67, 95% CI 1.07-2.56). CONCLUSIONS This systematic review and meta-analysis has found evidence for associations of maternal bleeding, birth order, sibship size and possibly caesarean section with risk of testicular cancer.
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Affiliation(s)
- Michael B Cook
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20852-7234, USA.
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Anderson PD, Lam MY, Poirier C, Bishop CE, Nadeau JH. The role of the mouse y chromosome on susceptibility to testicular germ cell tumors. Cancer Res 2009; 69:3614-8. [PMID: 19351821 PMCID: PMC3375048 DOI: 10.1158/0008-5472.can-08-4881] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Testicular germ cell tumors (TGCT) are sex limited, occurring only in males with a Y chromosome. Recently, the gr/gr deletion on the human Y chromosome was associated with increased risk of TGCTs. In addition, the presence of Y chromosome sequences is associated with TGCTs in cases of gonadal dysgenesis. TGCTs in strain 129 males recapitulate many aspects of testicular cancer in human infants and can be used to evaluate the role of the Y chromosome in TGCT risk. We used chromosome substitution strains and a sex-reversing mutant to test the role of the Y chromosome on TGCT susceptibility. Our results show that a Y-linked gene that does not differ among the tested strains is essential for tumorigenesis.
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Affiliation(s)
- Philip D. Anderson
- Department of Genetics and Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Man-Yee Lam
- Department of Genetics and Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | | | - Colin E. Bishop
- Institute for Regenerative Medicine, Wake Forest University Health Sciences, Winston-Salem, North Carolina
| | - Joseph H. Nadeau
- Department of Genetics and Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
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Martin O, Shialis T, Lester J, Scrimshaw M, Boobis A, Voulvoulis N. Testicular dysgenesis syndrome and the estrogen hypothesis: a quantitative meta-analysis. CIENCIA & SAUDE COLETIVA 2009; 13:1601-18. [PMID: 18813661 DOI: 10.1590/s1413-81232008000500024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Accepted: 11/07/2007] [Indexed: 05/25/2023] Open
Abstract
Male reproductive tract abnormalities such as hypospadias and cryptorchidism, and testicular cancer have been proposed to comprise a common syndrome together with impaired spermatogenesis with a common etiology resulting from the disruption of gonadal development during fetal life, the testicular dysgenesis syndrome (TDS). The only quantitative summary estimate of the link between prenatal exposure to estrogenic agents and testicular cancer was published over 10 years ago; other reviews of the link between estrogenic compounds, other than the potent pharmaceutical estrogen diethylstilbestrol (DES), and TDS end points have remained inconclusive. We conducted a quantitative meta-analysis of the association between the end points related to TDS and prenatal exposure to estrogenic agents. Inclusion in this analysis was based on mechanistic criteria, and the plausibility of an estrogen receptor (ER)-alpha-mediated mode of action was specifically explored. Eight studies were included, investigating the etiology of hypospadias and/or cryptorchidism that had not been identified in previous systematic reviews. Four additional studies of pharmaceutical estrogens yielded a statistically significant updated summary estimate for testicular cancer. Results of the subset analyses point to the existence of unidentified sources of heterogeneity between studies or within the study population.
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Affiliation(s)
- Olwenn Martin
- Centre for Environmental Policy, Imperial College London, London, UK
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35
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Akre O, Pettersson A, Richiardi L. Risk of contralateral testicular cancer among men with unilaterally undescended testis: a meta analysis. Int J Cancer 2008; 124:687-9. [PMID: 18973229 DOI: 10.1002/ijc.23936] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The association between undescended testis (cryptorchidism) and testicular cancer is established, but it is not known whether the risk of testicular cancer among men with unilateral maldescent is increased in both testes, or only on the undescended side. This is a meta-analysis of 11 case-control studies and 1 cohort study that all assessed the risk of testicular cancer separately for the undescended and descended testis. We used fixed-effects meta-analysis to calculate pooled estimates and 95% confidence intervals (CIs) for the relative risk. Of 199 tumors in men with unilateral cryptorchidism, 158 (79%) were on the ipsilateral side and 41 (21%) on the contralateral side. The pooled relative risks for testicular cancer in the ipsilateral and contralateral testis were 6.33 (95% CI, 4.30 to 9.31) and 1.74 (95% CI, 1.01 to 2.98), respectively. We conclude that in 1-sided undescended testis, the risk of testicular cancer may be increased in both testes, although to a much greater extent on the ipsilateral side.
