Paediatric dysgerminoma: Results of three consecutive French germ cell tumours clinical studies (TGM-85/90/95) with late effects study

METHODS

French patients (≤18years) treated for dysgerminoma between 1985 and 2005 in TGM-85, 90, 95 protocols were included. Treatment was based on primary unilateral oophorectomy followed by prophylactic lymph node irradiation (1985-1998) or a wait-and-see strategy (1998-2005) for localised completely resected tumours (pS1) or by platinum-based chemotherapy for advanced diseases.

RESULTS

Forty-eight patients (median age 12.8 years) were included. Six patients had gonadal dysgenesis. Two had bilateral dysgerminoma. Twenty-eight patients had loco-regional dissemination, seven with para-aortic lymph nodes. None had distant metastases. Primary surgery was performed in 47/48 patients. Among the 15 patients with pS1 tumour: seven did not receive adjuvant treatment, six had lymph node irradiation and two received chemotherapy. Among the 32 patients with advanced tumour, 31 received cisplatinum-based (n = 25) or carboplatin-based (n = 8) regimen with lymph node irradiation for one of them and one did not receive adjuvant treatment. With a median follow-up of 14 years, all patients are alive in complete remission. Five events occurred: 2 contralateral dysgerminomas, 1 peritoneal relapse and 2 second neoplasms (teratoma and melanoma). Bilateral oophorectomy was necessary for 12 patients. Desire of pregnancy was expressed for 17/36 patients with unilateral oophorectomy, which succeeded in 13 cases (5 medically assisted). 2/17 had ovarian failure. The renal function was normal in 24/25 evaluated patients treated with platinum, ifosfamide or irradiation. The hearing function was evaluated on 17/36 patients treated with platinum: 12 Brock grade-0, 3 brock grade-1 and 2 grade-4.

CONCLUSION

Dysgerminoma has an excellent prognosis even in advanced cases with conservative surgery and platinum-based chemotherapy. However the disease and/or treatment resulted in a high rate of bilateral oophorectomies and a significant impact on future fertility.

[Malignant ovarian germ cell tumors--clinical characteristics and analysis of outcomes]

OBJECTIVES

Presentation of a group of patients with diagnosed malignant ovarian germ cell tumors (MOGCT), determination of prognostic factors and outcome analysis.

MATERIAL AND METHODS

We selected patients with diagnosed malignant ovarian germ cell tumors from the patient registry of Cancer Center in Warsaw from 1990 to 2001. We analyzed clinical and pathological features of the study group, as well as methods and results of treatment.

RESULTS

We collected documentation of 83 patients. Most were diagnosed with dysgerminoma and immature teratoma in the early stages of development. 73 patients received adjuvant chemotherapy after surgery At the end of the first line of treatment complete response was achieved in 63 patients (75.9%). Time to recurrence ranged from 25 to 518 days (mean 176 days). The most common site of recurrence was the true pelvis. The five-year overall survival was 62.7%. Significant favorable prognostic factor was early stage of disease and the histological diagnosis of dysgerminoma. From the 46 women after fertility-sparing surgery, 8 became pregnant.

CONCLUSIONS

MOGCT are a group of potentially curable, yet very aggressive malignant ovarian tumors. The main condition for obtaining good results is quick diagnosis and appropriate treatment, usually surgery associated with multidrug chemotherapy The stage of the disease remains the most important prognostic factor. Patients diagnosed with dysgerminoma are a separate group with very good prognosis.

Risk of Contralateral Testicular Cancer: A Population-based Study of 29 515 U.S. Men

BACKGROUND

Although risk estimates for synchronous and metachronous contralateral testicular cancers vary widely, many clinicians recommend routine biopsy of the contralateral testis for patients diagnosed with unilateral testicular cancer. We evaluated the risk of contralateral testicular cancer and survival in a large population-based cohort of men diagnosed with testicular cancer before age 55 years.

METHODS

For 29 515 testicular cancer cases reported to the National Cancer Institute's Surveillance, Epidemiology and End Results Program from 1973 through 2001, we estimated the prevalence of synchronous contralateral testicular cancer, the observed-to-expected ratio (O/E) and 15-year cumulative risk of metachronous contralateral testicular cancer, and the 10-year overall survival rate of both synchronous and metachronous contralateral testicular cancer, using the Kaplan-Meier method for the two latter assessments. Age-adjusted multivariable analyses were used to examine risk according to histologic type of the original cancer.

RESULTS

A total of 175 men presented with synchronous contralateral testicular cancer; 287 men developed metachronous contralateral testicular cancer (O/E = 12.4 [95% confidence interval {CI} = 11.0 to 13.9]; 15-year cumulative risk = 1.9% [95% CI = 1.7% to 2.1%]). In the multivariable analysis, only nonseminomatous histology of the first testicular cancer was associated with a statistically significantly decreased risk of metachronous contralateral testicular cancer (hazard ratio [HR] = 0.60, 95% confidence interval [CI] = 0.46 to 0.79; P<.001). Increasing age at first testicular cancer diagnosis was associated with decreasing risk of nonseminomatous metachronous contralateral testicular cancer (odds ratio = 0.90, 95% CI = 0.86 to 0.94). The 10-year overall survival rate after metachronous contralateral testicular cancer diagnosis was 93% (95% CI = 88% to 96%), and that after synchronous contralateral testicular cancer was 85% (95% CI = 78% to 90%).

CONCLUSIONS

The low cumulative risk of metachronous contralateral testicular cancer and favorable overall survival of patients diagnosed with metachronous contralateral testicular cancer is in accordance with the current U.S. approach of not performing a biopsy on the contralateral testis.

Age at immigration and duration of stay in relation to risk for testicular cancer among Finnish immigrants in Sweden

Although the incidence of testicular cancer is increasing, substantial differences in incidence between countries and populations exist. These differences cannot be explained solely by genetic differences, but environmental exposures, particularly early exposures, have been implicated in the etiology of testicular cancer. To assess whether early exposures contribute to the incidence of testicular cancer, we identified 93 172 Finnish men who immigrated to Sweden between 1969 and 1996 and followed them for the occurrence of testicular cancer. The risk of testicular cancer was lower for Finnish immigrants to Sweden than for the Swedish general population (standardized incidence ratio [SIR] = 0.34, 95% confidence interval [CI] = 0.21 to 0.53). The reduced risk was associated with both seminomas and non-seminomas. Neither age at immigration nor duration of stay in Sweden had any impact on the reduced risk. Although the type of environmental exposures remains unknown, the results strongly indicate that early exposures are major determinants for testicular cancer.

