Intratubular germ cell neoplasms of the testis and bilateral testicular tumors: Clinical significance and management options

Abstract

Objectives:Intratubular germ cell neoplasia (ITGCN) is the precursor lesion for invasive testicular germ cell tumors (TGCTs) of adolescents and young adults. The rising incidence of these tumors has prompted a rigorous investigation of the etiology, diagnosis and management of ITGCN. Bilateral testicular cancer is closely linked with ITGCN, as patients with unilateral testicular cancer are at the highest risk for a future malignancy in the contralateral testicle.Methods:A literature review directed at ITGCN and bilateral testis cancer was performed using the Medline/PubMed database. Our review focused on the pathogenesis, risk factors, diagnosis and treatment regimens utilized.Results:Major advances have been made in the understanding of ITGCN over the past 30 years. There is evidence that TGCTs arise from ITGCN, ITGCN is closely related to fetal gonocytes, and that events in pre- and perinatal period may result in abnormal persistence of fetal gonocytes leading to ITGCN and subsequent TGCT. Controversy exists regarding the need to biopsy men at increased risk of TGCT, as well as the best approach to managing patients with known ITGCN. Bilateral testicular cancer has excellent outcomes in the current era of platinum-based chemotherapy.Conclusion:The optimal management of patients at risk for ITGCN and future TGCT is still a matter of debate. Individualization of management, including biopsy and treatment, should be based on risk factors for TGCT, compliance with potential surveillance, and patient preferences particularly with regard to fertility.

Current urologic care for testicular germ cell tumors in pediatric and adolescent patients

“…ITGCN and TGCTs share many immunohistochemical staining patterns and characteristic genetic mutations in chromosome 12p in adult men. However, prepubertal TGCTs do not show histologic or genetic similarities to ITCGN [10].…”

Management of Metachronous Bilateral Testis Cancer in a Patient with Pre-B Cell ALL

“…Testicular cancer is the most common cancer of young men and its incidence continues to rise, with current estimates of 5.3 cases per 100,000 men [ 1 , 2 ]. The development of bilateral testis cancer is exceedingly rare, estimated to be between 1 and 5% of patients with testis cancer [ 3 ].…”