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Affiliation(s)
- Olof Akre
- Cancer Epidemiology Unit, CeRMS and CPO-Piemonte, University of Turin, Turin 10126, Italy.
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36
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Abstract
When methyl tertiary-butyl ether (MTBE) in gasoline was first introduced to reduce vehicle exhaust emissions and comply with the Clean Air Act, in the United States, a pattern of complaints emerged characterised by seven "key symptoms." Later, carefully controlled volunteer studies did not confirm the existence of the specific key symptoms, although one study of self-reported sensitive (SRS) people did suggest that a threshold at about 11-15% MTBE in gasoline may exist for SRSs in total symptom scores. Neurobehavioral and psychophysiological studies on volunteers, including SRSs, found no adverse responses associated with MTBE at likely exposure levels. MTBE is well and rapidly absorbed following oral and inhalation exposures. Cmax values for MTBE are achieved almost immediately after oral dosing and within 2 h of continuous inhalation. It is rapidly eliminated, either by exhalation as unchanged MTBE or by urinary excretion of its less volatile metabolites. Metabolism is more rapid humans than in rats, for both MTBE and tert-butyl alcohol (TBA), its more persistent primary metabolite. The other primary metabolite, formaldehyde, is detoxified at a rate very much greater than its formation from MTBE. MTBE has no specific effects on reproduction or development, or on genetic material. Neurological effects were observed only at very high concentrations. In carcinogenicity studies of MTBE, TBA, and methanol (included as an endogenous precursor of formaldehyde, without the presence of TBA), some increases in tumor incidence have been observed, but consistency of outcome was lacking and even some degree of replication was observed in only three cases, none of which had human relevance: alpha(2u)-globulin nephropathy-related renal tubule cell adenoma in male rats; Leydig-cell adenoma in male rats, but not in mice, which provide the better model of the human disease; and B-cell-derived lymphoma/leukemia of doubtful pathogenesis that arose mainly in lungs of orally dosed female rats. In addition, hepatocellular adenomas were significantly higher in female CD-1 mice and thyroid follicular-cell adenomas were increased in female B6C3F1 mice treated with TBA, but these results lack any independent confirmation, which would have been possible from a number of other studies.
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Martin OV, Shialis T, Lester JN, Scrimshaw MD, Boobis AR, Voulvoulis N. Testicular dysgenesis syndrome and the estrogen hypothesis: a quantitative meta-analysis. ENVIRONMENTAL HEALTH PERSPECTIVES 2008; 116:149-57. [PMID: 18288311 PMCID: PMC2235228 DOI: 10.1289/ehp.10545] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Accepted: 11/07/2007] [Indexed: 05/22/2023]
Abstract
BACKGROUND Male reproductive tract abnormalities such as hypospadias and cryptorchidism, and testicular cancer have been proposed to comprise a common syndrome together with impaired spermatogenesis with a common etiology resulting from the disruption of gonadal development during fetal life, the testicular dysgenesis syndrome (TDS). The hypothesis that in utero exposure to estrogenic agents could induce these disorders was first proposed in 1993. The only quantitative summary estimate of the association between prenatal exposure to estrogenic agents and testicular cancer was published over 10 years ago, and other systematic reviews of the association between estrogenic compounds, other than the potent pharmaceutical estrogen diethylstilbestrol (DES), and TDS end points have remained inconclusive. OBJECTIVES We conducted a quantitative meta-analysis of the association between the end points related to TDS and prenatal exposure to estrogenic agents. Inclusion in this analysis was based on mechanistic criteria, and the plausibility of an estrogen receptor (ER)-alpha-mediated mode of action was specifically explored. RESULTS We included in this meta-analysis eight studies investigating the etiology of hypospadias and/or cryptorchidism that had not been identified in previous systematic reviews. Four additional studies of pharmaceutical estrogens yielded a statistically significant updated summary estimate for testicular cancer. CONCLUSIONS The doubling of the risk ratios for all three end points investigated after DES exposure is consistent with a shared etiology and the TDS hypothesis but does not constitute evidence of an estrogenic mode of action. Results of the subset analyses point to the existence of unidentified sources of heterogeneity between studies or within the study population.