Malignant ovarian germ cell tumors: analysis of 32 cases

OBJECTIVE

In this study, some clinicopathologic characteristics and the outcome of patients with malignant ovarian germ cell tumors (MOGCT) were evaluated.

MATERIALS AND METHODS

The clinical charts and pathologic reports of 32 patients with MOGCT treated at the Department of Obstetrics and Gynecology, and diagnosed at the Department of Pathology, Medical Faculty of Dicle University, Turkey from 1983 to 1999 were reviewed.

RESULTS

Thirteen patients (40.6%) had dysgerminoma, nine (28.1%) had immature teratoma (four grade 1, three grade 2, and two grade 3), eight (25%) had endodermal sinus tumor, and two (6.3%) patients had mixed germ cell tumors. Site of involvement was unilateral in 30 (19 on the right and 11 on the left) and bilateral in two. All patients underwent primary surgery and 26 patients combination chemotherapy. There seemed to be a relationship between pathologic findings and clinical outcome, and MOGCT histologic types may affect the prognosis.

CONCLUSION

Dysgerminoma had a better prognosis than the nondysgerminomatous group (p < 0.05). This study provides additional data in confirmation of previous reports that management of MOGCT with fertility preservation is safe.

[Central nervous system. Experience of the Bordeaux University Hospital Center and review of the literature]

PURPOSE

Retrospective analysis of 17 patients with intracranial germ cell tumors treated in a multidisciplinary consultation at the Bordeaux University Hospital a and literature review.

MATERIALS AND METHODS

Seventeen consecutive patients were treated from 1978 to 1995 for a primary intracranial germ cell tumor. Median age was 14 (range 3-29 years). There were two malignant teratoma, six proved germinoma and nine presumed germinoma (diagnostic based on biological, radiological and treatment criteria). All received radiotherapy from 30 to 60 Gy (median 40 Gy) in different volumes. Chemotherapy was administered in 15 cases, three after surgery and 12 after radiotherapy.

RESULTS

All tumours were in complete remission after initial treatment. The two malignant teratomas recurred in non-irradiated area after nine and 48 months, and the patients died. None of the germinoma recurred within a follow-up period of two to 17 years (median 65 months). Five and 10 year actuarial overall survival rates were the same: 84% for all histologies and 100% for germinomas. Only two patients developed school difficulties and six presented an hypopituitarism, of which one was consecutive to radiotherapy. Chemotherapy was well tolerated.

CONCLUSION

This retrospective study and literature analysis are in favor of limited dose and volume of radiation therapy associated with chemotherapy.

Post-orchiectomy radiotherapy for stages I and II testicular seminoma

PURPOSE

In 1984 the following changes were made in the management of testicular seminoma at The University of Texas M.D. Anderson Cancer Center: (1) abdominopelvic computerized tomography replaced the bipedal lymph-angiogram for evaluating retroperitoneal nodes; (2) elective mediastinal radiation was totally abandoned; (3) patients with abdominal adenopathy < 10 cm were classified as having Stage IIA disease. This report evaluates the impact of these management policy changes on disease outcome.

METHODS AND MATERIALS

Between 1960 and 1991, 350 patients with Stages I or II testicular seminoma received post-orchiectomy radiation. The 241 patients treated prior to 1984 constitute our old series, and the 109 patients treated since then are our new series. The outcomes in the new series were compared to those in the old series.

RESULTS

The distribution of patients by stage was Stage I, 282 (old series, 190; new series, 92); Stage IIA, 55 (old series, 39; new series, 16); Stage IIB, 13 (old series, 12; new series, 1). The freedom-from-relapse at 5 years correlated with stage: Stage I, 97%; Stage IIA, 87%; Stage IIB, 69%. Elevated post-orchiectomy chorionic gonadotropin levels or involvement of the spermatic cord were adverse for disease relapse in Stage I but not Stage II disease. Patients with Stage I disease fared extremely well in both series (freedom-from-relapse 97%); the outcome for patients with Stage IIA was significantly worse in the new series (5-year freedom-from-relapse 73% vs. 92%) because of a 20% actuarial incidence of apparently solitary left supraclavicular nodal relapse. Although elective mediastinal radiation in the old series prevented this failure pattern, such treatment appeared to significantly decrease the survival of patients older than 40 years.

CONCLUSIONS

(1) Abdominopelvic computerized tomography scanning is adequate for the evaluation of abdominal lymph nodes in patients with seminoma; (2) Post-orchiectomy radiation to the para-aortic and ipsilateral hemipelvic regions remains the treatment of choice for patients with Stage I disease; (3) Patients with Stage IIA disease experience a 20% relapse rate especially in the left supraclavicular fossa and we recommend elective radiation to this site delivered concomitantly with para-aortic irradiation.

Static and dynamic vascular impact of large artery irradiation

PURPOSE

To evaluate functional post-radiotherapy arterial change in a select patient population.

METHODS AND MATERIALS

Thirty-five seminoma patients were identified in the Radiation Oncology departmental records at Indiana University Medical Center. In this group the ipsilateral pelvis is treated with the contralateral pelvis available for evaluation as a matched control. Additionally, this group is generally young and unlikely to have pre-existing vascular disease, and shows excellent radiocurability with historically standard radiotherapy. Nineteen patients volunteered for a noninvasive vascular evaluation which included: Doppler ultrasound, segmental leg pressures, pulse volume recordings, and post-exercise testing. Average age at treatment was 36 (range 14-68) with an average follow-up of 8.8 years (range 1-20) with five patients now over 15 years post-treatment. The majority of the patients received 2500-2600 cGy.

RESULTS

Three of 19 patients had abnormal vascular evaluations. Of these, two had bilateral abnormalities not felt to be solely associated with irradiation. The remaining patient showed both resting and post-exercise ipsilateral vascular abnormalities. Irradiation was the only identifiable etiologic agent for this patient's vascular abnormality.

CONCLUSION

Subclinical vascular change attributable to low dose radiotherapy was identified in one of 19 patients (5%). Considering the radiocurability of seminoma patients this incidence is acceptable. In light of this slight, yet documented, arterial abnormality occurring with low dose radiotherapy, we recommend additional study of high dose radiotherapy patients to determine the incidence and morbidity of radiation-induced arteriopathy in this group.

