The association of gynaecomastia and testicular tumours is well described in the literature. A testicular examination should be routine as part of the assessment of young males presenting with breast enlargement. We describe two cases where gynaecomastia preceded the appearance of testicular swelling by several months. Case reports Case 1 A 27 year old man was routinely referred to a general surgery department and assessed by a breast surgeon (RB) for bilateral gynaecomastia. On examination, the testes were normal. Six months later he was referred to the urology department with a history of persistent terminal haematuria. The patient mentioned during the examination that he had discovered a lump in a testicle since his attendance at the breast clinic. He had paid no attention to it and had not complained about it to his general practitioner. An abdominal examination showed an epigastric mass. An urgent ultrasound scan confirmed a testicular tumour measuring 2.4×2.0×1.6 cm and a retroperito-neal mass measuring 6.9×7.3 cm resulting from meta-static deposits in para-aortic lymph nodes. His fetoprotein was raised (639 700 IU/l (normal < 7000 IU/l)), as was his total human chorionic gonado-trophin (64.0 IU/l (reference range 0.1-3 IU/l)). The patient was admitted urgently for radical orchidectomy and endoscopic assessment. The cystos-copy showed venous congestion of the bladder neck as the likely source of haematuria. Histology testing of the orchidectomy specimen showed 80% classic seminoma and 20% mature teratoma. The staging computed tomogram confirmed the enlargement of para-aortic and inguinal lymph nodes consistent with metastatic disease. The patient was referred to the regional oncology service for further treatment in the form of chemoradiation. Case 2 A 20 year old man with unilateral breast enlargement was routinely referred to a general surgery department by his general practitioner. He was seen in a breast clinic six weeks later (by RB), where a testicular swelling was discovered on physical examination. An urgent ultrasound scan confirmed a testicular tumour. His testicular tumour markers were substantially raised (fetoprotein 3 290 000 IU/l and total human chorionic gonadotrophin 87.0 IU/l). The patient was admitted for urgent radical orchid-ectomy. The staging computed tomogram showed no evidence of metastatic disease. Histology testing of the orchidectomy specimen showed features of mixed germ cell tumour, with 50% of differentiated teratoma, 25% of embryonal carci-noma, and 25% of yolk sac tumour. The patient was referred to the regional oncology service for further management. Discussion The incidence of gynaecomastia in adult men is reported as being 35-65%, depending on the criteria for diagnosing gynaecomastia and the age group. 1 However, only 2% of men presenting with gynaeco-mastia are found to have testicular tumours. 2 Gynaeco-mastia is usually attributed to an imbalance of oestrogen and androgen but may be due, in part, to a more direct action of luteinising hormone or human chorionic gona...
after gastrectomy or gastrojejunostomy, is very much less after vagotomy and anterior pylorectomy.The authors conclude that vagotomy and anterior pylorectomy is probably the best operation available for the treatment of chronic duodenal ulcer.We are indebted to Miss Zita Stead for the illustration.
STUDIES carried out on patients with malignant disease have demonstrated that operative manipulation of a malignant tumour releases cancer cells into the circulation, frequently in considerable number (Moore, Sandberg and Watne, 1960;Cole, McDonald, Roberts and Southwick, 1961). It is, therefore, of considerable importance during operation to avoid, as far as is possible, any procedure which will promote the development of tumour metastases from these circulating cancer cells.Many operations for malignant disease entail extensive and lengthv surgical procedures and it has become common practice for patients submitted to this type of surgery to receive intravenous fluids during the course of the operation. The intravenous infusion apparatus, frequently set up some hours before operation, can be used for blood transfusions should this be required. For the purpose of fluid replacement it may be retained for a few days after operation. When blood is not being used, under different circumstances various fluids may be infused into the patient. Little is known about the effect of intravenous fluids on cancer cells and, in particular, the influence these solutions may have on the metastatic potential of circulating cancer cells.It is the purpose of this experimental study to determine the effect both in vitro and in vivo of four clinically available intravenous solutions on cell suspensions of the Walker 256 tumour system. Because it is established that tumour cell aggregates are more liable to give rise to metastases than single circulating cancer cells (Watanabe, 1954) particular attention has been paid to the aggregating effect of the intravenous fluids on the experimental tumour cells. METHODSIn the present series of experiments the Walker 256 tumour was used in the form of a suspension of single tumour cells prepared by a modification of the method described by Rodin, Turner and Couves (1963). The tumour cells were suspended in Hank's balanced salt solution (BSS).Four intravenous solutions were used:1. Dextraven (Benger Laboratories Ltd.)-a sterile solution of 10% w/v dextran, having an average molecular weight of 150,000, in 5 % dextrose solution.It is designated a high molecular weight dextran (HMWD) solution.2. Rheomacrodex (Pharmacia G.B. Ltd.)-a sterile solution of 10% w/v dextran, having an average molecular weight of 40,000, in 5% dextrose solution.It is designated a low molecular weight dextran (LMWD) solution.
Scrotal ultrasound scans carried out on 156 patients were reviewed in a retrospective study and the sonographic findings and indications evaluated. Ultrasound was able accurately to distinguish the normal from the pathological scrotum. Extratesticular lesions were readily differentiated from testicular lesions. Abnormal testicular echo patterns were usually associated with tumours, but orchitis, granulomas and haematomas were found to have a similar appearance. Occult testicular tumours could readily be identified. Ultrasound was also useful in excluding underlying pathology in hydroceles, in the diagnosis and follow-up of epididymitis and other epididymal lesions and in the assessment of underlying testicular damage in traumatic haematoceles. Ultrasound may also be useful in post-orchiectomy follow-up examinations to exclude tumour in the contralateral testis.
Forty patients with multiple recurrent superficial bladder tumours received an 8-week course of weekly instillations of 4' epirubicin 30 mg in 50 ml saline. The overall response rate was 58% and side effects were minimal.
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