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Paraneoplastic limbic encephalitis (PLE) is an immunopathologic syndrome associated with malignancy and represents a rare remote outcome of tumor on the nervous system. We report a case of PLE caused by a regressed testicular germ cell tumor in an otherwise healthy young man, who presented with acute-onset confusion, memory impairment and anterograde amnesia. Prompt recognition of PLE is critical as it allows early treatment of both the primary tumor and PLE-related neurologic impairments, which can be severe and irreversible if treatment is delayed. Complete tumor treatment response offers the best chance for neurologic recovery in patients with PLE. To our knowledge, this is the second reported case of PLE with radiologic-pathologic correlation in the setting of a regressed testicular germ cell tumor.

Testicular neoplasms are reported rarely in pet and laboratory rabbits (Oryctolagus cuniculi f. dom.), with interstitial cell tumours being the most commonly described testicular neoplasm. In this retrospective study, paraffin wax-embedded testicles with neoplastic changes from 52 rabbits were investigated. Five out of 52 animals exhibited more than one tumour type, resulting in a total of 57 tumours. Granular cell tumours were the most prevalent neoplasm with 36 examples (63%) out of the 57 testicular tumours. Interstitial cell tumours, Sertoli cell tumours and seminomas occurred less frequently. Granular cell tumours of the testis are rare in rabbits. Histological similarities between granular cell and interstitial cell (Leydig cell) tumours in haematoxylin and eosin-stained tissue sections may lead to misdiagnoses. The periodic acid-Schiff reaction or immunohistochemistry for periaxin and S100 protein, as well as ultrastructural analysis, are useful methods to confirm the diagnosis.

Background/purpose Pediatric testicular tumors are rare, constituting only 1% of all pediatric solid tumors. Single-institution studies addressing pediatric testicular tumors published to date have been limited in the number of patients. Methods We utilized the National Cancer Data Base (1998–2012) to review all prepubescent patients (≤12 years old) with testicular neoplasms. Demographics, tumor characteristics, treatment modalities, and outcomes were abstracted. Results A total of 479 patients were identified, with a median age of 3 years (IQR 0–4) at diagnosis. 67% of cases were diagnosed by 3 years of age. Yolk sac tumors were the most common histology (202 patients, 42.2%). Most tumors were diagnosed at a low stage. Resection was performed in 465 boys, with 75% having undergone radical orchiectomies. Chemotherapy was utilized in 28% of cases and radiotherapy in 7%. With mean follow-up of 5.6 years, mortality rate was 3%. No difference in mortality was noted based on histology or extent of surgical resection. Conclusions This series of prepubertal testicular tumors is the largest yet reported and highlights the patient demographics, tumor characteristics, treatment modalities and outcomes for these tumors. Type of study Prognosis study Level of evidence II.

