The Prognosis of Sarcoma of the Testicle

Abstract

It sometimes requires a personal interest to stimulate a real effort to find out the facts about a given surgical problem. Recently we operated on a case of sarcoma of the testicle and it happened that "the case" was an intimate friend of one of the writers. We had seen the tumor when it was quite small and had made a diagnosis of tuberculous epididymitis. This diagnosis was based on the fact that apparently the epididymis was involved and not the testicle proper, and that small nodules were present in the other epididymis and in one of the seminal vesicles. It was further substantiated by the presence of a quiescent tuberculous focus in the apex of one lung. Two prominent genitourinary specialists confirmed the diagnosis and two tuberculosis specialists accepted the diagnosis without question.These facts are mentioned because our further investigations showed that similar mistakes occasionally occur and that the reason is that the text-books usually state that sarcoma does not begin in the epididymis. We have found cases which show that this is not a fact.Eventually the testicle was removed-nine months after the lesion was first noticed and when the tumor was the size of a small lemon.Fortunately we had begun to suspect sarcoma, and removed the entire contents of the scrotum from the internal ring down, without attempting exploration, which might have spread the disease. On section the epididymis and testicle were almost wholly replaced by the growth, a portion only of the testicle being compressed to one side. Nevertheless, the disease had not passed the tunica albugínea anywhere and was perfectly encapsulated. Therefore on the whole the conditions were more favorable than usual, for it was fairly early, no obvious metastasis or local extension had taken place, and neither tapping nor exploration had been given their opportunity to spread the disease.What are the chances for this patient? Here is what prominent text-books say in regard to the matter. Watson and Cunningham say :' ' The operation to be of any value and tr offer any hope of cure must be done early and must include the cord, the inguinal lymph nodes and also the deeper abdominal chain."Bevan in Keen's Surgery says: "The prognosis is bad. I have never seen a permanent cure, even after fairly early and complete castration." Bonney gives the most hopeful statement in regard to our patient. He says : " It is only when the tumor is still confined within the tunica albugínea that there is any hope of cure." Guiteras remarks vaguely but probably truly that the "prognosis depends almost entirely on the presence or absence of metastatic involvement of the abdominal glands." Greene-Brooks offers slightly more hope in saying that "early removal generally warrants a better prognosis than in most cases of sarcoma elsewhere. ' ' In regard to origin, Watson and Cunningham say that the disease rarely begins in the epididymis. From other authors we gather little information that this is even a possibility.In all the books the classical differentiation is between...

The Histogenesis of Malignant Tumors of the Testicle

“…In the literature since the appearance of Ewing's article there have been reports of sarcoma by Fata,2 Stokes,3 Codman and Sheldon, 4 Leuzzi,5 Petit de la Villéon,6 Smith,7 Lister,8 Grant,9 Aguirre,10 Fansler j11 of perithelioma by Nizzi12 and by Brandeis ;13 of hypernephroma by Thompson;14 of fibroma by Lardennois and Lecène,15 by Makins,16 and by Boyer,17 and of fibrolipoma by Baldwin.18 In most of these, the microscopic description is too incomplete to permit critical study, but all are probably epithelial tumors except the fibromas and the fibro¬ lipoma. The reported fibromas are apparently pure tumors derived from the tunic of the testis.…”