Testicular cancer

Despite the overall cure rate now in excess of 90%, innovation in management of germ cell tumors continues. The report that 80% of patients with extragonadal germ cell tumors have either carcinoma in situ or atrophic tubules as evidence of tumor rejection emphasizes the need to investigate the testis in patients with undiagnosed primary cancer because even today treatment delay is worsening prognosis. The evidence that testicular atrophy is a precursor of malignancy may explain why testis cancer has increased while normal sperm count has fallen over the past 50 years and why there is an association between exposure during service in Vietnam to agents that damage spermatogenesis and development of testis cancer. The improved prognostication from analysis of large databases and salvage with high-dose chemotherapy and bone marrow rescue are giving confidence to explore new innovations, eg, carboplatin instead of cisplatin. In addition, as the database on patients with stage I disease on surveillance enlarges, so does interest in adjuvant chemotherapy, encouraging the search for better markers to predict poor response. Linkage between overproduction of the tumor marker lactate dehydrogenase-1 and the increased copy number of the isochrome 12p in the tumor may be of use in this respect. Reports that germ cell tumor patients exposed to etoposide, eg, leukemic, lung, and ovarian cancer patients, can develop an acute myeloid leukemia with a marker on chromosome 11 are tempering enthusiasm for its use in adjuvant therapy. However, the observation that radiotherapy or chemotherapy may reduce second testis tumor incidence more effectively than surgery does encourages more detailed exploration of the results of adjuvant treatment.

[Is lymphography still relevant in seminoma?]

In the radiotherapist's point of view lymphography and computed tomography scan compete for staging and therapy planning of testicular seminoma. We investigated whether lymphogram can be replaced by computed tomography scan. 114 patients with histologically confirmed seminoma of the testis were treated by radiotherapy at the Nürnberg Community Hospital (n = 65) and the University of Erlangen (n = 49) from 1978 through 1991. Radiological staging included both computed tomography scan and lymphography in all cases. The results of both methods were similar in 79%. Computed tomography scan led to an upstaging in 4% while lymphography was negative. 17% of the patients showed negative results considering computed tomography scan while lymphogram was positive. In accordance with these data treatment portals or doses were altered in 21%. Using the M.D. Anderson Hospital clinical staging system a stage IIa (micrometastasis < 2 cm) is not safely identified by computed tomography scan. Just lymphography can safely identify a stage IIa patient. On the other hand, lymphography shows a very high amount of false positive interpretations. However, two conclusions are made: 1. Using a conventional technic (radiation of para-aortal and ipsilateral iliac region, dose about 30 Gy HD) lymphogram can be superseded by computed tomography scan. 2. In the case of reducing treatment volume and/or dose lymphogram should be added to computed tomography scan.

Clues to the aetiology of testicular germ cell tumours from descriptive epidemiology

The descriptive epidemiology of testicular cancer in Denmark shows that the incidence of both seminoma and non-seminoma has increased gradually since the 1940s to the present. The age-incidence pattern has remained unchanged, and is the same in the Nordic countries despite variation in the overall incidence level. Men born during the early 1940s have a lower risk in all age groups than expected from the overall trend in incidence. These observations support the idea that the occurrence of testicular cancer (both seminoma and non-seminoma) is determined early in life, and most probably before birth. Once the carcinogenic process is established, the age of occurrence of cancer or the histological type of the cancer does not seem to depend upon external factors.

Early detection of relapse after treatment for metastatic germ cell tumour of the testis: an exercise in medical audit

The relapse patterns of 29 patients who recurred following treatment for metastatic germ cell tumours of the testis (seminoma n = 7, non-seminomatous germ cell tumour n = 22) have been analysed and the relative effectiveness of clinical follow-up and routine investigations in detecting relapse at an early stage have been examined. The analysis shows that routine estimation of the serum tumour markers human chorionic gonadotrophin and alpha-foetoprotein (HCG and AFP) is the single most important follow-up procedure. This is so, even in patients who were previously marker negative; it was the first indicator of relapse in 55% of the patients. Regular clinical examination and chest radiograph in asymptomatic patients was of little value. Chest radiograph gave the first evidence of relapse in only 2 cases (7%). The optimum frequency for follow-up computed tomographic scanning of the chest and abdomen remains debatable. In this series, it was the first abnormal investigation in 7 patients (24%) and proved to be particularly important in patients who had residual radiological abnormalities at the end of initial therapy. Cost analysis shows that intensive follow-up produces a total expenditure on investigations of approximately 4,500 pounds per relapse detected. Regular computed tomographic scanning is especially demanding on resources and costs approximately 12,880 pounds per relapse detected if the recommended protocol is followed.

Accuracy of frozen section examination of testicular tumors

Benign testicular masses are recognized with increasing frequency and testis-sparing surgery, based on benign frozen section diagnosis, is practiced more often. However, there is a paucity of information in the medical literature regarding the accuracy of frozen section diagnoses of testicular tumors, and misdiagnoses could have dire consequences. We reviewed thirty frozen section examinations that were performed between 1962 and 1991, a period in which five hundred inguinal orchiectomies were performed. The entire testicle was available for histologic evaluation in 26 cases. Frozen sections correctly identified all of twenty-four malignant and two benign testicular masses. This study demonstrates that frozen section examinations can accurately diagnose testicular cancer.

[Radiation therapy of intracranial germinoma]

The appropriate radiation dose and field for the treatment of intracranial germinoma were investigated in 33 patients. Recurrences were observed in 4 cases treated with local field irradiation only, and all of them were recognized at the margin of the radiation field or under the dose (less than 25 Gy) area. This suggests that whole cranial irradiation (dose of 25 to 30 Gy) should be added even if the tumor is solitary. The effective dose for cerebrospinal dissemination appears to be 25-35 Gy, but prophylactic CNS irradiation seems unnecessary for patients who have not undergone surgical procedures. Changes in mental status were seen in 5 patients (26.3%). Doses of over 59 Gy may be related to this complication.

Increased incidence of germ cell testicular cancer in New Zealand Maoris

A higher incidence of germ cell testicular cancer was found in Maoris (6.84/100,000) compared with non-Maoris (5.26/100,000) in New Zealand from 1975 to 1986, especially in the 15-49 year age group (Maoris 12.30/100,000, non-Maoris 9.47/100,000; P = 0.04). Previous studies have shown Whites to have the highest incidence of this malignancy. Possible reasons for this and some other epidemiological features are discussed.

