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Key Clinical Message: Early diagnosis and aggressive treatment of testicular rhabdomyosarcomas including surgery and chemotherapy significantly reduce local recurrence and improve survival rates in young adults with metastases. Adjuvant chemotherapy is highly recommended to enhances prognosis and survival outcomes. [ABSTRACT FROM AUTHOR]

Abstract Background Testicular metastasis from malignant solid tumors is extremely rare. It is usually found by chance during autopsy or pathological examination of testicular specimens. Therefore, we consider it necessary to report our patient’s case of testicular metastasis from colon cancer. Case presentation We report a 61-year-old Han Chinese male patient who presented to our clinic with progressive painless swelling of the right testicle for 2 years. Positron emission tomography–computed tomography scans showed increased 18F-fluorodeoxyglucose metabolism in the right testicle, possibly owing to distant metastasis. His previous medical history suggested that he had undergone laparoscopic-assisted right hemicolectomy for ascending colon cancer 4 years ago. Considering the ascending colon cancer metastasis to the right testicle, we performed a right radical testicular resection through an inguinal approach. Postoperative histological examination showed intestinal metastatic adenocarcinoma. Conclusion Colon cancer metastasis to the testes is uncommon. The clinical and imaging manifestations of this tumor are nonspecific, so the diagnosis relies on postoperative pathology. If testicular metastasis is found, treatment principles for advanced colon cancer should be followed.

Background: Testicular metastasis from malignant solid tumors is extremely rare. It is usually found by chance during autopsy or pathological examination of testicular specimens. Therefore, we consider it necessary to report our patient's case of testicular metastasis from colon cancer. Case presentation: We report a 61-year-old Han Chinese male patient who presented to our clinic with progressive painless swelling of the right testicle for 2 years. Positron emission tomography–computed tomography scans showed increased 18F-fluorodeoxyglucose metabolism in the right testicle, possibly owing to distant metastasis. His previous medical history suggested that he had undergone laparoscopic-assisted right hemicolectomy for ascending colon cancer 4 years ago. Considering the ascending colon cancer metastasis to the right testicle, we performed a right radical testicular resection through an inguinal approach. Postoperative histological examination showed intestinal metastatic adenocarcinoma. Conclusion: Colon cancer metastasis to the testes is uncommon. The clinical and imaging manifestations of this tumor are nonspecific, so the diagnosis relies on postoperative pathology. If testicular metastasis is found, treatment principles for advanced colon cancer should be followed. [ABSTRACT FROM AUTHOR]

Key Clinical Message Early diagnosis and aggressive treatment of testicular rhabdomyosarcomas including surgery and chemotherapy significantly reduce local recurrence and improve survival rates in young adults with metastases. Adjuvant chemotherapy is highly recommended to enhances prognosis and survival outcomes.

Bilateral testicular tumors account for 1 to 5% of all testicular tumors. Most bilateral tumors are observed metachronously. Synchronous tumors usually present with the similar histological pattern. Bilateral synchronous testicular tumors with discordant pathology are extremely rare. Only 56 cases have been documented since Bidard first described synchronous testicular tumors with discordant pathology in 1853. To our best knowledge, this study will be the 57th case in the literature.

The authors present a case report of an unusual occurence of mucinous adenocarcinoma metastasis of the colon in the testis of a patient. [ABSTRACT FROM AUTHOR]

The occurrence of synchronous bilateral testicular germ cell tumors (BTGCTs) of different pathologic histologic types in pediatric patients is rare. We reported a case of a left testicular yolk sac tumor (YST) combined with a right testicular mature teratoma. Left orchiectomy and right testis-sparing surgery were performed. Retroperitoneal recurrence was noted 6 months after surgery. The patient underwent reoperation for the resection of a retroperitoneal mass, which was pathologically diagnosed as a recurrent YST. A full cycle of chemotherapy was then administered. No tumor metastasis or recurrence has yet been detected. We present this new case, and we review the previous literature on synchronous BTGCTs to explore the clinicopathologic features and summarize the diagnostic and therapeutic experience. Radical orchiectomy, as the standard treatment for YSTs, should be considered with caution in patients with bilateral testicular tumors. Rapid intraoperative frozen pathology provides support for timely surgical planning. In patients with intraoperative frozen pathologic specimens suggestive of benign lesions, testis-sparing surgery is the preferred treatment option.