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Affiliation(s)
- Olwenn V. Martin
- Centre for Environmental Policy and
- Experimental Medicine and Toxicology Group, Imperial College London, United Kingdom
| | | | - John N. Lester
- Centre for Water Sciences, Cranfield University, Cranfield, United Kingdom
| | - Mark D. Scrimshaw
- Institute for the Environment, Brunel University, Uxbridge, United Kingdom
| | - Alan R. Boobis
- Experimental Medicine and Toxicology Group, Imperial College London, United Kingdom
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38
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Urology. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Richiardi L, Pettersson A, Akre O. Genetic and environmental risk factors for testicular cancer. ACTA ACUST UNITED AC 2007; 30:230-40; discussion 240-1. [PMID: 17488341 DOI: 10.1111/j.1365-2605.2007.00760.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Germ-cell testicular cancer has a well-characterized descriptive epidemiology, whereas the aetiology remains largely unknown. It is believed that exposures acting prenatally are instrumental to germ-cell cancer development, although no specific exposure has been identified. Several epidemiological studies have investigated a number of indicators of prenatal exposures, such as birth order, gestational duration, birth weight, maternal age and nausea during pregnancy, but results are inconsistent. This paper briefly reviews the current support for genetic and environmental factors in testicular cancer aetiology. In particular, we have summarized the evidence suggesting a strong role of inherited susceptibility, which is probably carried by the effect of several unknown moderate-risk genes. We have illustrated inconsistencies in the previous studies on prenatal factors by estimating the heterogeneity and pooled odds ratios among twelve studies investigating the association between low birth weight and testicular cancer. We have discussed the possibility that puberty is another time window during which environmental factors may increase the risk of testicular cancer. Finally, we have reviewed the results from studies on cryptorchidism and impaired fertility in relation to risk for testicular cancer. In conclusion, we propose that future aetiological studies on testicular cancer should take postnatal exposures acting during puberty into account and, whenever possible, investigate both main effects and interactions among prenatal factors, genetic factors and postnatal factors.
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Affiliation(s)
- Lorenzo Richiardi
- Cancer Epidemiology Unit, CeRMS and CPO-Piemonte, University of Turin, Turin, Italy.
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40
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Diz Rodriguez R, Virseda Chamorro M, Arance Gil I, Sáenz Benito D, Alpuente Román C, Paños Lozano P. [Bilateral testicular tumours]. Actas Urol Esp 2007; 31:250-2. [PMID: 17658153 DOI: 10.1016/s0210-4806(07)73630-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To study the incidence and characteristic of the bilateral tumours of testicle. MATERIAL AND METHODS It was carried out a retrospective study on a database of testiculars tumours 98 tried in our service among the years 1979 and 2004. RESULTS We registered 4 cases of bilateral tumours (4,1%) in the series. The interval of appearance of the second tumor oscillated between 14 months and 4 and a half years (being the medium of 47 months). In three cases the initial tumour was an embryonic Carcinoma and in one a tumour of Lydia. In two cases the second tumour was of the same type histological (embryonic Ca and tumour of Leydig), while in the other two cases of embryonic Ca, the second tumour was a seminoma and a teratocarcinoma. Regarding the histology of the first tumour, it was observed that only 3 of the 27 embryonic Ca (11%) of our series, they experienced a second neoplasia in front of 1 of the 2 tumours of Leydig (50%). CONCLUSIONS The incidence of bilateral tumours in our series was of 4,1%. In our series the risk of the second tumour seems to be higher in patients with Leyding tumours, therefore the lesser number of tumours do not allow us to know significantly conclusions.