Accurate diagnosis of primary and metastatic tumours is essential in testicular cancer. While many cases are straightforward, some pose difficulties, especially when variant morphologies occur. Seminoma with 'atypical' features, including increased nuclear pleomorphism and crowding and greater cytoplasmic density with loss of membrane definition, mimics embryonal carcinoma, although ancillary features (fibrous septa, lymphocytes) and immunohistochemistry are of great help. Other deceptive seminoma features include prominent to exclusive intertubular growth, microcystic/tubular patterns, and signet-ring tumour cells. Conversely, embryonal carcinomas may have 'seminoma-like' foci, as may Sertoli cell tumours with diffuse growth and pale cytoplasm. Solid pattern yolk sac tumour mimics seminoma and, conversely, microcytic seminoma resembles yolk sac tumour. Other architectural patterns, ancillary yolk sac tumour features (intercellular basement membrane deposits, hyaline cytoplasmic globules) and immunohistochemistry aid in distinction from seminoma. Embryonal carcinomas may show, in addition to 'seminoma-like' foci, pseudoendodermal sinus-like structures, sieve-like patterns, endometrioid-like morphology and prominent zones of stratified columnar tumour cells. These may cause confusion with yolk sac tumour and teratoma, although careful attention to cytological features usually suffices for accurate diagnosis. Recent work has defined 'new' primary trophoblastic tumours, i.e., cystic trophoblastic tumour and epithelioid trophoblastic tumour. The newly termed 'spermatocytic tumour' occasionally consists mostly of a monotonous proliferation of intermediate-sized tumour cells with prominent nucleoli, thereby simulating either seminoma or embryonal carcinoma. Prostatic adenocarcinoma remains the most common tumour to metastasise to the testis and can cause confusion with rete carcinomas and primary germ cell tumours. Post-chemotherapy resections pose their own challenges. Effete tumour cells in areas of necrosis and prominent fibroxanthomatous reactions should not be interpreted as persistent, viable germ cell tumour. 'Fibrosis' often has atypical widely scattered spindle tumour cells in a densely collagenous background but does not merit additional treatment apart from excision. The marked cytological atypia that may occur in metastatic teratoma may be disconcerting but, again, the proper treatment is complete surgical excision rather than more chemotherapy. Glandular and sarcomatoid yolk sac tumours, which are almost exclusively seen after chemotherapy, resemble adenocarcinomas and sarcomas, respectively. Unlike de novo malignancies, they are mostly seen in sites expected for metastases.

Background Patients on surveillance for clinical stage I (CSI) testicular cancer are counseled regarding their baseline risk of relapse. The conditional risk of relapse (cRR), which provides prognostic information on patients who have survived for a period of time without relapse, have not been determined for CSI testicular cancer. Objective To determine cRR in CSI testicular cancer. Design, setting, and participants We reviewed 1239 patients with CSI testicular cancer managed with surveillance at a tertiary academic centre between 1980 and 2014. Outcome measurements and statistical analysis cRR estimates were calculated using the Kaplan-Meier method. We stratified patients according to validated risk factors for relapse. We used linear regression to determine cRR trends over time. Results and limitations At orchiectomy, the risk of relapse within 5 yr was 42.4%, 17.3%, 20.3%, and 12.2% among patients with high-risk nonseminomatous germ cell tumor (NSGCT), low-risk NSGCT, seminoma with tumor size ≥3cm, and seminoma with tumor size Conclusions After 2 yr, the risk of relapse on surveillance for CSI testicular cancer is very low. Consideration should be given to adapting surveillance protocols to individualized risk of relapse based on cRR as opposed to static protocols based on baseline factors. This strategy could reduce the intensity of follow-up for the majority of patients. Patient summary Our study is the first to provide data on the future risk of relapse during surveillance for clinical stage I testicular cancer, given a patient has been without relapse for a specified period of time.

Highlights • MB reduces DWIBS scan time which can be reinvested in respiratory compensation. • MB enables respiratory trigger in DWIBS while maintaining low acquisition time. • MB enables very fast DWIBS sequences that still produce acceptable image quality., Purpose To prospectively compare artefacts and image quality in testicular stage I cancer patients using different combinations of breathing schemes and Multi-band (MB) in whole-body DWIBS at 1.5 T. Diffusion-Weighted whole-body Imaging with Background body signal Suppression (DWIBS) using inversion recovery (IR) fat saturation is a cornerstone in oncologic whole-body MRI, but implementation is restrained by long acquisition times. The new Multi-Band (MB) technique reduces scan time which can be reinvested in respiratory compensation. Methods Thirty testicular cancer stage I patients were included. Three variations of whole-body DWIBS were tested: Standard free Breathing (FB)-DWIBS, FB-MB-DWIBS and Respiratory triggered (RT)-MB-DWIBS. Artefacts and image quality of b = 800 s/mm2 images were evaluated using a Likert scale. No pathology was revealed. SNR was calculated in a healthy volunteer. Results RT-MB-DWIBS was rated significantly better than FB-DWIBS in the thorax (p < 0.001) and abdomen (p < 0.001), but not in the pelvis (p = 0.569). FB-MB-DWIBS was ranked significantly lower than both FB-DWIBS (p < 0.001) and RT-MB-DWIBS (p < 0.001) at all locations. However, FB-MB-DWIBS was scanned in half the time without being less than “satisfactory”. Few artefacts were encountered. SNR was similar for low-intensity tissues, but the SNR in high-intensity and respiratory-prone tissue (spleen) was slightly lower for FB-DWIBS than the other sequences. Conclusion Images produced by the sequences were similar. MB enables the use of respiratory trigger or can be used to produce very fast free-breathing DWI with acceptable image quality.