Key Clinical Message: The case of a 44‐year‐old male with signet‐ring cell adenocarcinoma metastasis in the testis emphasizes the significance of immunohistochemistry in identifying the primary site of metastatic tumors. Further research is needed to establish effective treatment strategies for rare malignancies like small intestine signet‐ring cell carcinoma. Early diagnosis and appropriate treatment are crucial for improved patient outcomes. Metastasis to the testes is a rare occurrence, and identifying the primary site of origin can pose a significant challenge. Signet‐ring cell carcinoma (SRCC) is an uncommon subtype of adenocarcinoma typically found in the stomach but can also occur in other organs. This case report presents a 44‐year‐old male with signet‐ring cell adenocarcinoma metastasis in the right testis. The patient's initial clinical manifestation was testicular painful swelling, and subsequent immunohistochemical analysis using CK7, CK20, and CDX2 markers suggested a gastrointestinal origin. Normal upper and lower endoscopies rise suspicion of a small intestinal origin. The rarity of SRCC of the small intestine and the lack of clinical trials make treatment decisions difficult. This case highlights the importance of immunohistochemistry in determining the primary site of metastatic tumors and underscores the need for further research to establish optimal treatment strategies for rare malignancies like SRCC of the small intestine. As early diagnosis and appropriate treatment are critical for better patient outcomes. [ABSTRACT FROM AUTHOR]

Paratesticular liposarcoma (PLS) causes scrotal mass changes, rarely in the urinary system. Before surgery, PLS causes scrotal mass changes that are difficult to distinguish from other causes. There has been a report of a giant paratestis liposarcoma resection and refusal to undergo orchiectomy. A 65-yearold man presented with finding the left scrotal mass after 2 years. Physical examination showed that the left scrotal mass was obviously difficult to retract. Pelvic CT showed that the left scrotal mass and flaky fat density shadow accompanied with left inguinal hernia. During surgery, laparoscopic exploration was performed to rule out inguinal hernia, and a scrotal exploration was also performed concurrently. The intraoperative frozen pathology considered lipogenic tumor, and the patient's wife refused to undergo simultaneous left radical orchiectomy. Later the mass was completely removed, and postoperative pathology confirmed paratestis liposarcoma. During a 15-month routine follow-up, the tumor did not recur locally or metastasize distantly. PLS should be focused on early diagnosis and treatment, preoperative examinations and postoperative pathology should be combined, and highly personalized treatment will be implemented. [ABSTRACT FROM AUTHOR]

Key Clinical Message The case of a 44‐year‐old male with signet‐ring cell adenocarcinoma metastasis in the testis emphasizes the significance of immunohistochemistry in identifying the primary site of metastatic tumors. Further research is needed to establish effective treatment strategies for rare malignancies like small intestine signet‐ring cell carcinoma. Early diagnosis and appropriate treatment are crucial for improved patient outcomes. Abstract Metastasis to the testes is a rare occurrence, and identifying the primary site of origin can pose a significant challenge. Signet‐ring cell carcinoma (SRCC) is an uncommon subtype of adenocarcinoma typically found in the stomach but can also occur in other organs. This case report presents a 44‐year‐old male with signet‐ring cell adenocarcinoma metastasis in the right testis. The patient's initial clinical manifestation was testicular painful swelling, and subsequent immunohistochemical analysis using CK7, CK20, and CDX2 markers suggested a gastrointestinal origin. Normal upper and lower endoscopies rise suspicion of a small intestinal origin. The rarity of SRCC of the small intestine and the lack of clinical trials make treatment decisions difficult. This case highlights the importance of immunohistochemistry in determining the primary site of metastatic tumors and underscores the need for further research to establish optimal treatment strategies for rare malignancies like SRCC of the small intestine. As early diagnosis and appropriate treatment are critical for better patient outcomes.

Objective:In our study, we retrospectively analyzed the pathology results of radical orchiectomy operations performed in our clinic and to correlate preoperative color Doppler ultrasonography (CDUSG) findings with small-testicular masses (SmTM) with negative serum tumor markers (STM).Materials and Methods:Male patients (n=98) who underwent radical orchiectomy between January 2010 and January 2021 to treat intratesticular solid lesions that were detected via CDUSG were evaluated retrospectively. All patients were evaluated in terms of age, atrophic testis, echogenicity, size of tumoral lesions, testicular palpability, preoperative STM and postoperative pathology results.Results:Expression of at least one STM was elevated in 58 (59.2%) patients preoperatively. STM elevation continued to occur in 25 (25.5%) patients postoperatively; furthermore, 81 (82.7%) patients presented with malignant pathology. The mean age of patients was 39.47±15.20 years, whereas the mean age of patients with benign pathology was higher than patients with malignant pathology (p=0.008). The mean size of malignant lesions was significantly greater than that of benign lesions (5.4 vs 3.5 cm; p=0.033). Statistically elevated STM, lower age, heterogeneity in CDUSG, and large lesion size were found as parameters predicting malignancy. Although lesions in 9 (45%) of 20 STM-negative patients with a lesion smaller than 3 cm were benign, benign pathology was detected in 6 (75%) of 8 STM-negative patients with a lesion smaller than 1.5 cm.Conclusion:CDUSG plays an important role in detecting small non-palpable masses. Especially in STM-negative patients with a SmTM, CDUSG can reasonably guide the decision-making phase although it cannot provide definitive diagnosis. Radical orchiectomy, which is the traditional approach for all solid testicular lesions, leads to unnecessary treatment in patients with benign lesions, so testicular-sparing surgery should be preferred in STM-negative non-palpable SmTMs because the risk of cancer is low.