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Affiliation(s)
- R Diz Rodriguez
- Servicio de Urología, Hospital Central de la Defensa, Madrid
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41
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Abstract
Testicular cancer is the most common solid organ tumor in young men and affects men during their reproductive years. Current therapeutic regimens have significantly improved survival but often adversely impact fertility. Understanding the effects of testicular cancer, the systemic effects of neoplasia, and the effects of treatment protocols, such as radiotherapy, chemotherapy, and retroperitoneal lymph node dissection, is essential to restoring and maintaining fertility in men who have germ cell neoplasms.
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Affiliation(s)
- Sarah M Lambert
- Male Reproductive Center, Department of Urology, Columbia University, College of Physicians and Surgeons, New York Presbyterian Hospital, 944 Park Avenue, New York, NY 10028, USA
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Abstract
Androgen receptor (AR) gene has been extensively studied in diverse clinical conditions. In addition to the point mutations, trinucleotide repeat (CAG and GGN) length polymorphisms have been an additional subject of interest and controversy among geneticists. The polymorphic variations in triplet repeats have been associated with a number of disorders, but at the same time contradictory findings have also been reported. Further, studies on the same disorder in different populations have generated different results. Therefore, combined analysis or review of the published studies has been of much value to extract information on the significance of variations in the gene in various clinical conditions. AR genetics has been reviewed extensively but until now review articles have focused on individual clinical categories such as androgen insensitivity, male infertility, prostate cancer, and so on. We have made the first effort to review most the aspects of AR genetics. The impact of androgens in various disorders and polymorphic variations in the AR gene is the main focus of this review. Additionally, the correlations observed in various studies have been discussed in the light of in vitro evidences available for the effect of AR gene variations on the action of androgens.
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MESH Headings
- Androgen-Insensitivity Syndrome/genetics
- Androgen-Insensitivity Syndrome/physiopathology
- Bone Diseases, Metabolic/genetics
- Bone Diseases, Metabolic/physiopathology
- Breast Neoplasms/genetics
- Breast Neoplasms/physiopathology
- Cognition Disorders/genetics
- Cognition Disorders/physiopathology
- Digestive System Diseases/genetics
- Digestive System Diseases/physiopathology
- Female
- Genital Neoplasms, Female/genetics
- Genital Neoplasms, Female/physiopathology
- Genital Neoplasms, Male/genetics
- Genital Neoplasms, Male/physiopathology
- Humans
- Infertility, Male/genetics
- Male
- Muscular Atrophy, Spinal/genetics
- Muscular Atrophy, Spinal/physiopathology
- Phenotype
- Point Mutation
- Polycystic Ovary Syndrome/genetics
- Polycystic Ovary Syndrome/physiopathology
- Polymorphism, Genetic
- Pre-Eclampsia/genetics
- Pre-Eclampsia/physiopathology
- Pregnancy
- Receptors, Androgen/genetics
- Receptors, Androgen/physiology
- Schizophrenia/genetics
- Schizophrenia/physiopathology
- Testosterone/deficiency
- Trinucleotide Repeats
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Affiliation(s)
- Singh Rajender
- Centre for Cellular and Molecular Biology, Uppal Road, Hyderabad 500007, India
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Hardell L, Carlberg M, Ohlson CG, Westberg H, Eriksson M, Hansson Mild K. Use of cellular and cordless telephones and risk of testicular cancer. INTERNATIONAL JOURNAL OF ANDROLOGY 2007; 30:115-22. [PMID: 17209885 DOI: 10.1111/j.1365-2605.2006.00721.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
A case-control study on testicular cancer included use of cellular and cordless telephones. The results were based on answers from 542 (92%) cases with seminoma, 346 (89%) with non-seminoma, and 870 (89%) controls. Regarding seminoma the use of analog cellular phones gave odds ratio (OR) = 1.2, 95% confidence interval (CI) = 0.9-1.6, digital phones OR = 1.3, CI = 0.9-1.8, and cordless phones OR = 1.1, CI = 0.8-1.5. The corresponding results for non-seminoma were OR = 0.7, CI = 0.5-1.1, OR = 0.9, CI = 0.6-1.4, and OR = 1.0, CI = 0.7-1.4, respectively. There was no dose-response effect and OR did not increase with latency time. No association was found with place of keeping the mobile phone during standby, such as trousers pocket. Cryptorchidism was associated both with seminoma (OR = 4.2, CI = 2.7-6.5) and non-seminoma (OR = 3.3, CI = 2.0-5.6), but no interaction was found with the use of cellular or cordless telephones.