Introduction It is essential to see if MRI can be used as an alternative to CT for the detection of retroperitoneal lymphadenopathy in patients with testicular neoplasms. By doing so, the amount of radiation received by these young patients might be reduced. Material and methods A systematic literature review was carried out in 5 databases between January 1984 until December 2020. The articles included were randomized and non-randomized clinical trials, cross-sectional studies, cohort, case and control, and retrospective studies that compare the accuracy of MRI against CT to detect retroperitoneal lymph nodes in patients with testicular neoplasms. Results The search string initially retrieved 222 non duplicated papers from which a total of 3 studies of diagnostic accuracy were included for analysis. These articles evaluated a total of 127 patients with testicular neoplasm; the sample size per study ranged from 25 to 52 patients, with a mean age between 29–34 years. MRI presented a sensitivity ranging from 98−80% and specificity of 100 % when read by an experienced radiologist. However, when it was read by a radiologist with 1 year of experience, the sensitivity dropped to 78 % and specificity to 91%. Conclusion This systematic literature review shows a knowledge gap since not much has been published regarding this topic; therefore, randomized clinical trials are mandatory. Research on when to use MRI over CT is necessary to reduce radiation exposure. The authors strongly suggest that readers start researching on this subject.

We hypothesized that cold ischemia during partial orchiectomy would lead to higher serum testosterone levels and preservation of testicular architecture than warm ischemia in a prepubescent rat model.Eighteen prepubescent male Sprague-Dawley rats were randomized to three different surgical groups: sham surgery, bilateral partial orchiectomy with 30 min of cord compression with cold ischemia, or bilateral partial orchiectomy with 30 min of cord compression with warm ischemia. Animals were killed at puberty, and serum, sperm, and testicles were collected. Histological tissue injury was graded by standardized methodology.Mean serum testosterone levels were 1445 ± 590 pg/mL for the sham group, 449 ± 268 pg/mL for the cold ischemia group and 879 ± 631 pg/mL for the warm ischemia group (p = 0.12). Mean sperm counts were 2.1 × 10(7) for sham, 4.4 × 10(6) for cold ischemia, and 9.9 × 10(6) for the warm ischemia groups (p = 0.48). Histological evaluation revealed significant difference in tissue injury grading with more injury in the cold ischemia than in the warm ischemia group (p = 0.01).In our preclinical rat model, we found no benefit for cold ischemia over warm ischemia at 30 min.

Backgrounds Incidence of secondary malignancies and cardiovascular diseases among testicular germ cell tumor (TGCT) survivors is higher compared to the general population. We sought to describe the rates of other-cancer (OCM), non-cancer related (NCRM), and cancer-specific mortality (CSM) among men with TGCT. Methods Using the Surveillance, Epidemiology, and End Results (SEER) database, 31,330 patients with a primary diagnosis of TGCT between 1973 and 2009 were identified. The primary endpoints comprised of 15-year CSM, OCM, and NCRM rates. Survival rates were stratified according to histology (seminoma vs. non-seminoma), median age (

