Granulomatosis and Testicular Germ Cell Tumors

Jeurkar, Neha; Mamtani, Ronac; Vaughn, David J.

doi:10.1016/j.urology.2012.08.018

Cited by 6 publications

(3 citation statements)

References 25 publications

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“…Leatham et al 18 in a retrospective review of 1120 patients with germ cell testicular tumors over a 13-year period found 9 patients with a combined diagnosis of sarcoidosis and testicular tumor. In another study, Jeurkar et al 19 observed that the incidence of granulomatous disease among patients with testicular germ cell tumor represented a 10-fold increase compared with the general population. Both these studies suggesting a link between testicular cancer and sarcoidosis are retrospective.…”

Section: Discussionmentioning

confidence: 97%

Disseminated Sarcoidosis With Testicular Involvement

Rohani

Rana

Barot

et al. 2014

Clinical Pulmonary Medicine

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Sarcoidosis is a multisystem inflammatory disease of unknown etiology that predominantly affects the lungs and intrathoracic lymph nodes. Testicular sarcoidosis is a rare presentation of this disease. We review the case of a patient with stage 2 sarcoidosis with bilateral intrascrotal involvement along with classic pulmonary, lymphoid, and dermatological manifestations. We provide a literature review of testicular sarcoidosis and discuss the diagnostic challenges and the management of intrascrotal mass in setting of disseminated sarcoidosis. (Clin Pulm Med 2014;21:96-100) S arcoidosis is a multisystem inflammatory disease of unknown etiology that predominantly affects the pulmonary system. Although the most common presentation involves granulomatous changes of the lungs and intrathoracic lymph nodes, sarcoidosis can involve almost any organ. Testicular sarcoidosis is a rare manifestation of this disease. CASE REPORTA 46-year-old male from the West Indies with a past medical history significant for Graves disease status-post radioactive ablation and chronic normocytic anemia presented to the emergency room with a chief complaint of testicular discomfort and swelling of 1-year duration. He reported increasing bilateral testicular swelling over the past year and recently had become associated with pain and discomfort. He denied any hematuria, dysuria, urinary discharge, or urinary hesitancy. He reported progressive dyspnea on exertion and a nonproductive cough for the prior 10 months. However, he denied hemoptysis, orthopnea, or paroxysmal nocturnal dyspnea. He noted 30 to 40 pounds of unintentional weight loss over the past year and the presence of nonhealing skin lesions over his right face of >10 months duration. He denied recurrent fevers, chills, or night sweats. His social history was pertinent for heterosexual intercourse with commercial sex workers. He also had a history of inhalational cocaine use 1 year before presentation but denied any tobacco use.At initial presentation, he was afebrile. Heart rate was 115 beats per minute, blood pressure was 124/73 mm Hg, respiratory rate was 16 breaths per minute, and oxygen saturation was 96% on room air.He appeared well-nourished and was not in respiratory distress. Chest auscultation revealed bilateral inspiratory crackles and expiratory wheezes. He was tachycardic with normal heart sounds. Pertinent negative findings included the absence of jugular venous distension, organomegaly, or lower extremity edema. Genitourinary examination revealed bilateral testicular fullness with mild tenderness to palpation. Also noted were multiple, raised, irregular papules on the right side of the face, the largest measuring 1.0 cm by 1.5 cm, and bilateral polygonal scaly plaques over the pretibial areas of the lower extremities that had been present since adolescence (Fig. 1).Laboratory studies revealed normocytic anemia (hemoglobin 11.6 g/dL, MCV 90 fL) with eosinophilia (8.4%) and monocytosis (18.0%). His white blood cell count was within normal range at 4000 cells/mL. His se...

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Section: Discussionmentioning

confidence: 97%

Disseminated Sarcoidosis With Testicular Involvement

Rohani

Rana

Barot

et al. 2014

Clinical Pulmonary Medicine

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“…Because of the non-specific nature of 18 F-FDG, it can also accumulate in infective/inflammatory lesions, and therefore these FP results as not surprising. 22 Also, low-grade 18 F-FDG uptake can be seen in the residual masses for a variable time after chemotherapy and radiotherapy. The inflammatory lesions resulting in FP 18 F-FDG PET/CT results have also been documented in results published by other groups.…”

Section: Periodic Measurement Of Serum Tumour Markers (Afp B-hcg Andmentioning

confidence: 99%

Diagnostic accuracy of integrated¹⁸F-FDG PET/CT for restaging patients with malignant germ cell tumours