Objective: There is a need for additional predictive factors for the malignant/benign differentiation to prevent overtreatment in intratesticular mass lesions with negative tumor markers. In this study, we evaluated the usability of systemic inflammatory markers, neutrophil-to-lymphocyte ratio (NLR), and tumor in the preoperative differentiation of benign and malignant intratesticular mass lesions. Methods: The records of patients who underwent radical inguinal orchiectomy with a preliminary diagnosis of testicular tumor between August 2007 and September 2020 were retrospectively reviewed. Patients with a malignant specimen histopathology result after radical orchiectomy were classified as group 1, and those with a benign pathology result were classified as group 2. The demographic data, tumor diameters, preoperative systemic inflammatory markers, and NLRs were statistically compared between the two groups. NLR was calculated by dividing the neutrophil count by the lymphocyte count. Results: The study included a total of 78 patients, of whom 47 (60.3%) were in group 1 and 31 (39.7%) were in group 2. The mean tumor sizes of groups 1 and 2 were 3.74±2.24 cm and 1.87±1.30 cm, respectively, being significantly higher in group 1 (p<0.001). For groups 1 and 2, the mean white blood cell (WBC) counts were determined as 8.60±2.23 and 7.54±2.02 µ/L, respectively; the mean neutrophil counts as 5.30±1.77 and 4.34±1.40 µ/L, respectively; the mean neutrophil ratios as 63.0±8.22 and 56.9±7.28%, respectively; the mean lymphocyte ratios as 26.2±6.69 and 31.9±6.05%, respectively; and the mean NLR values as 2.72±1.44 and 1.87±0.54, respectively. The mean WBC count, neutrophil count, neutrophil ratio, and NLR were significantly higher in group 1 (p=0.037, p=0.014, p<0.001, and p=0.002, respectively), and the mean lymphocyte ratio was significantly higher in group 2 (p<0.001). The analysis of the pathological results showed that malignancy correlated positively with tumor size, WBC count, neutrophil count, neutrophil ratio, and NLR, and a negative correlation with the lymphocyte ratio. Conclusion: Tumor diameter, WBC count, neutrophil count, neutrophil ratio, lymphocyte ratio, and NLR can be used as predictive factors in the differentiation of benign-malignant intratesticular masses with negative testicular cancer markers before radical orchiectomy to prevent overtreatment. While the increased values of tumor diameter, WCB count, neutrophil count, neutrophil ratio, and NLR correlate with the possibility of malignancy, a decreased lymphocyte ratio can be evaluated in favor of malignancy. [ABSTRACT FROM AUTHOR]

Objective: In our study, we retrospectively analyzed the pathology results of radical orchiectomy operations performed in our clinic and to correlate preoperative color Doppler ultrasonography (CDUSG) findings with small-testicular masses (SmTM) with negative serum tumor markers (STM). Materials and Methods: Male patients (n=98) who underwent radical orchiectomy between January 2010 and January 2021 to treat intratesticular solid lesions that were detected via CDUSG were evaluated retrospectively. All patients were evaluated in terms of age, atrophic testis, echogenicity, size of tumoral lesions, testicular palpability, preoperative STM and postoperative pathology results. Results: Expression of at least one STM was elevated in 58 (59.2%) patients preoperatively. STM elevation continued to occur in 25 (25.5%) patients postoperatively; furthermore, 81 (82.7%) patients presented with malignant pathology. The mean age of patients was 39.47±15.20 years, whereas the mean age of patients with benign pathology was higher than patients with malignant pathology (p=0.008). The mean size of malignant lesions was significantly greater than that of benign lesions (5.4 vs 3.5 cm; p=0.033). Statistically elevated STM, lower age, heterogeneity in CDUSG, and large lesion size were found as parameters predicting malignancy. Although lesions in 9 (45%) of 20 STM-negative patients with a lesion smaller than 3 cm were benign, benign pathology was detected in 6 (75%) of 8 STM-negative patients with a lesion smaller than 1.5 cm. Conclusion: CDUSG plays an important role in detecting small non-palpable masses. Especially in STM-negative patients with a SmTM, CDUSG can reasonably guide the decision-making phase although it cannot provide definitive diagnosis. Radical orchiectomy, which is the traditional approach for all solid testicular lesions, leads to unnecessary treatment in patients with benign lesions, so testicular-sparing surgery should be preferred in STM-negative non-palpable SmTMs because the risk of cancer is low. [ABSTRACT FROM AUTHOR]

