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A 10-year-old boy presented with a painless left scrotal mass that had been present for 2 years. Ultrasound examination revealed 2 left testes measuring 2.4 ml and 1.0 ml with the same echogenicity. Atsurgery, there were 2 similarly sized testes connecting with other spermatic vascular, but the supernumerary testis had no connection with the vas deferens. Histological findings showed immature testicular tissue without malignancy. We report the 26th case of polyorchidism in Japan and discuss this condition.

We retrospectively reviewed patients who underwent radical or partial nephrectomy and were followed up in Oji General Hospital from 1992 through 2012. A total of 6 patients had disease recurrence in the pancreas during follow-up. We investigated their clinical features and treatment outcomes. The median age at diagnosis was 75 years. The median interval from nephrectomy to the detection of pancreatic metastasis was 114 months. As local therapy for metastasis, surgical resection was selected for 4 patients. On the other hand, administration of medication, including interferon alpha and sunitinib was selected for 2 patients with other simultaneous metastatic sites. One of the 4 patients with surgical resection had disease recurrence in the residual pancreas and needed additional excision. At the median follow-up of 38 months after treatment of pancreatic metastasis, one patient remained alive without evidence of disease, 3 patients were alive with recurrent disease, and 2 patients had died of the disease.

We report here a case of intrascrotal malignant mesothelioma, arising from the tunica vaginalis, which was diagnosed after surgery for hydrocele testis. A 52-year-old man underwent left hydrocelectomy for hydrocele testis. After pathological diagnosis as malignant mesothelioma from the specimen of tunica vaginalis, left radical orchiectomy was performed. The patient had no exposure to asbestos and there has been no evidence of recurrence.

A 55-year-old male was referred to our hospital with the chief complaint of painless right scrotal swelling. Serum tumor marker levels were all within the normal range. A right radical orchiectomy was performed and the histopathological diagnosis was plasmacytoma. Chest and abdominal computed tomographic scan and bone scintigraphy did not show metastasis. Serum and urine protein electrophoresis and bone marrow biopsy were negative. Diagnosis was primary testicular plasmacytoma (extramedullary plasmacytoma). Eleven months after the operation, multiple bone lesions appeared and our diagnosis was conversion to multiple myeloma.

We retrospectively reviewed 190 patients with germ cell tumors of testis or extragonadal origin who were treated in our hospital between 1980 and 2007. Five (2.6%) of them had brain metastasis. We studied the clinical features and treatment outcome of these patients. Median age was 30 years old (23-48). The clinical stage was III in all the patients, except one with stage I disease. Two patients had brain metastasis at the initial presentation. All patients underwent multiple regimens of chemotherapy. As local therapies for brain metastases, surgical resection was done in 4 and gamma knife was in 1. Whole brain irradiation was added to surgery in 2 patients. All patients died of the disease within one year after brain metastasis development, except 1 patient who was free of disease 47 months after the presentation. The long survivor had solitary brain metastasis at the initial presentation and received 4 regimens of chemotherapy, 2 surgical resections of brain metastases and whole brain irradiation. Finally, chemotherapy consisting of irinotecan and nedaplatin resulted in normalization of the tumor markers and complete remission was proved by the subsequent surgical resection. Although most patients with brain metastasis have a poor clinical outcome, aggressive local treatment and employment of novel anticancerous agents may contribute to improve clinical course of selected patients with germ cell tumors and brain metastasis.