Search

Background. The rarity of testis tumor in black patients has made the study of a large series difficult. Much of the epidemiologic and clinical information regarding this neoplasm in this population is in dispute, including data on incidence, prognosis, histologic distribution, age and stage at presentation, and side distribution. Methods. A retrospective review of 66 blacks with testicular tumors from seven military medical centers was performed. Results. Similar results were found for blacks with testis tumor to those of the general testis cancer population regarding prognosis, side distribution, and age of onset for nonseminoma and interstitial tumors. There is a slight increase in the expected number of interstitial tumors in blacks, but the distribution between seminoma and nonseminoma is similar to the general population. The mean age of presentation for seminoma in blacks was younger than that of the general testis cancer population. For testis tumor treated at the same institution, there was an increased delay of diagnosis in blacks compared with whites. The number of new cases of testicular cancer between 1979 and 1991 at one major center was increased for whites but not for blacks. The availability of cisplatin-based combination chemotherapy has resulted in an improved prognosis for blacks, as has already been demonstrated for white populations. Conclusions. Testis tumor in blacks behaves similarly to testis tumor in the general population except that in blacks there are more interstitial tumors and the mean age of presentation for seminoma is younger. Further, there is an increased delay in diagnosis for blacks compared with whites, but the incidence of this tumor in this population does not appear to be increasing. Cisplatin-based chemotherapy has significantly improved survival in this population. Cancer 1994; 73:388-93.

In 3 patients undergoing therapy for germinal testis tumors (teratoma with choriocarcinoma, seminoma and teratocarcinoma) solitary pulmonary lesions developed consistent with metastatic tumor. After non-diagnostic medical pulmonary evaluation thoracotomy established benign lesions in each (sarcoidosis, Cryptococcus and postoperative inflammatory cyst). Surgical pathologic re-staging to obviate the institution of unnecessary chemotherapy and/or radiation with its attended morbidity in such instances is stressed.

We used aggressive individualized combinations of operation and cyclic actinomycin D therapy and/or irradiation for 12 patients with stage III germinal testis tumors, including 1 seminoma. Eight patients have survived free of tumor for 24 to 83 months. All but 1 survivor had retroperitoneal lymphadenectomy. Five thoracotomies and 4 neck resections were used to manage distant metastatic lesions. Cyclic actinomycin D was used in 7 of 8 survivors. The experience with this series and a review of cases in the literature strongly suggest the need to eradicate the most common source of tumor seeding the distant metastatic sites from the retroperitoneal lymphatics. Eradication can best be accomplished by retroperitoneal lymphadenectomy and is indicated even in patients with a complete response to chemotherapy. A general treatment plan is suggested for stage III testis tumors: selective irradiation and chemotherapy for seminoma and an aggressive individualized combination of operation and chemotherapy with irradiation in some instances for non-seminomatous disease.

Pelvic lymphadenectomy has become a recognized staging procedure in patients with locally confined adenocarcinoma of the prostate prior to therapy for cure. Our study of 343 patients shows that the grade of the primary tumor does definitely affect the results of pelvic lymphadenectomy. As the grade worsens in each clinical stage, the incidence of positive nodes increases. The result of the pelvic lymphadenectomy often directs the selection of the therapy for the patient and definitely influences the results of that therapy.

A retained biliary stone was removed with a ureteral stone basket inserted through a T tube drain tract. Neither reoperation nor general anesthesia were required. Although used in only one case, the simplicity and immediate success of the procedure make it promising. Further trial, including use of this device at the time of the original operation, seems warranted.