Epididymal leiomyosarcomas are rare malignant tumors of smooth muscle origin. We present a case of a low-grade tumor with negative margins managed with a high-radical inguinal orchiectomy. Our review of the literature suggests that low-grade and localized tumors with negative margins can be managed with simple epididymectomy and imaging surveillance. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the clinical presentation of testicular tumors and their histological pattern present in our setup. Study Design: Case series. Place and Duration of Study: Armed Forces Institute of Urology (AFIU) Rawalpindi, from Jul 2016 to Jun 2019. Methodology: The documents of all the cases of testicular tumors presenting in the last 3 years were retrieved and their relevant clinical detail: age, clinical presentation, side of involvement, operative procedure conducted and the histopathology report were documented. Results: Thirty two patients of testicular tumors were documented over a period of three years, making 10.66 cases reporting per year. The mean age was 30.10 ± 15.42 years, with the youngest 3 months old infant and the eldest being 58 years of age. The tumors were commonest on the right (59.3%) with 81.2% presentation as swelling of testis. Radical orchiectomy was performed in 90.6% of the cases and retro peritoneal lymph node dissection (RPLND) in 6.2%. Germ cell tumors were found in 71.8% cases with mixed germ cell tumorbeing the commonest histopathology seen in 31.2% of the cases followed by the seminoma (25%) and non-Hodgkin lymphoma (12.5%). Conclusion: Testicular tumors were relatively uncommon in our part of the world with a limited number of cases presenting to a tertiary care urology center. The presentation was variable but a rising trend in non-Hodgkin lymphoma results in a decrease in the overall number of germ cell tumors.

Objective: We aimed to evaluate the general knowledge and awareness of the patients about testicular cancer at admission,their adherence to follow-up period after the treatment and the factors that may affect this awareness in the patients who underwent radical orchiectomy due to diagnosis of testicular mass. We aimed to evaluate the factors that may affect overall survival by examining the complaints, demographic and clinical features of patients who underwent radical orchiectomy with a pre-diagnosis of testicular mass. Material and Methods: Between January 2010 and June 2018,demographic,clinical, pathological data and oncologic outcomes of 113 patients who underwent radical orchiectomy with a diagnosis of testicular mass were evaluated retrospectively.Reasons for admission to the doctor,the history of testicular canc er in himself and his relatives,the factors that led him to refer to the doctor, the rates of regular testicular self-examination during the pre-treatment and post-treatment period were recorded. Results: In 113 patients with a median age of 29 (ranged 17-60),the most common complaints were painless mass (%52.4), swelling (%10.6), history of testicular cancer in himself (%6.2) and his relatives (%7.1), his wife’s warning (%6.2).The patients having general knowledge about testicular cancer, university graduates, patients with enough income level, married individuals, patients with history of testicular cancer in himself and his relatives, performing regular testicular self-examination had the higher rates of early stage testicular germ cell tumor or benign pathology.History of testicular cancer in himself and his relatives,history of undescended testicle,low educational level,low income level,not to be married,no prior knowledge of testicular cancer,not performing regular testicular self-examination before diagnosis and during the follow-up period,advanced tumor stage, disrupt follow-up after treatment were found to be independent risk factors for decreased overall survival. Conclusion: We think that the history of testicular cancer, various social communication tools, higher education level and spouse awareness may increase the awareness of men about testicular cancer the likelihood of testicular masses’ being detected earlier.In this way, less toxic treatments can be administered since the increased tumor rates detected in the early stage, and also better oncologic outcomes can be achieved.

Liposarcoma of the spermatic cord is a malignant tumor so rare that there are less than 200 cases reported in the literature worldwide. Liposarcoma is a malignancy which originates from fat tissue. Although only 3%-7% of all paratesticular sarcomas primarily arise from structures of the spermatic cord, clinical significance of these tumors must not be neglected because they are often preoperatively misdiagnosed. A 66-year-old male presented with a painless swelling on the left side of the scrotum. Local examination revealed a solid, smooth, limited mass of approximately 4x3 cm in the left side of the scrotum. Tumor markers were within the reference range. Ultrasound examination showed a solid, clearly limited non-homogeneous mass of 40x20 mm localized in the left spermatic cord. Magnetic resonance imaging showed an expansive mass measuring 60x85x60 mm in the left inguinoscrotal region without propagation into the abdominal cavity. Both testicles and epididymides appeared normal on magnetic resonance examination and no locoregional enlarged lymph nodes were seen. The patient was treated operatively with radical inguinal orchiectomy. In conclusion, liposarcomas of the spermatic cord are extremely rare neoplasms that clinically present as slow-growing, painless, palpable inguinal or scrotal masses. Radical orchiectomy with high ligation of the spermatic cord and wide excision of the surrounding soft tissues within the inguinal canal remains the gold standard treatment option. Recurrence of the disease is frequent even several years after primary therapy, therefore long-term follow-up is mandatory.