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Affiliation(s)
- L Hardell
- Department of Oncology, University Hospital, Orebro, Sweden.
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Michos A, Xue F, Michels KB. Birth weight and the risk of testicular cancer: A meta-analysis. Int J Cancer 2007; 121:1123-31. [PMID: 17471572 DOI: 10.1002/ijc.22771] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The high incidence of testicular cancer in young males indicates a potential role of events during early life. Birth weight has been identified as a factor possibly associated with the risk of cancers later in life. To investigate the association between birth weight and testicular cancer, we conducted a Systematic Review and Meta-Analysis of published studies investigating the association between birth weight and testicular cancer. Data were combined using a fixed-effects model. Thirteen epidemiologic studies, published between 1983 and 2004, were included in the analysis, encompassing 5,663 patients with testicular cancer. Men weighing less than 2,500 grams at birth had a higher risk for developing testicular cancer later in life than those with normal birth weight (2,500-4,000 g) (OR = 1.18; 95% confidence interval (CI) 1.01-1.38). A similar trend was found for men with a birth weight above 4,000 g, (OR = 1.12; 95% CI 1.02-1.22). When seminoma and nonseminoma testicular cancer cases were considered separately, low birth weight was a risk factor specifically for seminomas (OR = 1.44; 95% CI 1.11-1.88). A U-shaped association was observed between birth weight and the risk for testicular cancer. The underlying biological mechanisms for this phenomenon remain to be elucidated.
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Giuliano CJ, Freemantle SJ, Spinella MJ. Testicular Germ Cell Tumors: A Paradigm for the Successful Treatment of Solid Tumor Stem Cells. CURRENT CANCER THERAPY REVIEWS 2006; 2:255-270. [PMID: 24482633 PMCID: PMC3904303 DOI: 10.2174/157339406777934681] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Treatment of testicular germ cell tumors (TGCTs) has been a success primarily due to the exquisite responsiveness of this solid tumor to cisplatin-based therapy. Despite the promise of cure for the majority of TGCT patients, the effectiveness of therapy for some patients is limited by toxicity and the problem of resistance. There is compelling rationale to further understand the biology of TGCTs in order to better treat other solid tumors and to address the shortcomings of present TGCT therapies. TGCTs contain undifferentiated pluripotent stem cells, known as embryonal carcinoma, that share many properties with human embryonic stem cells. The importance of cancer stem cells in the initiation, progression and treatment of solid tumors is beginning to emerge. We discuss TGCTs in the context of solid tumor curability and targeted cancer stem cell therapy.