Acute and subacute side effects due to infra-diaphragmatic radiotherapy for testicular cancer: a prospective study

Acute/subacute side effects were evaluated in 39 testicular cancer patients before infra-diaphragmatic radiotherapy, twice during therapy and 3, 6, and 12 months after treatment discontinuation. The evaluation was primarily based on questionnaires filled in by the patients. At the end of radiotherapy nausea was reported by all responding patients, and 29 patients complained of diarrhea. Two-thirds of the patients reported abdominal pain and/or meteorism, and one-half complained of retching and/or vomiting. During therapy the median weight was significantly reduced by three kilos and the median value of the performance status decreased by 20%. The hematological and biochemical toxicity was low. At the 3-month evaluation more patients complained of nausea, abdominal pain, and meteorism than before irradiation. Compared to the pretreatment situation the patients evaluated their physical condition to be reduced during treatment and at the first follow-up visit. One year posttreatment the patients had regained their physical fitness. All patients in income-producing activity were on sick leave during the period of radiotherapy and for 5 weeks (median) thereafter. In conclusion, infra-diaphragmatic radiotherapy leads to significant but reversible acute/subacute side effects lasting for a median of 9 weeks. It is hoped that better symptomatic therapy and modifications of the radiotherapy technique will reduce the side effects.

Pathology of testicular germ cell tumors

The pathology report on a testicular germ cell tumor should include the following information: Tumor type: The histologic type of tumor present. If the tumor is of mixed type, the components should be listed, in order of relative abundance. The pathologist may endeavor to give a numeric estimate of the percentages of each element. Staging information: The size of the tumor should be listed. Local spread--into rete testis, tunica albuginea, epididymis, and spermatic cord--should be listed. If the cord is involved, possible involvement of its surgical resection margin should be assessed. Vascular/lymphatic invasion should be assessed for its presence or absence. Status of the remainder of the testis: Evidence of cryptorchidism or other dysgenetic features should be mentioned. Such features may imply a greater risk for the development of a contralateral tumor. Also, the presence of normal spermatogenesis elsewhere in the uninvolved testis should be reported. This finding may suggest a relatively decreased risk for contralateral tumor development and is a likely indicator of fertility should the patient consider sperm banking prior to retroperitoneal surgery and chemotherapy. The finding of mature sperm in the epididymis is an easy way to confirm spermatogenesis in the testis. Incidental findings: Lipomas or hydroceles of the cord, adrenal rests, and adnexal cysts may be found. The pathologist plays a crucial role in the diagnosis of germ cell tumors. In addition to elucidating tumor type, the pathologist is relied upon for precise local staging and for the classification of metastases, all of which have important implications in determining optimal therapy. As the clinical management of germ cell tumors evolves, the pathologist will continue to play a role in defining those features that have a bearing on patient outcome.

Intracranial and spinal germinomas occurring four years after spinal cord germinoma--case report

Intracranial and thoracic tumors developed in a 31-year-old male 4 years after irradiation therapy for a cervical tumor. He received irradiation for the pineal, suprasellar, and thoracic tumors. All tumors disappeared by neuroradiological imaging after treatment. The previous and present tumors were probably germinomas, possibly with multifocal origins.

Pediatric germ cell and human chorionic gonadotropin-producing tumors. Clinical and laboratory features

Germ cell tumors may cause various aberrations in pubertal development. In prepubertal boys, these tumors may secrete human chorionic gonadotropin, resulting in precocious puberty. Human chorionic gonadotropin and alpha-fetoprotein are both useful as germ cell tumor markers in the diagnosis and detection of recurrence. Pregnancy-specific beta 1-glycoprotein, another oncoplacental antigen, has been used as a tumor marker for trophoblastic neoplasms, but not previously for human chorionic gonadotropin-producing tumors associated with precocious puberty. Patients with germ cell tumors may also have abnormal karyotypes. Herein, we describe six male pediatric patients with germ cell tumors and pubertal derangements seen during an 8-year period. We confirm the high incidence of associated sexual precocity, the usefulness of alpha-fetoprotein, human chorionic gonadotropin, and pregnancy-specific beta 1-glycoprotein as tumor markers in the diagnosis and follow-up of these patients, and the occurrence of sex chromosomal abnormalities.

Risk of bilateral testicular germ cell cancer in Denmark: 1960-1984

The incidence of a second primary testicular germ cell cancer among 2850 (96.6% of eligible) men with a histologically verified first primary germ cell cancer diagnosed in the period 1960-1979 in Denmark was established. Of these 2850 men, 73 (2.6%) developed a contralateral testicular cancer. In five of these patients (0.18%), the tumors were synchronous. The cumulative risk of developing a contralateral cancer 25 years after diagnosis of the first testicular germ cell cancer was 5.2% according to a Kaplan-Meier estimate. It was higher among men with a nonseminoma as the first tumor (8.4%) than among men with a seminoma as the first tumor (3.6%). Of the second tumors, 12% were stage II and 17% were stage III at the time of diagnosis. Based on 24,588 person-years at risk and 68 nonsimultaneously occurring bilateral testicular germ cell cancers, the overall relative risk (RR) of developing a second primary cancer in the contralateral testicle following a first germ cell cancer was found to be 24.8 (95% confidence interval = 19-38). Among men with a nonseminoma, the risk was higher (RR = 27.1) than among men with a seminoma (RR = 22.5). The excess risk was not affected by age at diagnosis, calendar period, or time since diagnosis. Close surveillance by screening for and treatment of carcinoma in situ of the remaining testicle in testicular cancer patients are advised.

[Tumor of the vitelline sac of the testicle (yolk sac carcinoma)]

The tumour of the yolk sac is a germinal cell neoplasia arising in the prepubertal testicles which was included in the WHO's histological classification of neoplasia of the testicles in 1977. We contribute a case of this histological variety in Stage I, according to the Royal Marsden criteria. The patient was treated with inguinal orchidectomy only and 3 years later remains disease-free.

MRI for evaluation of scrotal pathology

Since 1986, 205 patients, age 2-84 years, mean age 33 years, with scrotal pathology were examined by magnetic resonance imaging (MRI). A 1.5-T Siemens Magnetom and specially designed external coils were used for obtaining T1- and T2-weighted images. Of these, 88 patients underwent MRI studies for suspicion of testicular cancer, and 117 for a variety of benign scrotal lesions. MRI studies yielded excellent diagnostic information of scrotal pathology: predictive value for diagnosing testicular cancer was 100% with 62% of correct differentiation between seminoma and non-seminomatous tumors. In future, the incidence of diagnostic surgical explorations of scrotal pathology can be reduced by MRI studies.