A painless inguinal or scrotal tumor is a characteristic of the uncommon illness known as liposarcoma of the spermatic cord (LSC). We introduce a 40-year-old man who was hospitalized to the Surgery Department with indications of a right inguinal unilateral, painless, hard, firm mass that was slow-growing. Histopathology evaluation revealed a lipomatous neoplasm formed of lobules of fat cells of variable size having large nuclei with few showing nuclear indentation by vacules. The fat cells are separated by either loose myxoid stroma or fibrous stroma that shows atypical cells with large hyperchromatic nuclei. The mass is surrounded by an intact facia. The submitted membranes and fibrofatty tissues are free from tumor invasion. [ABSTRACT FROM AUTHOR]

Objective:The pre-op differentiation of testicular tumors from paratesticular masses cannot be made clearly. Generally, radical orchiectomy is performed with pre-diagnosis of testicular tumor and a clinical approach is planned according to the final pathological result.When clinicians diagnose a scrotal mass, they should considered that this mass may be originated from epididymidis, tunica vaginalis, spermatic cord, fat-muscle-connective tissue, and embryonic remnants and should determine the treatment management accordingly. Materials and Methods:The pathology results of 140 patients, who were admitted to our center between 2008 and 2018 presenting scrotal mass and underwent inguinal radical orchiectomy considering as testicular tumor, were retrospectively analyzed. Preoperative and postoperative data, clinical course, and treatment management of the cases reported to be paratesticular mass by pathology were discussed in the light of the literature. Results:Paratesticular mass(PTM)was detected in 13 cases of our retrospectively analyzed series. Of these, 10 patients were found to have adenomatoid tumors(AT) 2 patients have rhabdomyosarcoma(RMS), and 1 patient angiomyxoma(AM). Conclusion:The differential diagnosis of whether intrascrotal masses are originating from testicular tissues or paratesticular structures is usually cannot be made. Therefore, radical orchiectomy is performed in the same way as testicular tumors and a definite diagnosis can be made by pathological examination. The paratesticular masses, 2-3% of the scrotal masses, should be considered in the differential diagnosis. In this regard, there is a need for studies with a higher number of series.

Objective: To report our experience on management of testicular teratoma in pediatric patient. Case(s) presentation: A 2-years-old boy presented with progressive mass in his left testis. The mass was found 3 months ago but became larger in a few days. The patient had no other genitourinary complaint. Vital signs were within normal limits. A hard and tender mass in the left scrotum sized 5x4x2.5 cm was palpated from the physical examination. An imaging study with Computed Tomography (CT) Scan revealed an enhancement in the left scrotum mass area. There was no ring enhancement in pelvic and paraaortic lymph nodes. The laboratory examination within normal limit. Inguinal radical orchiectomy was performed, and histopathological examination revealed a mature testicular teratoma of the left testis. Discussion: Testicular teratoma in children is usually benign. Testicular germ cell tumors generally have a good prognosis with current therapy. Post-orchiectomy management depends on the histology type, staging, and tumor markers. Conclusion: Testicular teratoma is a rare case and can cause minimal symptoms until it grows significantly. Testicular teratoma should be considered in the differential diagnosis of non-traumatic painless progressive scrotal mass. Inguinal radical orchiectomy may be considered as the primary management.

Background: Tumors arising from the spermatic cord are typically lipomas or sarcomas, and treatment with radical orchiectomy and high ligation of the spermatic cord is the standard of care. Very few cases of metastatic spread to the spermatic cord from other malignancies have been described. Herein we report a case of a patient with a spermatic cord tumor that was found after radical orchiectomy to be an extramedullary site of a known multiple myeloma. Case: A 62-year-old man undergoing Bispecific T-cell Engager (BiTE) therapy for relapsing multiple myeloma was found on surveillance imaging to have a new enhancing mass in his left spermatic cord. He underwent left radical orchiectomy. Pathologic examination revealed the tumor to consist of neoplastic plasma cells consistent with extramedullary spread of multiple myeloma and a paucity of T-cells. There was no involvement of the left testicle. He had no surgical complications but was found to have systemic disease progression despite ongoing therapy. He ultimately elected for palliative care and died six months after surgery. Discussion: This is a case of relapsing multiple myeloma manifesting as an enlarging spermatic cord tumor. Although proceeding to radical orchiectomy is the standard approach to most spermatic cord tumors, this scenario highlights a potential need for further diagnostic workup when the spermatic cord tumor is found in a patient with another active pre-existing malignancy. If metastasis is high on the differential, obtaining a tissue diagnosis via biopsy should be considered, especially in patients for whom testosterone production and fertility preservation are a high priority.