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Affiliation(s)
- Caryl J. Giuliano
- Department of Pharmacology and Toxicology, Dartmouth Medical School, and the Norris Cotton Cancer Center, Dartmouth Hitchcock-Medical Center, Hanover, NH 03755, USA
| | - Sarah J. Freemantle
- Department of Pharmacology and Toxicology, Dartmouth Medical School, and the Norris Cotton Cancer Center, Dartmouth Hitchcock-Medical Center, Hanover, NH 03755, USA
| | - Michael J. Spinella
- Department of Pharmacology and Toxicology, Dartmouth Medical School, and the Norris Cotton Cancer Center, Dartmouth Hitchcock-Medical Center, Hanover, NH 03755, USA
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Kumi-Diaka J, Hassanhi M, Brown J, Merchant K, Garcia C, Jimenez W. CytoregR inhibits growth and proliferation of human adenocarcinoma cells via induction of apoptosis. J Carcinog 2006; 5:1. [PMID: 16401338 PMCID: PMC1343545 DOI: 10.1186/1477-3163-5-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2004] [Accepted: 01/09/2006] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Cancer is one of the devastating neovascular diseases that incapacitate so many people the world over. Recent reports from the National Cancer Institute indicate some significant gain therapy and cancer management as seen in the increase in the 5-year survival rate over the past two decades. Although near-perfect cure rate have been reported in the early-stage disease, these data reveal high recurrence rate and serious side effects including second malignancies and fatalities. Most of the currently used anticancer agents are only effective against proliferating cancer cells. Thus attention has been focused on potential anti-cancer agents capable of killing cancer cells independent of the cell cycle state, to ensure effective elimination of most cancer cells. The objective of this study was to test the chemosensitivity and potential mechanism of action of a novel cancer drug, CytoregR, in a panel of human cancer cells. METHODS the study was performed using a series of bioassays including Trypan blue exclusion, MTS Growth inhibition, LDH-cytotoxicity, TUNEL-Terminal DNA fragmentation Apoptosis Assay, and the Caspase protease CPP32 activity assays. RESULTS CytoregR induced significant dose- and time-dependent inhibition of growth in all the cells; with significant differences in chemosensitivity (P < 0.05) between the target cells becoming more apparent at 48 hr exposure. CytoregR showed no significant effect on normal cells relative to the tumor cells. Growth inhibition in all the cells was due to induction of apoptosis at lower concentrations of cytoregR (> 1:300). CytoregR-induced caspase protease-3 (CPP32) activation significantly and positively correlated with apoptosis induction and growth inhibition; thus implicating CPP32 as the principal death pathway in cytoregR-induced apoptosis. CONCLUSION CytoregR exerted a dose-and time-dependent growth inhibitory effect in all the target cells through induction of apoptosis via the CPP32 death pathway, independent of hormonal sensitivity of the cells. The present data indicate that not only could CPP32 provide a potential target for regulation of cytoregR-induced apoptosis but also that cytoregR could play a significant role in chemotherapeutic regimen in many human malignant tumors.
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Affiliation(s)
- J Kumi-Diaka
- Department of Biological Sciences, Florida Atlantic University, Davie FL, 33314, USA
| | - M Hassanhi
- School of Medicine, Blood Bank Division, University of Zulia Maracaibo, Venezuela
| | - J Brown
- Department of Biological Sciences, Florida Atlantic University, Davie FL, 33314, USA
| | - K Merchant
- Department of Biological Sciences, Florida Atlantic University, Davie FL, 33314, USA
| | - C Garcia
- Cytorex BioSciences Inc. 2700 Glades Circle #138, Weston FL. 3331, USA
| | - W Jimenez
- Cytorex BioSciences Inc. 2700 Glades Circle #138, Weston FL. 3331, USA
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Storgaard L, Bonde JP, Olsen J. Male reproductive disorders in humans and prenatal indicators of estrogen exposure. Reprod Toxicol 2006; 21:4-15. [PMID: 16005180 DOI: 10.1016/j.reprotox.2005.05.006] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2004] [Revised: 04/03/2005] [Accepted: 05/30/2005] [Indexed: 11/18/2022]
Abstract
Male reproductive disorders in humans and prenatal indicators of estrogen exposure. A review of published epidemiological studies. Reports of an increase in male reproductive disorders in several countries led to the hypothesis that estrogens during fetal life may cause reduced sperm counts, cryptorchidism, hypospadias and testicular cancer. So far the hypothesis is based on animal studies and reports from the wild life. We systematically searched the epidemiological literature for evidence linking indicators of prenatal serum levels of maternal estrogens with sperm density, hypospadias, cryptorchidism and testicular cancer in humans. Indicators of fetal estrogen exposure included direct measurements, recorded intake of hormones (diethylstilbestrol (DES), oral contraceptives (OCs) and estrogens), pregnancy conditions with known deviant estrogen level as for instance twin pregnancies and some environmental exposures. Among 425 papers we reviewed 81 publications with appropriate information. With the possible exception of testicular cancer there is no strong epidemiological evidence to indicate that prenatal exposure to estrogen are linked to disturbed development of the male reproductive organs.