Testicular teratoma typically consists of heterogeneous mixtures of diverse epithelial and stromal components. The biological nature and genetic characteristics of the fibrous stroma of testicular teratomas have not been thoroughly investigated. Chromosome 12p abnormalities are the hallmark genetic alterations of germ cell tumors. We studied chromosome 12p abnormalities in the fibrous stroma and other components of pure testicular teratomas from 32 patients using interphase fluorescence in situ hybridization. Overall, 72% (23/32) of pure testicular teratomas had chromosome 12p abnormalities. Isochromosome 12p or 12p overrepresentation independent of isochromosome 12p was detected in the fibrous stroma in 53% (17/32) and 41% (13/32) of cases, respectively. Among the 17 cases positive for isochromosome 12p, 8 (47%) also had 12p overrepresentation. In 31% (10/32) cases, the fibrous stroma showed neither 12p overrepresentation nor isochromosome 12p. Isochromosome 12p and 12p overrepresentation were identified, respectively, in the gastrointestinal-type epithelium of 14/23 (61%) and 15/23 (65%) cases; in the respiratory-type epithelium of 41% (7/17) and 41% (7/17) cases; in the squamous epithelium of 62% (8/13) and 54% (7/13) cases; and in the cartilage of 63% (5/8) and 38% (3/8) cases. Concordant chromosomal 12p abnormalities were observed between the fibrous stroma and epithelial elements of testicular teratomas. Our results indicate that the fibrous stroma of testicular teratomas frequently has genetic abnormalities similar to those of the epithelial components. Concordant chromosome 12p alterations between the fibrous stroma and epithelial elements provide further evidence that both epithelial and fibrous components of teratoma are derived from a common progenitor.

Background Testicular cancer (TC) is one of the most curable cancers. Given survival rates of close to 100% with appropriate therapy, ensuring proper treatment is essential. We reviewed and summarized the literature on the association of socioeconomic position (SEP) along the cancer control spectrum from risk factors to survivorship. Methods We searched PubMed from 1966 to 2011 using the following terms: testicular cancer, testicular neoplasm, poverty, and socioeconomic factors, retrieving 119 papers. After excluding papers for the non-English (10) language and non-relevance (46), we reviewed 63 papers. We abstracted information on socioeconomic position (SEP), including occupation, education, income, and combinations of the 3. Five areas were examined: risk factors, diagnosis, treatment, survival, and survivorship. Results Most studies examined area-based measures, not individual measures of SEP. The majority of studies found an increased risk of developing TC with high SEP though recent papers have indicated increased risk in low-income populations. Regarding diagnosis, recent papers have indicated that lower levels of education and SEP are risk factors for later-stage TC diagnosis and hence higher TC mortality. For treatment, 1 study that examined the use of radiation therapy (RT) in stage I seminoma reported that living in a county with lower educational attainment led to lower use of RT. For survival (mortality), several studies found that men living in lower SEP geographic areas experience lower survival and higher mortality. Conclusion The strongest evidence for SEP impact on testicular germ cell tumor (TGCT) was found for the risk of developing cancer as well as survival. The association of SEP with TGCT risk appears to have changed over the last decade. Given the highly curable nature of TGCT, more research is needed to understand how SEP impacts diagnosis and treatment for TGCT and to design interventions to address disparities in TGCT outcomes and SEP.

The most common neoplasms of the male genital tract are tumours of the testis and prostate. Testicular germ cell tumours are particularly important because they affect young men and even the advanced stages have a high rate of cure. The WHO classification emphasizes the recognition of seminoma and individual non-seminomatous germ cell tumour patterns. Included in this group are the embryonal carcinoma, yolk sac tumour, trophoblastic tumour and teratoma. Many of the tumours are combined, containing more than one tumour component. It is important to differentiate between embryonal carcinoma and a high-grade variant of seminoma, or distinguish a malignant change in a teratomatous deposit from one of the patterns of high-grade germ cell tumours. The WHO classification also emphasizes the recognition of various yolk sac tumour patterns. Non-germ cell tumours of testis are uncommon, but it is important to recognize sex cord stromal tumours and differentiate them from germ cell tumours. The sex cord stromal tumours include Leydig cell tumours, Sertoli cell tumours, Granulosa cell tumours and tumours of the the coma/fibroma group. Malignant lymphoma is the most common amongst haematopoietic tumours occurring in the testis. Prostate cancer is the most common malignancy in elderly men in the UK. The use of needle biopsy of prostate has improved early diagnosis, but creates difficulty in interpretation. High-grade prostate intraepithelial neoplasia is a clinically significant finding requiring intervention. Prostate adenocarcinoma is graded by the Gleason scoring system.