Objective: To evaluate the clinical presentation of testicular tumors and their histological pattern present in our setup. Study Design: Case series. Place and Duration of Study: Armed Forces Institute of Urology (AFIU) Rawalpindi, from Jul 2016 to Jun 2019. Methodology: The documents of all the cases of testicular tumors presenting in the last 3 years were retrieved and their relevant clinical detail: age, clinical presentation, side of involvement, operative procedure conducted and the histopathology report were documented. Results: Thirty two patients of testicular tumors were documented over a period of three years, making 10.66 cases reporting per year. The mean age was 30.10 ± 15.42 years, with the youngest 3 months old infant and the eldest being 58 years of age. The tumors were commonest on the right (59.3%) with 81.2% presentation as swelling of testis. Radical orchiectomy was performed in 90.6% of the cases and retro peritoneal lymph node dissection (RPLND) in 6.2%. Germ cell tumors were found in 71.8% cases with mixed germ cell tumorbeing the commonest histopathology seen in 31.2% of the cases followed by the seminoma (25%) and non-Hodgkin lymphoma (12.5%). Conclusion: Testicular tumors were relatively uncommon in our part of the world with a limited number of cases presenting to a tertiary care urology center. The presentation was variable but a rising trend in non-Hodgkin lymphoma results in a decrease in the overall number of germ cell tumors. [ABSTRACT FROM AUTHOR]

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We present a 42 year old man, who was admitted in the Urology Department with symptoms of unilateral, painless, hard and firm slow-growing mass of the left scrotum for 4 months. Pelvic computed tomography (CT) scan showed a 8 cm3 mass lesion in the left hemiscrotum. Left radical orchiectomy and wide excision were performed and a yellowish soft tissue mass measuring closely attached to the spermatic cord was resected during surgery. Histopathologic evaluation revealed a tumor mass composed of well-differentiated liposarcoma.

BACKGROUND: Germ cell tumors usually manifest as 90% unclassifiable intratubular germ cell neoplasia, with a peak in the fourth decade of life, and most often affect Caucasian individuals. CLINICAL CASE: A 26-year-old man with a testicular tumor treated with radical orchiectomy and chemotherapy. Histology showed the characteristics of a mixed germ cell tumor with mature teratoma components, polyembrioma with embryonal carcinoma component and endodermal sinus tumor. CONCLUSIONS: Polyembrioma is a distinctive component of germ cell neoplasms. Some authors consider this component the most immature form of teratoma and others think that it is a distinctive pattern within mixed germ cell tumors. [ABSTRACT FROM AUTHOR]

Bilateral testicular tumors account for 1 to 5% of all testicular tumors. Most bilateral tumors are observed metachronously. Synchronous tumors usually present with the similar histological pattern. Bilateral synchronous testicular tumors with discordant pathology are extremely rare. Only 56 cases have been documented since Bidard first described synchronous testicular tumors with discordant pathology in 1853. To our best knowledge, this study will be the 57th case in the literature., Competing Interests: Conflict of Interest None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. ( https://creativecommons.org/licenses/by/4.0/ ).)

Computed tomography has been considered the preferred imaging modality for the surveillance of patients with testicular tumors (TTs) following radical orchiectomy. However, because of the concerns of frequent radiation exposure and intravenous iodinated contrast, biparametric magnetic resonance imaging (bpMRI) is a valid and safer alternative in the surveillance of patients with TT, instead of multiparametric magnetic resonance imaging. In this review article, we propose a protocol algorithm that utilizes bpMRI in the evaluation of patients after radical orchiectomy for TTs. [ABSTRACT FROM AUTHOR]

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• Liposarcomas typically presents as bulky heterogeneous solid lesions that are larger/firmer than simple "cord lipoma." Tumors range from 3 to 30 cm in diameter. • Current controversy in management of liposarcomas pertains to the use of adjuvant chemotherapy or radiotherapy and whether these treatment options decrease recurrence/survival. • We recommend an initial complete resection with wide margins without the use of adjuvant therapy with aggressive long-term surveillance. • Based on extrapolated data from studies pertaining to sarcomas of the extremities, adjuvant radiation or chemotherapy may serve a role but further research is crucial. Malignant spermatic cord tumors have an annual incidence of 0.3 cases/million. The vast majority of tumors in this region are benign. We present a rare case of a dedifferentiated liposarcoma of the spermatic cord successfully treated. A 59-year-old gentleman presented complaining of an enlarging painful right groin mass. On exam there was an obvious 10 cm inguinal mass. Imaging illustrated a right inguinal soft tissue mass that was not present on imaging 22 months prior. The patient underwent a right inguinal exploration, en bloc resection of the mass, and radical orchiectomy to ensure negative margins. Histopathological analysis revealed a grade 2 dedifferentiated liposarcoma that measured 9 × 6 × 5 cm, with 5 cm negative margins. The patient did well and was discharged on postoperative day one. On 6-month follow-up there was no evidence of recurrence. We present a rare dedifferentiated liposarcoma of the spermatic cord that was successfully treated with surgical resection. This case highlights the importance of maintaining a high index of suspicion coupled with a thorough history and physical examination when encountering an enlarging inguinal mass. This rare pathology is lacking level one evidence-based standardized treatment algorithms. The mainstay of treatment is surgical resection. For spermatic cord liposarcomas, the surgical approach is en bloc resection with radical orchiectomy aiming for R0 margins. Prognosis depends on tumor grade, anatomic site, and the ability to achieve a microscopically tumor negative resection. Despite our patient's disease free status, prolonged surveillance with physical examination and cross sectional imaging is still warranted. [ABSTRACT FROM AUTHOR]