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Affiliation(s)
- Lone Storgaard
- Department of Occupational Medicine, University Hospital of Aarhus, Nørrebrogade 44, DK 8000 Aarhus C, Denmark.
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Shankar S, Davies S, Giller R, Krailo M, Davis M, Gardner K, Cai H, Robison L, Shu XO. In utero exposure to female hormones and germ cell tumors in children. Cancer 2006; 106:1169-77. [PMID: 16421921 DOI: 10.1002/cncr.21670] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Maternal exposure to exogenous female hormones during pregnancy has been implicated as a risk factor for malignant germ cell tumors (GCTs) in the offspring in some epidemiologic studies of testicular and ovarian carcinoma in adults. METHODS From 1996 to 2002, 278 children younger than 15 years of age with malignant GCTs and 423 healthy controls, frequency-matched for geographic location, age, and sex were enrolled in a case-control study to investigate whether in utero exposure to female hormones is associated with the risk of malignant GCT in children. Cases were recruited from 84 institutions in the U.S. and controls were enrolled through random digit dialing. Information was obtained through telephone interview with the biological mothers of the subjects and through blinded review of the mothers' medical records. RESULTS Neither self-reported (odds ratio [OR] = 1.15; 95% confidence interval [CI], 0.63, 2.12) nor medical chart based (OR = 1.14; 95% CI, 0.75, 1.73) maternal exposure to exogenous female hormones was related to malignant GCT risk. Pregnancy-related conditions that may have altered serum levels of circulating female hormones were also unrelated to the risk of GCT in the offspring. CONCLUSION This study failed to provide strong evidence to support the hypothesis that maternal exposure to exogenous female hormones during pregnancy increases the risk of GCT in the offspring.
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Affiliation(s)
- Sadhna Shankar
- Department of Pediatrics and Vanderbilt University Center for Health Services Research, Nashville, Tennessee 37232, USA
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Nathanson KL, Kanetsky PA, Hawes R, Vaughn DJ, Letrero R, Tucker K, Friedlander M, Phillips KA, Hogg D, Jewett MAS, Lohynska R, Daugaard G, Richard S, Chompret A, Bonaïti-Pellié C, Heidenreich A, Olah E, Geczi L, Bodrogi I, Ormiston WJ, Daly PA, Oosterhuis JW, Gillis AJM, Looijenga LHJ, Guilford P, Fosså SD, Heimdal K, Tjulandin SA, Liubchenko L, Stoll H, Weber W, Rudd M, Huddart R, Crockford GP, Forman D, Oliver DT, Einhorn L, Weber BL, Kramer J, McMaster M, Greene MH, Pike M, Cortessis V, Chen C, Schwartz SM, Bishop DT, Easton DF, Stratton MR, Rapley EA. The Y deletion gr/gr and susceptibility to testicular germ cell tumor. Am J Hum Genet 2005; 77:1034-43. [PMID: 16380914 PMCID: PMC1285161 DOI: 10.1086/498455] [Citation(s) in RCA: 142] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2005] [Accepted: 09/30/2005] [Indexed: 02/04/2023] Open
Abstract
Testicular germ cell tumor (TGCT) is the most common cancer in young men. Despite a considerable familial component to TGCT risk, no genetic change that confers increased risk has been substantiated to date. The human Y chromosome carries a number of genes specifically involved in male germ cell development, and deletion of the AZFc region at Yq11 is the most common known genetic cause of infertility. Recently, a 1.6-Mb deletion of the Y chromosome that removes part of the AZFc region--known as the "gr/gr" deletion--has been associated with