Objective: Testicular biopsy has recently gained a role in early detection of testicular cancer. However, its use is still limited mainly because of the fear of untoward consequences. There is a paucity of data regarding unfavourable effects of testicular biopsy. Therefore, we systematically looked to the consequences of the procedure by using clinical observational methods and by modern imaging techniques, respectively. Patients, methods: 1874 patients with testicular cancer enrolled in a nation-wide contralateral biopsy study were prospectively analyzed in regard to surgical complications. Serial scrotal imaging was performed by scrotal sonography (7.5Mhz) in 55 patients and by magnetic resonance tomography (1.5 Tesla machine, surface coil, contrast media) in 60 patients, respectively. Imaging examinations were done preoperatively and again at 1 week, 6 months, 12 months, and 18 months respectively. Imaging results were tabulated according to an abnormality score and analyzed by descriptive statistics. Results: 52 patients (2.78%; 95% confidence intervals 2.05–3.60) experienced surgical complications. Forty minor complications were managed conservatively. Twelve patients (0.64%) required repeat surgery; 1 testicle was ultimately lost following a sequence of unfortunate events. No pre-existing clinical parameter was associated with complications. One week after surgery, abnormalities were detected in 33% by sonography and in 45% by MRI, respectively. Importantly, the abnormalities resolved in 96% of the cases, as found in both of the imaging modalities in the serial scans. Conclusions: Testicular biopsy is associated with a low burden of clinically significant complications. However, scrotal imaging discloses intratesticular abnormalities in a high proportion of cases one week after the biopsy. These changes represent focal haematoma, oedema or circumscript injury to vascular supply. Most of these lesions resolve with time and are thus not significant, clinically. Evidently, testicular biopsy is a safe procedure provided the vascular anatomy of the testis is respected upon surgery.

Splenogonadal fusion is a rare congenital anomaly in which there is fusion of the spleen and the gonad or mesonephric derivatives. To date, approximately 150 cases have been reported since the condition was first described by Bostroem in 1883 (Bostroem E. Demonstration eines Praparates von Verwachsung der Milz mit dem lenken Hoden. Gesellschaft deutscher Naturforscher und Aerzte, Verhandlungen der 56 Versammlung, Freiburg; 1883. p. 149). Very few cases have been diagnosed preoperatively, and many cases presenting as a testicular swelling underwent an unnecessary orchiectomy with the suspicion of a testicular neoplasm. A case is presented and the related literature is reviewed.

Tubular ectasia of rete testis is a rare benign condition often confused with testicular neoplasm. Though not thought of clinically, it is usually an incidental finding on ultrasound. Here, we report a case of bilateral rete testis associated with multiple epididymal cysts in otherwise normal patients.