Trebling of the incidence of testicular cancer in victoria, Australia (1950-1985)

Changes in the incidence of testicular cancer in Victoria, Australia were studied from 1950 to 1985. Cases from the period 1950 to 1978 were derived from many sources (1116 cases). Emphasis was placed on diagnostic reliability; 97% of cases were confirmed histologically, and of these, 86% were reviewed at the Peter MacCallum Cancer Institute. For the years 1982 to 1985, Victorian Cancer Registry data were used. The incidence rose by a factor of 2.9 from 1.44 (95% confidence interval [CI], 1.15 to 1.73) per 100,000 in 1950 to 1954 to 4.16 (95% CI, 3.73 to 4.59) per 100,000 in 1982 to 1985. Between 1950 to 1954 and 1965 to 1969, there was a sharp rise, followed by a plateau or dip, then a further rise. Among seminomas, the rates rose in most adult age groups, whereas among nonseminomas, the rise was concentrated in younger age groups. There was a significant trend to earlier age of occurrence among nonseminomas (P = 0.0004) but not among seminomas (P = 0.89). Cohort analysis revealed a trend toward increasing rates for both seminomas and nonseminomas, and confirmed the trend toward earlier age of onset for nonseminomas. Disproportionate increases were observed for the 1915 to 1924 cohort of seminomas and the 1930 to 1939 cohort of nonseminomas. Analysis of available data from other Australian states indicated comparable rising incidence in New South Wales, Tasmania, and Western Australia.

Optimal drug therapy in the treatment of testicular cancer

Although testes cancer is the most common malignancy affecting young men, dramatic survival rates are now possible with the development of optimal individualised drug therapy. Human chorionic gonadotropin and alpha-fetoprotein are important tumour markers associated with testes cancer, and can provide essential information about prognosis and treatment efficacy. For treatment purposes, testicular germ-cell malignancies are broadly classified as seminomatous or non-seminomatous. Early stage seminomas are treated with radiotherapy, while more advanced disease requires systemic chemotherapy. Stage I nonseminoma patients can now be offered the option of retroperitoneal lymph node dissection (RPLND) or close clinical observation, while patients with stage II or III nonseminoma should generally be treated with chemotherapy. The dramatic survival rates now apparent with chemotherapy are due in large part to the introduction of cisplatin (cisplatinum II)-based chemotherapy and to the optimisation of therapy based on pretreatment risk analysis. The most common chemotherapeutic regimen for standard risk patients includes cisplatin and etoposide (VP 16213) and long term disease-free survival rates exceed 80%. A subset of poor risk patients with significantly reduced survival can be defined. These patients, and patients with relapsed or refractory disease, should receive more aggressive regimens, and ifosfamide (isophosphamide) is proving to be a particularly promising new agent in this regard. High-dose carboplatin with autologous bone marrow rescue is another encouraging alternative currently being investigated for these patients. Chemotherapy, despite substantial effectiveness, is not without toxicity, which consists primarily of myelosuppression, nausea and emesis, and renal toxicity. With careful monitoring and prophylaxis, however, these toxicities can generally be ameliorated or avoided.

Ovarian germ cell malignancies in England: epidemiological parallels with testicular cancer

The epidemiology of germ cell cancer of the ovary has been little investigated. We studied ovarian germ cell cancers incident 1971-84 in England, using data from the England and Wales national cancer register. The age distribution showed a sharp peak at ages 15-19, to which both teratomas and dysgerminomas contributed equally, and a secondary, much wider peak, at ages 65-69, mainly due to teratomas. For teratomas there were diverging secular trends by age: incidence has been increasing at ages 0-44 (P around 0.05) and decreasing at ages over 44 (P less than 0.01). Birth cohort analysis showed an increase in risk at ages 0-44 for more recent generations of women. There were no changes over time for dysgerminomas. There was no clear geographic pattern of distribution across the regions of England. The early age peak, and the increase in incidence of ovarian germ cell cancers at young ages but decrease at older ages, resembles testicular cancer epidemiology. Interestingly, discrepancies and similarities in the age distribution of these tumours between the sexes parallel lifetime profiles of gonadotropin levels in each sex.

[Significance of serum ferritin level in testicular tumors]

The clinical value of serum ferritin level in patients with testicular cancer was studied. Seven cases of seminoma and nine cases of non-seminoma from 1983 to 1989 were evaluated. The serum levels of ferritin, human chorionic gonadotropin (beta-HCG), alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA) and lactate dehydrogenase (LDH) were estimated before and after treatment. Abnormally high values of serum ferritin before treatment were noted in 4/7 (57%) in seminoma, 3/9 (33%) in non-seminoma and 7/16 (44%) in total. The total rate showing abnormally high values of serum ferritin was lower than that of beta-HCG and LDH. Meanwhile it was the same as that of AFP and higher than that of CEA. Changes in the serum ferritin level did not always correspond with the clinical course. In 3 out of 6 tumor free patients, higher levels of serum ferritin before treatment became normal after treatment. In one patient with a high level of serum ferritin before treatment, the level of serum ferritin remained higher and retroperitoneal lymph node metastasis developed after treatment. In 9 cases with normal serum ferritin level, 7 showed the normal range of ferritin level throughout the treatment course. These findings suggests that in some patients with testicular cancer, the serum ferritin level might serve as a tumor marker indicating the efficacy of the treatment and the tumor recurrence.

Malignant potential of the cryptorchid testis

A follow-up study of 224 male patients from Rochester, Minnesota, diagnosed with cryptorchidism during the period from 1935 through 1974 was conducted to assess the frequency of subsequent testicular neoplasms. Age-specific rates for testicular neoplasm in this community were used to estimate an expected number for comparison with that observed. Two malignant testicular neoplasms have occurred in this cohort; thus, the standardized morbidity ratio was 11.4 (95% confidence interval, 1.4 to 41.1). Of the 158 patients born in the community, 11% were known to have birth weights of less than 2,500 g, approximately twice the expected occurrence. Increased risks were also noted for inguinal hernia, hypospadias, Down's syndrome, cleft lip or palate (or both), clubfoot, and congenital heart disease, for which the standardized morbidity ratios were 3.6, 4.7, 17.8, 11.3, 11.7, and 2.7, respectively. The increased risk for malignant neoplasms observed in this cohort of patients with cryptorchidism is consistent with that found in earlier studies.

