[Recent Therapy of Organ-confined Testis Cancer]

BACKGROUND

In Germany, testicular cancer accounts for about 1-2% of all malignant tumours. Although, therefore, this is a rare tumour, it assumes an exceptional position among malignant tumours in several respects. In male patients aged 20-35 years it is the most common tumour, which directly affects the family and life planning of young men, a matter of prime importance at this age. Another aspect of testicular cancer is its excellent prognosis since the introduction of platinum-based chemotherapy into the armamentarium of testicular cancer therapy. Therefore, therapeutic innovations increasingly focus on reducing the radicality of treatment, even more so since this therapy, in addition to acute toxicity, can cause severe long-term consequences up to and including secondary malignancies.

OBJECTIVES

This article gives an overview of the present therapeutic standard of stage I testicular cancer treatment.

MATERIAL AND METHODS

Selective PubMed research Results and Discussion: Besides potential implications for organ-sparing surgery, the article elucidates the benefits of a risk-adapted therapeutic approach and indications for a surveillance strategy for patients with localised testicular cancer.

[Organ-sparing therapy for testicular cancer]

BACKGROUND

The therapy of malignant testicular neoplasms has always been characterized by a high degree of radicality. Thanks to a number of medical achievements the cure rate of testicular cancer has notably increased through the last decades. In the meanwhile the main focus is on reducing therapy load, scrutinizing radical orchiectomy as the only adequate therapy for the primary tumour.

OBJECTIVES

This article discusses the question, if and under which conditions an organ-sparing approach can be used appropriately in clinical practice.

MATERIALS AND METHODS

A selective literature search was performed in PubMed.

RESULTS

A set of data suggest that endocrine and exocrine function of the testis can be preserved using an organ-sparing approach and many patients could benefit regarding their quality of life, e.g., preserving the ability to father a child at least temporarily and avoiding the need for hormone substitution. Different from kidney tumors, precancerous lesions (testicular intraepithelia neoplasia, TIN) can almost inevitably be found in the surrounding tissue of testicular tumors. This has to be considered when making a decision in favor of an organ-sparing approach, because radiation therapy on the affected testis has to be performed after tumor resection. Despite the absence of prospective data, organ-sparing surgical tumor resection can be recommended in carefully selected patients.

CONCLUSION

After careful selection of patients, particularly young men can profit from an organ-sparing therapy regimen. Therefore, organ preservation should always be considered in the surgical treatment of testicular masses.

[Nuchal swelling]

In the unusual case of a 68-year-old woman with one-sided painless lateral neck swelling, the ENT examination showed a firm nuchal mass (4 × 4 cm) on the right side with no other pathological findings. Angio-MRI confirmed a solid, sharply demarcated tumor with arterial hyperperfusion. Core needle aspiration biopsy was performed, revealing well-circumscribed tufts showing the typical "cannonball" aspect. After preoperative embolisation we performed extirpation of the mass. Histological examination showed an acquired tufted angioma. Clinical as well as radiological follow-up examination detected neither local relapse nor metastases.