Testicular intraepithelial neoplasia (TIN; or carcinoma in situ of the testis) is the precursor of testicular germ-cell tumours (GCT). It is detected by conventional surgical biopsy of the testis. To date, only little information is available in regard to the accuracy of the biopsy. False-negative biopsies have been reported only sporadically.Twenty-one patients who developed a testicular GCT despite a testicular biopsy negative for TIN were analysed clinically and histologically. The median age of the patients is 34 years. The median interval from biopsy to the clinical appearance of GCT is 39 months. Four of the 21 patients had their biopsy done within a previously reported multicentric study (n=1859 cases with negative biopsy including five cases with false-negative biopsy hitherto known). All of the biopsy specimens were re-examined immunohistologically. In 15 cases, the orchiectomy specimens were re-examined for the presence of TIN in the tumour-surrounding tissue.In five cases, TIN was found in the biopsy specimen upon re-examination. In all of the 15 orchiectomy specimens there was evidence of TIN in the tissue adjacent to the tumour. In three biopsy specimens there were microcalcifications in the seminiferous tubules. Severe impairment of the spermatogenesis was observed histologically in only 3 of the 21 patients. The relative proportion of false-negative biopsies is 0.5% (95% confidence intervals (CI): 0.22%; 0.92%). The sensitivity of the biopsy to detect TIN is 0.914 (95% CI: 0.842; 0.959) and the overall accuracy is 0.995 (95% CI: 0.991; 0.9979). A total of 44 false-negative biopsies are reported to date.False-negative biopsies for TIN do occur but the proportion is only 0.5%. There is no clear-cut clinical nor histological feature associated with false-negative biopsies. However, young age (i.e.18 years) and intratubular microcalcifications should increase the clinician's and pathologist's vigilance. The majority of false-negative biopsies are caused by the non-random distribution of TIN in the testis while some few cases are caused by technical problems. Two-site biopsies would probably increase the accuracy of the biopsy in high risk cases.

We report the case of a 20-year old male with a right testicular tumor. Bilateral orchidectomy was practised considering the synchronous clinical, ultrasonographical and histological (intraoperative biopsy) findings of the left testis. The definitive pathological report showed a right embryonal carcinoma with wide intratubular germ cell neoplasia (IGCN) of the contralateral testis. IGCN (formerly carcinoma in situ) is present in about 5% of cases in the contralateral gonad of those patients with a testicular neoplasm. More than 50% will develop cancer in that testis. Clinical and physical examination findings are usually unspecific. The diagnosis of IGCN is based on biopsy, although ultrasonography could give some data too, as some authors report. We analyze the therapy options for IGCN: (orchidectomy, chemotherapy, radiotherapy, or "wait and see"). In our case, the first one was made. Chemotherapy was used due to existence of retroperitoneal lymph node metastases, with an excellent follow-up afterwards.

The assessment of risk in testicular cancer can be applied to different situations—the risk for the development of a testicular neoplasm, the risk for metastasis in patients with an established tumor, and the risk for recurrence following treatment. Pathologic assessment provides some insight into the levels of these various risks in all of these contexts.

Testicular tumour is the most common neoplasm in males between ages 15 and 34 years with metastatic disease thought to be as high as 4–14% at presentation. On the contrary, primary extragonadal germ cell tumour (EGCT) is a rare disease, accounting for only 1–4% of all germ cell tumours. Differentiation between the primary and the secondary germ cell tumour can be challenging, as testicular tumour often regress or burn-out and can emerge unexpectedly many years later. We report on a case of retroperitoneal extragonadal metastatic germ cell tumour who presented with backache after a seemingly sports related injury.

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.

At the time of initial diagnosis, testicular malignancy is usually limited to the testicle and infradiaphragmatic lymph nodes. Metastases initially follow the retroperitoneal lymph channels and subsequently extend to the supradiphragmatic lymph nodes in the mediastinum and supraclavicular fossa. Testicular metastases to the pericardium are rare and usually asymptomatic. These lesions are most commonly identified at autopsy; therefore, the actual incidence is unknown. The authors report a 32-year- old man with testicular carcinoma, who developed asymptomatic pericardial metastases without concomitant supradiaphragmatic nodal or pulmonary metastases. They review the efficacy of echocardiography in diagnosis and follow up or pericardial metastasis.

