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Contralateral intratubular germ cell neoplasia in a patient with testicular cancer

Nature Clinical Practice Urology volume 5, pages 284–288 (2008)Cite this article

Abstract

Background A 27-year-old man was referred to an oncology department following right orchiectomy for a stage I testicular seminoma at high risk for recurrence. He presented 6 weeks after the orchiectomy with an atrophic left testis, fatigue and a history of infertility.

Investigations Measurement of serum levels of urea, electrolytes, liver enzymes, bilirubin, human chorionic gonadotropin, α-fetoprotein, lactate dehydrogenase, testosterone and luteinizing hormone, full blood count, and left testicular biopsy.

Diagnosis Tubular atrophy of the left testis with islands of intratubular germ cell neoplasia (ITGCN), and hypergonadotropic hypogonadism.

Management The patient received adjuvant chemotherapy as a single dose of carboplatin for the seminoma at high risk for recurrence, and testosterone replacement for the hypergonadotropic hypogonadism. Radiotherapy to the ITGCN-bearing solitary testis or a second orchiectomy was offered to prevent the progression of ITGCN into an invasive germ cell tumor. After exploring his options with regards to fertility treatment, the patient chose to undergo second orchiectomy with a subsequent, unsuccessful, attempt at sperm retrieval. At 20 months after diagnosis of his initial seminoma the patient showed no sign of recurrence.

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Figure 1: Histological findings on biopsy samples from the atrophic left testis of the case patient, who had previously undergone right orchiectomy for a stage I seminoma.

References

  1. Fordham MV et al. (1990) Management of the contralateral testis in patients with testicular germ cell cancer. Br J Urol 65: 290–293

    Article  CAS  Google Scholar 

  2. Fossa SD et al. (2005) Risk of contralateral testicular cancer: a population-based study of 29,515 US men. J Natl Cancer Inst 97: 1056–1066

    Article  Google Scholar 

  3. Hoei-Hansen C et al. (2005) Carcinoma in situ testis, the progenitor of testicular germ cell tumours: a clinical review. Ann Oncol 16: 863–868

    Article  CAS  Google Scholar 

  4. von der Maase H et al. (1986) Carcinoma in situ of contralateral testis in patients with testicular germ cell cancer: study of 27 cases in 500 patients. Br Med J (Clin Res Ed) 293: 1398–1401

    Article  CAS  Google Scholar 

  5. Dieckmann KP and Loy V (1996) Prevalence of contralateral testicular intraepithelial neoplasia in patients with testicular germ cell neoplasms. J Clin Oncol 14: 3126–3132

    Article  CAS  Google Scholar 

  6. Bettocchi C et al. (1994) A review of testicular intratubular germ cell neoplasia in infertile men. J Androl 15 (Suppl): S14–S16

    Google Scholar 

  7. Daugaard G et al. (1992) Management of extragonadal germ-cell tumors and the significance of bilateral testicular biopsies. Ann Oncol 3: 283–289

    Article  CAS  Google Scholar 

  8. Harland SJ et al. (1998) Intratubular germ cell neoplasia of the contralateral testis in testicular cancer: defining a high risk group. J Urol 160: 1353–1357

    Article  CAS  Google Scholar 

  9. Karellas ME et al. (2007) ITGCN of the testis, contralateral testicular biopsy and bilateral testicular cancer. Urol Clin North Am 34: 119–125

    Article  Google Scholar 

  10. von der Maase H (2005) Is a contralateral testicular biopsy in patients with unilateral germ cell testicular cancer indicated as a routine procedure? Acta Oncol 44: 523–525

    Article  Google Scholar 

  11. AACE Hypogonadism Task Force (2002) American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hypogonadism in adult male patients—2002 update. Endocr Pract 8: 440–456

  12. Geldart TR et al. (2002) Orchidectomy after chemotherapy for patients with metastatic testicular germ cell cancer. BJU Int 90: 451–455

    Article  CAS  Google Scholar 

  13. Christensen TB et al. (1998) Effect of chemotherapy on carcinoma in situ of the testis. Ann Oncol 9: 657–660

    Article  CAS  Google Scholar 

  14. Oliver RT et al. (2005) Radiotherapy versus single-dose carboplatin in adjuvant treatment of stage I seminoma: a randomised trial. Lancet 366: 293–300

    Article  CAS  Google Scholar 

  15. Petersen PM (2002) Effect of graded testicular doses of radiotherapy in patients treated for carcinoma-in-situ in the testis. J Clin Oncol 20: 1537–1543

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. T Buchler is a Medical Oncology Registrar in the Department of Oncology, Thomayer University Hospital, Prague, Czech Republic,

    Tomas Buchler

  2. and S Harland is a Consultant in the Department of Oncology, A Freeman is a Consultant at the Institute of Pathology, at University College Hospital London, London, UK.,

    Alex Freeman & Stephen Harland

Authors
  1. Tomas Buchler
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  2. Alex Freeman
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  3. Stephen Harland
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Corresponding author

Correspondence to Tomas Buchler.

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The authors declare no competing financial interests.

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Buchler, T., Freeman, A. & Harland, S. Contralateral intratubular germ cell neoplasia in a patient with testicular cancer. Nat Rev Urol 5, 284–288 (2008). https://doi.org/10.1038/ncpuro1100

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