[Analysis of ferritin immunostaining in testicular tumors]

Localization of ferritin in testicular tumors was studied by the immunohistochemical method and the usefulness of ferritin was evaluated compared with the clinical course. Seven cases of seminoma and 9 cases of non-seminoma were used for the study. Formalin-fixed, paraffin-embedded tissue sections were stained by the avidin-biotin complex method. Commercial rabbit anti-human ferritin polyclonal antibody in 1/100 dilution was allowed to react at room temperature for one hour. In normal testicular tissues, the epithelium in germinal cells was not stained for ferritin. In seminomas, some tumor nests were stained for ferritin. Interstitial cells, especially histiocytes, were also stained for ferritin. In stained tumor cells, cytoplasm was stained uniformly. Necrotic cells were not stained. The same findings were obtained in non-seminomas. In metastatic lesions and tumor thrombi in the vessels, some tumor cells were stained as intensely as in the origin. A case was calculated positive if more than 5% of the tumor cells in the specimen were stained. The positive rate in ferritin immunostaining was significantly higher than that of human chorionic gonadotropin (beta-HCG), alpha-fetoprotein (AFP) and carcinoembryonic antigen (CEA) immunostaining with the same materials. The specimens from cases with abnormally high serum ferritin level, were stained more intensely than those from cases with normal serum ferritin level. The result suggests that ferritin might be a useful tumor marker in some of testicular tumors.

Pattern of urological malignancy in Zambia. A hospital-based histopathological study

The pattern of urological malignancy among the indigenous population of Zambia (determined on the basis of histopathological reports from a major national hospital during an 8-year period) is presented. A total of 6514 malignancies were observed, of which 784 (12%) were of urological origin. Bladder carcinoma, predominantly squamous type, was the commonest urological tumour (51%), followed by carcinoma of the prostate (26%), carcinoma of the penis (18%), renal tumours (4.3%) and testicular malignancy (0.7%). In nearly 32% of the bladder tumours, bilharzial ova were demonstrated histopathologically. Nephroblastoma accounted for 70% of the renal tumours and from a total of 7 cases of testicular tumours 5 were embryonal carcinoma and 2 seminoma. A brief reference is made to the pattern and aetiology of urological malignancies in some neighbouring countries.

Influence of prior orchiopexy on stage and prognosis of testicular cancer

Thirty-four cryptorchid testis cancer cases were studied, of whom 9 patients had prior orchiopexy at the time of cancer diagnosis. Disease stage in this group was: stage I = 4, stage II = 1 and stages III and IV = 4 cases. Seventy-eight percent of these cases (n = 7) had non-seminomas; 4 of these patients died. In the uncorrected cryptorchidism group (n = 25), disease stage was: stage I = 12, stage II = 9 and stages III and IV = 4 cases. Of these cases, 64% (n = 16) had seminomas and 6 patients died. Orchiopexy marginally reduced the symptomatic interval for subsequent cancer and probably decreased the risk of seminoma development. Orchiopexy did not lead to a more favourable disease presentation or prognosis because of the adverse bias of advanced-stage non-seminomas in this group.

Testicular cancer in young men and parental occupational exposure

To investigate whether parental occupation, especially during the 12 month period before birth, could be responsible for elevated rates of testicular cancer in young men, we used data from a case-control study of 223 cases and 212 controls conducted in the Washington, DC area. For all histologic types of testicular cancer combined, no significant associations were found for specific occupations, nor for the broad occupational categories of professional, other white collar, or blue collar workers. However, for cases with seminomas, excess risks were seen for those with parents employed in the following occupations: mothers in health-related occupations, O.R. = 4.6 (1.1-19.1), and fathers working in automobile service stations, O.R. = 4.0 (0.6-24.5), manufacturing industries, O.R. = 2.2 (1.0-4.2), and aircraft production and maintenance, O.R. = 5.3 (0.7-24.1). Although these findings for seminoma are intriguing, they do not explain the increase of testicular cancer in young men.

Gonadoblastoma in an anatomically normal man: a case report and literature review

Gonadoblastoma, a rare gonadal neoplasm, presents most frequently in phenotypic female or phenotypically male patients with dysgenetic gonads or undescended testes. To date, only 2 cases of gonadoblastoma have been reported in anatomically normal male patients with scrotal testes. Both of these patients presented with testicular masses and germ cell tumors. We report a case of a genotypically and phenotypically normal, fertile man with descended testes who on evaluation for chronic orchialgia had a gonadoblastoma unaccompanied by a germ cell neoplasm. The tumor was nonpalpable and was initially discovered on scrotal ultrasound.

Occupation and risk for testicular cancer: a case-control study

A case-control study of 271 testicular cancer cases aged 18-42, including 60 seminomas and 206 other germinal cell tumours, and 259 controls was carried out to study the association between occupation and testicular cancer risk. Study subjects were identified at three medical centres, two of which treat military personnel. Controls were men diagnosed with a cancer other than of the genital tract. Associations were identified between professional employment (administrators, teachers and other professionals) and risk for testicular seminoma, OR = 2.8 (95% Cl: 1.4-5.4) and between employment in production work and risk for other germinal cell tumours, OR = 1.8 (95% Cl: 1.1-2.7). No specific occupations within these broad groups were responsible for observed increases. Self-reported exposure to microwave and other radio waves was associated with an excess risk for both seminomas and other germinal cell tumours. However, an assessment of radio wave exposure based on job title did not support this finding. Although testicular cancer has been increasing in recent decades among young males, occupational factors did not appear to account for a substantial proportion of testicular cancer occurrence in the population studied.

Testicular carcinoma in patients positive and at risk for human immunodeficiency virus

Patients with the acquired immunodeficiency syndrome are at increased risk for certain malignancies. Because acquired immunodeficiency syndrome and testicular cancer affect primarily young men, the potential complications that acquired immunodeficiency syndrome might impose raise significant concern. To address this question we performed a retrospective review of all cases of testicular cancer during an 11-year period. Of 140 patients 6 had human immunodeficiency virus infection and 7 were from human immunodeficiency virus risk groups. All cases were either stage I or II disease with seminoma in 8, teratocarcinoma in 3, embryonal cell carcinoma in 1 and teratoma in 1. The clinical presentations of these patients were comparable to those of patients without human immunodeficiency virus risk factors. The majority of the patients received standard therapy, including orchiectomy followed by lymphadenectomy, radiation therapy or chemotherapy depending on stage and pathological subtype. Patients tolerated therapy well with only 1 course of radiation therapy complicated by Pneumocystis carinii pneumonia. All patients achieved complete remission and none died of testicular cancer. Since treatment of these patients may worsen the immunosuppression, surveillance is recommended after orchiectomy for acquired immunodeficiency syndrome patients with stage I disease. However, the majority of patients with human immunodeficiency virus infection should receive standard therapy.