Objective To suggest a reasonable consideration to avoid the maltreatment of splenogonadal fusion. Methods A 6-year-old male patient (Case 1) underwent unilateral orchiectomy for a suspected tumor of the testis. A 12-year-old male patient (Case 2) underwent bilateral groin exploration and urethroplasty. Postoperative abdominal magnetic resonance imaging revealed an oval-shaped mass in the lower pole of the left kidney and no abnormalities in the spleen. Laparoscopy was considered. Results In Case 1, a red mass was found in the upper pole of the testis; the mass occupied one-third of the testis volume. No connection with the cord was found. In Case 2, a red testis-like mass in the lower pole of the left kidney was found and resected. Orchidopexy was performed for the right testis. Postoperative pathology confirmed splenogonadal fusion. Conclusion Splenogonadal fusion is a rare congenital abnormality. Most patients undergo unnecessary orchiectomy because of suspicion of a primary testicular neoplasm. Common imaging examinations, negative serologic examinations, and 99mTc-sulphur colloid liver-spleen scans can help to achieve a diagnosis. Careful review of the chronicity of the lesion may suggest a benign growth.

"TESTICULAR ADRENAL REST TISSUE HYPERPLASIA: AN UNUSUAL CAUSE OF MALE INFERTILITY" We report the case of a 37-year-old man with infertility caused by bilateral testicular masses secondary to congenital adrenal hyperplasia (21-hydroxylase deficiency). Testicular biopsy was done and its was initially interpreted as Leydig cell tumor but after clinical information was histologically reclassified as tumor of the adrenogenital syndrome. The differential diagnosis with Leydig cell tumor is discussed and it must be established through the clinical, biochemical, radiological and pathological features.

Non-Leydig cell gonadal stromal tumors of the testis are rare and most are benign. Criteria for determining malignancy are poorly defined. A gonadal stromal tumor of spindle fibroblastic cells presented in a 34 year old male. The patient remains alive and well with no evidence of metastasis 3 years following surgery. Light and electron microscopical features of the tumor are described.

Classical seminoma is the most commonly encountered testicular neoplasm. Most clinically localised seminomas are now managed by surveillance, though adjuvant chemo or radiotherapy can be given. The diagnosis of seminoma can be relatively straightforward, but may present unforseen challenges leading to inappropriate treatment or serious misdiagnosis in a number of ways. 1) Thorough macroscopy. Seminomas require rigorous blocking. This is because tiny amounts of non-seminoma may be missed, leading to potential under-treatment. Inflammatory lesions and granulomatous lesions may also harbour small foci of seminoma and should be treated with suspicion. 2) Unusual histological patterns. Some seminomas show unusual features. They may show frequent syncytiotrophoblastic cells leading to misdiagnosis as choriocarcinoma. A minority show tubular elements or even signet ring change. 3) Mimicks. Solid type yolk sac tumour may mimic seminoma as well as a number of other entities, especially some malignant sex cord stromal tumours. The former should be considered for adjuvant treatment, while the latter may require a prophylactic retroperitoneal lymph node dissection. Spermatocytic seminoma, especially when monomorphic may be mistaken for seminoma. Close morphological inspection allied to to judicious use of immunochemistry and knowledge of clinical details including serology is essential for the accurate diagnosis of seminoma.

We report a case of a small, intratesticular, incidentally identified, nonpalpable Leydig-cell tumor in which preoperative, dynamic, contrast-enhanced MRI was essential in characterizing the lesion as a neoplasm. Sonographic evaluation failed to demonstrate internal color Doppler flow, resulting in a differential diagnosis that included debris-filled cyst. At surgical resection, intraoperative ultrasound was essential to locate the mass and confirm complete removal. This case highlights the value of dynamic, contrast-enhanced MRI and intraoperative ultrasound for the management of incidental intratesticular lesions with indeterminate sonographic and Doppler characterization. Radiologists and urologists should be familiar with this approach to the incidental, sonographically indeterminate, nonpalpable intratesticular lesion identified on scrotal ultrasound.