BACKGROUND: Fibrous pseudotumor is a rare benign lesion, reactive in nature, which can appear in the form of nodules (single or multiple) or diffusely in the testicular tunics. Clinically it simulates a malignant tumor, so the treatment consists of radical orchiectomy. CLINICAL CASE: A 70-year-old man, who came to the clinic due to an increase in testicular volume of several months of evolution. Ultrasound revealed a right simple hydrocele, 170 cm3. Treatment consisted of hydrolectomy, using the right hemiscrotal technique. In the surgical act, multiple nodules adhered to the tunica vaginalis and albuginea were evidenced. Immunohistochemistry showed positivity for caldesmon and CK (AE1 / AE3), and negativity for desmin, actin, CD34, CD31, calretinin, EMA, CK7, CK5 / 6 and WT1. The final diagnosis was: multiple nodular fibrous pseudotumor. CONCLSUIONS: It is important to know the fibrous pseudotumor, since when obtaining an intraoperative biopsy it can be confused with a high-grade lesion. The possibility of IgG4 disease should be ruled out, because it is a systemic disease that can affect any location. [ABSTRACT FROM AUTHOR]

The aim of the present study was to assess the oncological and functional outcomes of testis-sparing surgery (TSS) for testicular tumors compared with radical orchiectomy (RO) in a single center. A retrospective comparative cohort study was conducted in Changzheng Hospital. Patients were identified using the hospital information system from January 1999 to December 2016, collecting all of the data regarding clinical, treatment and prognostic profiles. Patient follow-up was also executed to obtain information on patients' survival status, serum markers profiles, disease progression, androgen substitution requirement and paternity status. In total 158 patients were enrolled into the cohort study, including 23 TSS cases. The TSS procedure was primarily conducted in younger patients (average age, 31.9 vs. 47.7 years) or those with smaller tumors (average tumor diameter, 26.0 vs. 51.5 mm). The overall survival and recurrence free survival revealed no differences in the two groups, suggesting similar oncological outcomes. Kaplan-Maier analysis demonstrated a higher cumulative paternity rate in the TSS group than in RO group, indicating a possible advantage of preserving patients' fertility in TSS over RO. TSS with proper adjuvant therapies proved to be a promising alternative in the avoidance of emasculation, infertility, life-long androgen substitution and other psychosexual difficulties, as the oncological outcomes were not inferior to RO in the selected cases. However, further investigation is required in order to assess its oncological and functional values. [ABSTRACT FROM AUTHOR]

Mesothelioma is an aggressive tumor originating from mesothelial cells. Mesothelioma of the spermatic cord is a very rare disease, and the most common presentation of this disease is that of aggressive mesothelioma with no description of mesothelioma in situ. We report an extremely rare case of mesothelioma in situ of the spermatic cord arising from a patent processus vaginalis. To our best knowledge, this is the first report of this finding. The identification of a patent processus vaginalis and investigation of single-layered atypical mesothelial cells led to the final diagnosis. [ABSTRACT FROM AUTHOR]

Hydrocele is a very common condition that is simple to evaluate and treat. Management of hydrocele is usually delegated to the junior members of the surgical team. Sometimes this simple condition can spring huge surprises. A 20-year-old man presented with acute onset large, painless fluctuant left hemi-scrotal swelling. Scrotal ultrasonography showed thickened tunica vaginalis. A diagnosis of left hydrocele was made and repair by excision of sac was planned. During the procedure, the sac was found studded with red nodular growths; histopathology reported malignant mesothelioma of tunica vaginalis. Metastatic evaluation showed extensive retroperitoneal lymph nodal involvement. Despite receiving adjuvant chemotherapy with radiotherapy patient died due to extensive metastasis within 16 months. This case is presented for rarity of diagnosis, young age of presentation, absence of etiological factor and rapidly progressive clinical course.