Prospective study of long-term pulmonary manifestations of mantle irradiation

Given the high cure rate of patients with Hodgkin's disease, the complications related to therapy take on great significance. Mantle irradiation to the thorax is used in virtually all patients with early stage Hodgkin's disease. Prior studies of patients receiving mantle irradiation demonstrated short-term (up to 24 months) abnormalities of pulmonary function. In the present study, we prospectively studied 13 patients for up to 60 months after irradiation only with serial pulmonary function tests, arterial blood gas tests, diffusing capacity of carbon monoxide, chest radiographs, and ventilation-perfusion scans. No respiratory symptoms attributable to therapy were noted. Frequent radiographic changes (62%) were found consisting of apical fibrosis, paramediastinal fibrosis, or pleural thickening. Two patients developed an asymptomatic spontaneous pneumothorax that resolved with conservative management. Ventilation-perfusion scans often (73%) revealed decreased perfusion to the lung apices with associated ventilatory deficits in one-half of these patients. Patients with intrathoracic disease had decreased lung volumes prior to therapy, and lung volumes did not change following irradiation. Lung mechanics were normal throughout the study. Gas exchange at rest was normal in patients with extrathoracic disease. Patients with intrathoracic disease often presented with an abnormal arterial PO2 and widened alveolar-arterial partial pressure gradient for oxygen. However, these parameters normalized by 9 months after therapy. Despite the frequent development of radiographic and V/Q scan abnormalities in the lung apices, patients tolerated mantle radiotherapy remarkably well. In fact, patients with intrathoracic disease demonstrated improved gas exchange at rest following therapy.

Testicular neoplasms: seminoma

From 1969 to 1984, 58 patients with a diagnosis of testicular seminoma were seen and treated at the University of Kansas Medical Center. The median age was 34 years (range of 20 to 62 years). The American Joint Committee on Cancer Staging System was followed: stage I (34 patients); stage II (6); stage III (8); and stage IV (10). Forty-two patients had typical seminoma, and 16 had anaplastic histology. Nine patients had elevated B subunit of human chorionic gonadotropin, and nine had a history of cryptorchidism. Fifty-six patients received radiation treatment, and seven received chemotherapy with or without radiation. The median follow-up was 7 years (range 3 to 16 years). The overall disease-free (absolute) survival according to stage was: stage I, 91% (100%); stage II, 66% (80%); stage III, 75% (85%); and stage IV, 50% (50%). There were no late complications. The survival for patients with anaplastic histology or with elevated B subunit of human chorionic gonadotropin was not significantly different from that of typical seminoma.

[Testicular germ cell tumors--epidemiology and risk factors]

An increasing incidence of testicular germ cell tumours has been observed in many white populations in this century. Ethnic genetic implications and lifestyle seem to influence the development of testicular cancers, whereas the influence of intrauterine conditions is under debate. Epidemiologic studies cannot explain the increasing incidence among young men. The age variation of incidence and histologic type indicates at least two different aetiological mechanisms. Testicular cancers among young men are most probably due to gonadal dysgenesis, whereas in old men they reflect the general increased risk of cancer with old age. The increased risk of developing testicular germ cell tumours among cryptorchid young men supports the gonadal dysgenesy hypothesis.

Excess of seminomas observed in Vietnam service U.S. military working dogs

During the Vietnam War, US military working dogs served with their companion dog handlers in close proximity, sharing common exposures to war-related activity, many zoonotic infectious agents, chemical pesticides, phenoxy herbicides, and extensive use of therapeutic drugs. To gain insight into the effects of the Vietnam experience, we investigated the occurrence of neoplasms in military working dogs based on standard necropsy examination by the Armed Forces Institute of Pathology. We observed that these dogs experienced significant elevated risks for testicular seminoma and, independently, testicular dysfunction. Experimental evidence shows testicular dysfunction and impaired spermatogenesis in laboratory animals exposed to phenoxy herbicides, dioxin, or tetracycline, and antibiotic used extensively in military working dogs in Vietnam. Because an unexplained significant decrease in sperm quality in Vietnam veterans has been observed by the Centers for Disease Control, further research is warranted if we are to clarify military service in Vietnam as a risk factor for testicular dysfunction. The testis should be made a priority site in the study of Vietnam experience-related cancers.

The risk of second cancer (SC) in patients treated for testicular seminoma

The exact risk of second cancer (S.C.) following treatment of testicular seminoma is not well determined in most series. At our institution, 122 patients with pure seminoma were treated by orchidectomy followed by radiation therapy from 1951 to 1986. Six were lost to follow-up. For the 116 remaining patients, the overall 5-, 10-, 15- and 20-year survival probability was 95%, 90%, 87%, and 84%, respectively. Eleven patients developed 12 second cancers, with a cumulative risk of 7%, 16%, and 16% at 10, 15, and 20 years, respectively. Overall, the risk of second cancer was increased (O/E = 1.97, p = 0.023). There were 3 controlateral seminoma (O/E = 50, p = 0.001), 2 transitional carcinoma of the bladder (O/E = 6.9, p = 0.035), 2 non-Hodgkin's lymphoma (N.S.), 1 acute myeloblastic leukemia, 1 chronic lymphocytic leukemia, 1 intracranial dysgerminoma, 1 rectal and 1 lung adenocarcinoma. Four tumors developed within the previously irradiated field (O/E = 2.2, N.S.). Excluding second seminoma, the overall risk of second cancer was not significant (O/E = 1.33). Five of the 11 patients with second cancer are currently alive without recurrent cancer. We conclude that patients treated for seminoma have an increased risk of second cancer but the overall prognosis remains excellent. The potential factors responsible for second cancer, including irradiation, are discussed.

[Epidemiology of germinal cell testicular tumor in Hungary]

The data of 1286 testis cancer persons were analyzed by the authors, which were identified in Hungary between 1981 and 1986. The comparison was carried out with international findings in this field. The incidence rate of testis tumor in Hungary reaches a value of 4.16/100,000 men/year, which seems to be quite near to the frequency of cases occurred in Northern-Europe. The patient's age was 32.9 year in the mean at the time of the diagnosis, and the age-specific incidence rate was the highest (11.2) between 25-34 years, according to international experiences. A significant difference was found in the frequency of testis cancer among 19 counties of Hungary. The extremely high testis cancer incidence in the county Vas (West-Hungary) requires further explanations. A seasonal pattern according to the patients birth months was shown, which did not correlate with data of other Hungarian authors concerning seasonal pattern of the undescendent testis.