Polyarteritis nodosa is a systemic vasculitis characterized by segmental necrotizing lesions of medium and small-size arteries. Rarely, the inflammatory process is isolated and involves a single organ without systemic manifestations. We describe a patient with isolated polyarteritis nodosa of the testis who presented with a testicular mass mimicking primary testicular tumor. The postoperative laboratory evaluation was negative. Long-term follow-up, without systemic treatment, showed no evidence of recurrence in the remainder of the testis or development of systemic vasculitis.

Localized testicular infarction appears to represent a relatively uncommon phenomenon. We describe a patient presenting with a testicular mass simulating a neoplasm, who proved to have a localized hemorrhagic infarction.

The hypothalamic-pituitary-testicular axis finely regulates levels of circulating sex steroids--especially testosterone and estradiol--and spermatogenesis. Testosterone, directly as an androgen and as a prehormone for estradiol, regulates LH secretion at both hypothalamic and pituitary levels. Leydig cells, principally under the control of LH, produce testosterone. Sertoli cells, under the control of FSH, and sensitive to intratesticular levels of testosterone, produce estradiol. This locally produced estrogen seems to be necessary for maturation of the germ cells. An abnormality in this sensitive control system, leading to elevations in gonadotrophins or steroid levels, may be etiologically important in both germ cell and nongerm cell neoplasia. Testicular cancers are associated frequently with endocrinologic manifestations, which may be more disabling to the patient than the malignant potential of the tumor, especially with childhood Leydig cell tumors. Estrogen dominance with an elevated estrogen/testosterone ratio can be seen in any testicular neoplasm and may result in gynecomastia. It may be due to a decrease in circulating testosterone or to an increase in estrogens. Virilization is seen frequently in Leydig cell tumors of adolescents. Further elucidation of hormonal interrelationships should lead to better understanding of the genesis of testicular neoplasia and to more effective therapy.

Fifty-one patients with malignant lymphoma presenting in the testis are reported. The tumours were all diffuse non-Hodgkin's lymphoma. Eight patients had bilateral involvement. Fifty-three per cent of patients had evidence of spread beyond the testis at presentation and 75% at some time. The actuarial survival for all patients was 20% and for patients with disease apparently confined to the testis 40%. There was a survival advantage for patients with right sided tumours and lymphocytic histology. Chemotherapy using the VAP regime followed by radiotherapy to sites of bulky disease is recommended for patients with evidence of spread at presentation. For patients with disease apparently confined to the testis it is suggested that consideration should be given to adjuvant chemotherapy following radiotherapy to the abdominal nodes and scrotum

Thirty-five testicular neoplasms diagnosed over a twenty-year period in Nigerian children up to the age of twenty years were analyzed. Burkitt lymphoma was the most common cause of testicular neoplasm, while germ cell tumors formed the bulk of non-Burkitt neoplasia (72 per cent). Shortage of testicular germ cell tumors in adult males may account for the over-all low frequency of tumors of the testis in Nigerian Africans.

A nineteen-year retrospective study of the usefulness of liver scanning in the staging evaluation of germinal cell testicular neoplasms was undertaken at the National Naval Medical Center. Of 94 patients, 90 (96 per cent) demonstrated accurate correlation between liver scan and histopathologic diagnosis.

A twenty-nine-year-old black male presented with a testicular mass and hilar adenopathy. Histologic sections of the testis showed the 3 by 2 by 2-cm mass was an inflammatory granuloma due to sarcoidosis. The epididymides were involved bilaterally. The initial differential diagnosis included: sarcoidosis, testicular neoplasm, an infectious process, or a combination of the three. Biopsy of the testicle is recommended to confirm the diagnosis of sarcoidosis. We believe there are only 6 reported cases of clinically detected testicular sarcoidosis.

Two sets of testicular tumors involving nontwin siblings are reported. The possibility of dysgenesis and dysgonesis and the totipotentiality of the cells in the pathogenesis of these tumors are described and discussed.