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Objective: Treatment modalities applied after orchiectomy in early-stage germ cell tumors (GCTs) include significant changes in each new study. In this study we reevaluated the treatment approaches used in our hospital between 2010-2014 according to current guidelines. Materials and Methods: We retrospectively evaluated the oncologic treatments and follow-up data of 32 patients who underwent radical orchiectomy between January 2010 and December 2014 due to testicular tumor and were diagnosed with early stage GCT in the Urology Clinic of Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital of University of Health Sciences. Results: Of 19 patients diagnosed with stage 1 seminomas, 3 patients in the low risk group were followed. Of 4 patients who received single-dose carboplatin therapy, 2 were at low risk and 2 were at high risk. Therefore, 2 patients at low-risk had overtreatment. Twelve patients were treated with radiotherapy (RT) that was no longer recommended in guidelines after 2014. Two patients in the low risk group of stage 1 non-seminoma were followed. One of them had recurrence at 12 months, and received 3 cycles of bleomycin + etoposide + cisplatin (BEP) according to current guidelines. Four patients with stage 1 non-seminoma underwent 2 cycles of BEP because they were considered at high risk. These patients are now recommended to receive 1 cycle BEP according to the current guidelines. While 4 patients with stage 1 mixed GCT were followed because of low risk, one patient was administered 2 cycle of BEP based on the old guidelines, at that time because of high risk. In the seminoma group that was administered RT, acute myeloblastic leukemia and oligospermia toxicity were detected, but these were not observed in the carboplatin group. One of high-risk non-seminoma patients who received 2 doses of BEP developed Myelodysplastic syndrome. Conclusion: Early-stage GCTs have high cancer-specific and overall survival rates with appropriate treatment approaches. Although there are still controversial issues regarding their management, treatment approaches are changing with each study. Therefore, it is crucial to remain informed about current international guidelines and new scientific studies. [ABSTRACT FROM AUTHOR]

Objective To compare the oncological outcomes of testicle-sparing surgery (TSS) and radical orchiectomy (RO) in patients with Leydig cell tumor (LCT) of the testis. Patients and methods A multicenter retrospective clinical study was conducted in 12 centers in France. All the patients with histologically proven LCT were included and analyzed according to treatment (organ-sparing surgery or radical orchiectomy). Patients underwent preoperative clinical, biological and imaging assessment. Demographic, clinical, and pathological variables were collected at baseline and compared between groups according to surgical treatment. Follow-up was calculated using the reverse Kaplan-Meier estimation and was updated at the end of 2015. Results: Between 1986 and 2014, 56 patients presented with LCT were identified and included in the study. Twenty-one patients (37.5%) underwent TSS and 35 (62.5%) RO. Demographics and tumor characteristics were not significantly different between the groups. Median follow-up was 62 months after TSS, but only 35 months after RO. Two patients (9.5%) developed local recurrence 15 and 34 months after TSS and underwent secondary RO. No local recurrence or metastasis was observed after complementary treatment. No recurrence was observed after RO. Disease-free survival did not differ between the groups (95.2% in TSS versus 77.1% in the RO group, p = 0.23). No patient died in the TSS group, but three patients (8.6%) in the RO group died from other diseases without evidence of relapse. One patient (4.8%) in the TSS group versus five (14.3%) in the RO group were lost to follow-up. Conclusion: Long-term follow-up suggests that testicle-sparing surgery does not compromise relapse-free survival in the treatment of Leydig cell tumor of the testis. [ABSTRACT FROM AUTHOR]

Malignant mesothelioma of the tunica vaginalis testis is an extremely rare tumor without specific clinical manifestations, mainly including hydrocele formation and a painless mass. We herein present the case of a patient with hydrocele of the left testis, without any other complaints. Tunica vaginalis subinvolution was performed, and postoperative pathological examination revealed a malignant mesothelioma arising from the left tunica vaginalis testis. Whole-body positron emission tomography-computed tomography (PET-CT) and subsequent abdominal and pelvic magnetic resonance imaging (MRI) revealed no evidence of local lymphadenopathy. Radical left orchiectomy was performed after the pathological diagnosis. The pathological examination after the second surgery demonstrated that the tumor had invaded the adjacent periorchium and spermatic cord, but there was no evidence of local lymph node metastasis. Pemetrexed and cisplatin were administered at a dose of 900 and 130 mg, respectively, on the first day of a 28-day cycle. After 6 months of therapy, the disease had not progressed on abdominal and pelvic PET-CT and MRI. The patient was still followed up in our urology outpatient clinic at the time of the present report. Although testicular hydrocele is a common and easily diagnosed condition, detailed medical history and physical examination are required. Thus, when clinicians encounter patients with testicular hydrocele, a variety of possible causes must be considered, including testicular or paratesticular tumors, even rare tumors such as mesothelioma of the tunica vaginalis testis. [ABSTRACT FROM AUTHOR]