Retroperitoneal Extragonadal Endodermal Sinus Tumor With Bilateral Diffuse Classic Testicular Microlithiasis

Meyer, Monique A.; Gilbertson-Dahdal, Dorothy

doi:10.7863/jum.2010.29.12.1843

Cited by 11 publications

(14 citation statements)

References 12 publications

(58 reference statements)

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“…The prevalence of classic testicular microlithiasis in boys is 2.4%, which increases with age. 1 The prevalence of testicular microlithiasis in adults is 5.6%. 1,2 Because microlithiasis is less prevalent in pediatric patients, it may be more clinically relevant when we see it.…”

Section: Replymentioning

confidence: 99%

Extragonadal Tumor and Testicular Microlithiasis

Harris

2011

Journal of Ultrasound in Medicine

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To the Editor: The recent case report on an extragonadal tumor and testicular microlithiasis 1 is commendable for presenting an interesting case with important clinical ramifications. Unfortunately, it includes several misleading or erroneous statements about the appearance of regressed testicular tumors and about the clinical importance of testicular microlithiasis. 1. Most, if not all, of the burned-out germ cell cancers I have seen in the testis in 23 years of practice (probably 5 cases) have been amorphous and chunky, not the "focal microlithiasis" that the authors state is common in these situations. I have not found any data to describe the prevalence of coarse calcifications versus microlithiasis, but most textbooks showing a case of a burned-out tumor show chunky or macrocalcifications and not the tiny calcifications of microlithiasis. 2. The authors state in the "Discussion" section that "The prevalence of testicular microlithiasis is reported to be lower than initially expected and therefore may be more clinically important." Lower prevalence than what? And how does this statement relate to microlithiasis being more clinically relevant? 3. The authors appear to have overstated the importance of testicular microlithiasis as a risk factor for testicular germ cell tumors. A meta-analysis of 33 studies of testicular microlithiasis 2 was published at about the same time as the case report discussed here and was therefore probably unavailable to the authors. The metaanalysis reviewed 33 studies through 2009 and found that testicular microlithiasis was not associated with an increased risk of testicular germ cell tumors in lowrisk, asymptomatic men. It was associated with a very high risk in referral populations. Other studies have reached much the same conclusions for testicular microlithiasis and metachronous testis carcinoma, and testicular microlithiasis in the general population, without any risk factors for testicular carcinoma, most likely does not merit any sonographic follow-up but monthly or bimonthly testicular self-examinations, as in any other young patient of testicular cancer age. The authors do make several comments regarding microlithiasis follow-up in pediatric patients, but they need to make it clearer that their recommendationsif the data support them, and I do not think they doare targeted at the pediatric population.I note also that the authors did not have references after 2002 for testicular microlithiasis and only list 2 references for testicular microlithiasis and testicular cancer. I suggest an update of their references to more recent articles on the importance of testicular microlithiasis and the risk for developing testicular germ cell tumors to more accurately reflect the current thinking of most experts. 3 References 1. Meyer MA, Gilbertson-Dahdal DL. Retroperitoneal extragonadal endodermal sinus tumor with bilateral diffuse classic testicular microlithiasis.

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Section: Replymentioning

confidence: 99%

Extragonadal Tumor and Testicular Microlithiasis

Harris

2011

Journal of Ultrasound in Medicine

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“…An EGCT is by definition a germ cell neoplasm, displaying one of the histologic types associated with gonadal origin, but located outside the gonads [5]. The most widely accepted theory suggests that EGCTs arise from primordial germ cells misplaced during their migration to the gonads [1].…”

Section: Discussionmentioning

confidence: 99%

“…NSGCTs usually have a more aggressive course than seminomatous tumors [1]. Extragonadal nonseminomatous tumors present with an elevated α-fetoprotein or human chorionic gonadotropin level [5]. α-Fetoprotein is produced by endodermal sinus tumors, either alone or in association with other types of germ cell tumors.…”

Section: Discussionmentioning

confidence: 99%

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Incidental Discovery of Testicular Microlithiasis: What Is the Importance of Ultrasound Surveillance Two Case Reports

et al. 2013

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Many studies have demonstrated an association between diffuse bilateral testicular microlithiasis (TM) and gonadal and extragonadal germ cell tumors. Nevertheless, it is still uncertain whether ultrasound surveillance is really necessary in patients with TM in the absence of other risk factors such as previous testicular cancer, a history of cryptorchidism or testicular atrophy. We report the cases of a 33- and a 39-year-old man presenting with a retroperitoneal extragonadal tumor. The first patient underwent an MRI examination in order to rule out a lumbosacral hernia: MRI images showed no slipped disks but a voluminous retroperitoneal solid mass. The histological analysis revealed an immature teratoma. The second patient came to the emergency department complaining of abdominal pain, vomiting, weight loss and mild jaundice: ultrasound examination showed a large, ill-defined heterogeneous abdominal mass, confirmed by CT and MRI examination. The histology diagnosed a yolk sac tumor. In both patients, the testicular sonography was performed to rule out a focal lesion, but it displayed bilateral TM without a focal testicular mass. Based on our direct experience, we highlight the importance of annual ultrasonographic surveillance of the testis and the retroperitoneal space in patients with occasionally detected TM.

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“…The diagnosis of a malignant TT in children during follow up for TM has been reported only 4 times ( Table 1 ) ( 13 - 15 ) . Some other patients had synchronic DB TM and TT (2 years old, YST ( 16 ) ; 16 years old, retroperitoneal YST, no primary detected ( 17 ) ; 17 years old mixed GCT ( 18 )) . Another group reported on an 18 years old Klinefelter syndrome patient with a mediastinal malignant teratoma and DB TM.…”

Section: Discussionmentioning

confidence: 99%

Testis tumor associated to microlithiasis

Jesus¹,

Maciel²,

Monnerat³

et al. 2013

Rev. paul. pediatr.

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OBJECTIVE: To discuss the relationship between testicular microlithiasis and testis tumors in children and to consider the chances of testis preserving surgery in specific cases. CASE DESCRIPTION: Pre-adolescent presenting testicular microlithiasis and a larger left testis, corresponding to a cystic testicular tumor. The tumor was excised, with ipsilateral testis preservation. Histology diagnosed a testis dermoid tumor. COMMENTS: The relationship between testis tumors and testicular microlithiasis is ill defined in children. Pediatric urologists need to develop specific follow-up protocols for pre-pubertal children.

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Retroperitoneal Extragonadal Endodermal Sinus Tumor With Bilateral Diffuse Classic Testicular Microlithiasis

Cited by 11 publications

References 12 publications

Extragonadal Tumor and Testicular Microlithiasis

Extragonadal Tumor and Testicular Microlithiasis

Incidental Discovery of Testicular Microlithiasis: What Is the Importance of Ultrasound Surveillance Two Case Reports

Testis tumor associated to microlithiasis

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