infertility. In epidemiological studies, male infertility has shown an association with TGCT that is out of proportion with what can be explained by tumor effects. Thus, we hypothesized that the gr/gr deletion may be associated with TGCT. Using logistic modeling, we analyzed this deletion in a large series of TGCT cases with and without a family history of TGCT. The gr/gr deletion was present in 3.0% (13/431) of TGCT cases with a family history, 2% (28/1,376) of TGCT cases without a family history, and 1.3% (33/2,599) of unaffected males. Presence of the gr/gr deletion was associated with a twofold increased risk of TGCT (adjusted odds ratio [aOR] 2.1; 95% confidence interval [CI] 1.3-3.6; P = .005) and a threefold increased risk of TGCT among patients with a positive family history (aOR 3.2; 95% CI 1.5-6.7; P = .0027). The gr/gr deletion was more strongly associated with seminoma (aOR 3.0; 95% CI 1.6-5.4; P = .0004) than with nonseminoma TGCT (aOR 1.5; 95% CI 0.72-3.0; P = .29). These data indicate that the Y microdeletion gr/gr is a rare, low-penetrance allele that confers susceptibility to TGCT.
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Affiliation(s)
- Katherine L Nathanson
- Department of Medicine, Abramson Family Cancer Research Institute, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Giuliano CJ, Kerley-Hamilton JS, Bee T, Freemantle SJ, Manickaratnam R, Dmitrovsky E, Spinella MJ. Retinoic acid represses a cassette of candidate pluripotency chromosome 12p genes during induced loss of human embryonal carcinoma tumorigenicity. ACTA ACUST UNITED AC 2005; 1731:48-56. [PMID: 16168501 DOI: 10.1016/j.bbaexp.2005.08.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2005] [Revised: 08/08/2005] [Accepted: 08/17/2005] [Indexed: 10/25/2022]
Abstract
Testicular germ cell tumors (TGCTs) are the most common carcinomas of young men aged 15-35. The molecular events involved in TGCT genesis are poorly understood. TGCTs have near universal amplification of the short arm of chromosome 12, however positional cloning efforts have not identified causative genes on 12p involved in formation or progression of TGCTs. Human embryonal carcinoma (EC) are the stem cells of TGCTs and are pluripotent. EC cells terminally differentiate toward a neuronal lineage with all-trans retinoic acid (RA) treatment resulting in a concomitant G1 cell cycle arrest and loss of tumorigenicity. Our efforts to define the molecular mechanisms of RA-mediated tumor cell differentiation at a critical "commitment to differentiate" window has identified a cassette of genes on 12p that are repressed with RA precisely as EC cells lose tumorigenic potential. These are Nanog, CD9, EDR1 (PHC1), SCNN1A, GDF3, Glut3 and Stella. The master pluripotency regulator Oct4 is located on chromosome 6 and is also repressed by RA. Notably, knockdown of Oct4 with siRNA results in repression of basal Nanog, EDR1, GDF3 and Stella gene expression. Nanog has recently been identified to play a role in maintenance of the pluripotency of mouse embryonic stem cells and CD9, EDR1, GDF3, and Stella have each been implicated as stem cell markers. Since RA suppresses the tumorigenicity of EC cells, these genes may have a critical role in the etiology of TGCTs, suggesting a link between enforced pluripotency and transformation.
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Affiliation(s)
- Caryl J Giuliano
- Department of Pharmacology and Toxicology, 7650 Remsen, Dartmouth Medical School, Dartmouth Hitchcock-Medical Center, Hanover, NH 03755, USA
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