Sharma¹,

Jain²,

Parida³

et al. 2014

BJR

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Objective: Evaluation of utility of fluorine-18 fludeoxyglucose ( 18 F-FDG) positron emission tomography/CT (PET/CT) for restaging patients with primary malignant germ cell tumours (GCTs). Methods: Data of 92 patients (age, 31.94 6 10.1 years; male/ female, 86/6) with histopathologically confirmed malignant GCTs (gonadal, 88; mediastinal, 4; seminomatous, 47 and non-seminomatous, 45) who underwent 18 F-FDG PET/CT for restaging (suspected recurrence/post-therapy evaluation) were retrospectively analysed. Two experienced nuclear medicine physicians reviewed the PET/CT images in consensus, qualitatively and semi-quantitatively [maximum standardized uptake value (SUVmax)]. Histopathology (if available) and clinical/imaging/biochemical follow-up (minimum of 6 months) were employed as the reference standard. Results:18 F-FDG PET/CT was interpreted as positive in 59 and negative in 33 patients. Local disease was seen in 5, nodal disease in 50 and distant metastasis in 22 patients. PET/CT was true positive in 49, false positive in 10, true negative in 30 and false negative in 3 patients. 18F-FDG PET/CT showed sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 94.2%, 75.0%, 83.0%, 90.9% and 85.8% overall; 90.0%, 74.0%, 72.0%, 90.9% and 80.8% in seminomatous GCT; and 96.8%, 76.9%, 91.1%, 90.9% and 91.1% in non-seminomatous GCT, respectively. Difference in PET/CT accuracy for seminomatous and non-seminomatous GCTs was not significant (p 5 0.263). PET/CT demonstrated disease in 13 patients with negative/equivocal conventional imaging findings and in 9 patients with normal tumour markers. No site-or histology-based difference was seen in SUVmax. Conclusion:18 F-FDG PET/CT demonstrates high diagnostic accuracy for restaging patients with malignant GCTs. It has comparable diagnostic performance in both seminomatous and non-seminomatous malignant GCTs. Advances in knowledge:The present article demonstrates high diagnostic accuracy of 18 F-FDG PET/CT for restaging both seminomatous and non-seminomatous malignant GCTs in a large patient population.Germ cell tumour (GCT) is the commonest malignancy in males aged between 20 and 35 years.1 With cisplatin-based chemotherapy, high long-term cure rates can be achieved in patients with GCTs.2 Traditionally, the follow-up of patients with GCT is carried out with clinical examination, measurement of serum tumour markers [alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (b-HCG) and lactate dehydrogenase (LDH)], and with conventional imaging investigations such as CT or MRI.3 A major issue in the management of GCTs is post-chemotherapy residual masses, which harbour viable tumour cells in about 11-37% of cases. 4 Unfortunately, CT or MRI cannot predict the histology of residual masses and has limited specificity in post-therapy setting.5

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“…Although the synchronous occurrence of testicular seminoma and systemic sarcoidosis has been reported, 1 – 4) that of intracranial germinoma and systemic sarcoidosis is unknown. We report a unique case of synchronous occurrence of intracranial germinoma and systemic sarcoidosis.…”

Section: Introductionmentioning

confidence: 99%

A Case of Synchronous Occurrence of Intracranial Germinoma and Systemic Sarcoidosis

Hyakutake

Shibahara

Inukai

et al. 2021

NMC Case Report Journal

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Although the synchronous occurrence of testicular seminoma and systemic sarcoidosis has been reported, that of intracranial germinoma and systemic sarcoidosis is unknown. A 26-year-old man presented with symptoms of panhypopituitarism and consciousness disturbance. Imaging demonstrated a large nodule in the upper right lung field and swelling of multiple bilateral pulmonary and mediastinal lymph nodes in addition to the bifocal pineal and suprasellar tumors with obstructive hydrocephalus. The pathological diagnosis of the intracranial bifocal tumors was pure germinoma, whereas that of the mediastinal lymph nodes was epithelioid granuloma. Three courses of chemotherapy using carboplatin and etoposide were administered, followed by whole ventricle irradiation. The intracranial tumors completely disappeared, but the lung nodule and mediastinal lymph nodes progressed. Whole-body fluorine-18-fluorodeoxyglucose positron emission tomography demonstrated accumulation in the mediastinal lymphadenopathy, lung masses, and multiple lymph nodes of the whole body. Transbronchial lung biopsy revealed epithelioid granuloma with multinucleated giant cells. In conjunction with the high blood concentration of angiotensin-converting enzyme and soluble interleukin-2 receptor, these findings established a diagnosis of sarcoidosis. This is the first report of synchronous occurrence of intracranial germinoma and sarcoidosis. Such coexistence is extremely rare, but we should mind that sarcoidosis can occur with intracranial germinoma.

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Granulomatosis and Testicular Germ Cell Tumors

Cited by 6 publications

References 25 publications

Disseminated Sarcoidosis With Testicular Involvement

Disseminated Sarcoidosis With Testicular Involvement

Diagnostic accuracy of integrated¹⁸F-FDG PET/CT for restaging patients with malignant germ cell tumours

A Case of Synchronous Occurrence of Intracranial Germinoma and Systemic Sarcoidosis

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Granulomatosis and Testicular Germ Cell Tumors

Cited by 6 publications

References 25 publications

Disseminated Sarcoidosis With Testicular Involvement

Disseminated Sarcoidosis With Testicular Involvement

Diagnostic accuracy of integrated18F-FDG PET/CT for restaging patients with malignant germ cell tumours

A Case of Synchronous Occurrence of Intracranial Germinoma and Systemic Sarcoidosis

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Diagnostic accuracy of integrated¹⁸F-FDG PET/CT for restaging patients with malignant germ cell tumours