Use of electric blankets and risk of testicular cancer

Electric blankets are an important domestic source of electromagnetic fields (EMF) because of the relatively high intensity of emission, prolonged exposure, and intimate contact with the source. In a case-control study of testicular cancer in western Washington during 1981 to 1984, the relation between EMF exposure from electric blankets and the occurrence of testicular cancer was examined. The respective proportions of cases and controls who reported the use of an electric blanket were almost identical (age-adjusted rate ratio (RR) = 1.0, 95% confidence interval (CI) 0.7-1.4). Distributions of the duration of use were also very similar in cases and controls. Compared with controls, the frequency of use of an electric blanket was slightly lower in men with seminoma (RR = 0.7, 95% CI 0.5-1.2) and slightly higher among men with nonseminoma germ cell tumors (RR = 1.4, 95% CI 0.9-2.3). Overall, the results of this study suggest that increased exposure to EMF from electric blankets contributes little, if at all, to the risk of testicular cancer in adult white men.

Pineal and CNS germ cell tumors: Royal Marsden Hospital experience 1962-1987

A retrospective analysis has been made of all patients with pineal and CNS germ cell tumors who were treated at The Royal Marsden Hospital between 1962-1987. A total of 67 new cases were seen: 17 had initial histological verification of tumor type and the remainder were tested for radiosensitivity with a dose of 20 Gy following a shunting procedure. Patients with germ cell or radiosensitive tumors were treated with a uniform policy of whole neuraxis radiotherapy giving 50 Gy to the local tumor and 30 Gy to the remaining brain and spinal cord. Nonresponding lesions continued with local fields to a dose of 50 Gy. Patients were divided into three groups (a) germinoma and radiosensitive tumours, 34 cases; (b) malignant teratoma, 12 cases; (c) non-germ cell, 21 cases. Median follow-up is 83 months (range 2-246 months). Overall and cause specific actuarial 5/10 year survival were for group 1, 81.7%/69.4% and 86.5%;/86.5%; group 2, 18.2%/18.2% and 18.2%/18.2%, and group 3, 64.3%/46.8% and 64.3%/52.6%, respectively. No patient in group 1 treated during the last 12 years has recurred. Univariate analysis of factors at presentation, showed that neurological performance status (p less than .001) as well as tumor type (p less than .001) correlated with outcome. Recurrence was confined to the primary site in only 1 of 4 patients in group 1 compared to 6 of 9 patients in group 2 and 9 of 10 patients in group 3. No isolated spinal recurrence occurred in group 1 patients. A total of eight patients have received platinum containing chemotherapy for recurrence (6 cases) or adjuvant therapy (4 cases). Germinomas appear to respond better than teratomas, all of which have recurred rapidly following initial partial response. Shunting and radiosensitivity testing remains the treatment of choice for tumors compatible with germinoma. Craniospinal irradiation is associated with low morbidity providing spinal growth is complete and is recommended in older patients as salvage following spinal recurrence is unsatisfactory. Aggressive combined modality approaches with surgery, radiotherapy and chemotherapy need to be investigated to improve results in CNS teratoma.

Month of birth and testicular cancer risk in Denmark

On the basis of 40 years of national cancer registration, the authors analyzed the distribution of birth dates of patients with testicular cancer in the Danish male population, which has a particularly high incidence of this cancer. No significant peaks were identified, except for men with embryonal carcinomas born between 1950 and 1959, for whom a significant 12-month cycle was observed. This result differs from those of earlier studies. The number of cases of embryonal carcinomas in the 1950-1959 birth cohort is small, but it is possible that an etiologic factor that varies with season was present at the time. For all testicular cancers and for the three histologic subgroups analyzed, the authors found significant 2-month cycles. The biologic relevance of a 2-month cycle is not clear. It is concluded that there is little evidence to support the hypothesis of a systematic variation in month of birth among men with testicular cancer.

Carcinoma in situ in testicular biopsies

Carcinoma in situ of the testis is an abnormality of the seminiferous epithelium characterized by aneuploid cells with clear cytoplasm located along the tubular basement membrane or in the lumina of tubules. Morphological, cytogenetic, and histochemical features of this anomaly are presented. An adequate fixation of testicular tissue samples is necessary for correct diagnosis. The fact that approximately 50% of carcinoma in situ may develop into malignant germ cell tumours of the testis in 5 years and the investigations of the testicular tissue adjacent to these tumours support the malignant nature and invasive potential of testicular carcinoma in situ. The incidence of carcinoma in situ in persons at risk is reviewed.

Management of postchemotherapy residual mass in patients with advanced seminoma: Indiana University experience

Thirty-six patients with advanced seminoma treated with cisplatin combination chemotherapy were evaluated to assess the significance of postchemotherapy residual radiographic mass. All patients had a minimum follow-up of 2 years. Of the 36 patients 21 had an evaluable residual radiographic mass after completion of chemotherapy. Twelve of these patients had a less than 3 cm maximal transverse diameter residual mass, and nine had a greater than 3 cm persistent mass postchemotherapy. Only three of these 21 patients underwent postchemotherapy retroperitoneal lymph node dissection, and the histopathology revealed only necrotic fibrous tissue. The remaining patients were followed by close observation including repeat abdominal computed tomography (CT) every 3 months the first year and every 6 months the second year (or until normal); further therapeutic intervention was given only on evidence of progressive disease. Nineteen of these 21 patients have no evidence of disease, including eight of nine with greater than 3 cm persistent radiographic abnormality. The optimal management for advanced seminoma patients with a persistent radiographic mass postchemotherapy remains unresolved. However, based on this small series, we feel that observation is a viable option, reserving radiotherapy or chemotherapy for those patients who subsequently develop progressive disease.

[Undescended testis cancer: report of two cases--review of the literature of 179 cases in Japan]

Recently, we experienced two cases of testicular tumor in patients with cryptorchidism. Case 1: A 35-year-old man was admitted because of right inguinal mass. He had a tumor of right undescended testis and underwent right orchiectomy. Case 2: A 45-year-old man, who was pointed out to have bilateral cryptorchidism was admitted because of right groin mass. He underwent right orchiectomy and left orchiopexy. Histological examination of two cases were seminoma. Testicular tumor in undescended testis was made with 179 reported cases from the Japanese literature.