Treatment of testicular intraepithelial neoplasia (intratubular germ cell neoplasia unspecified) with local radiotherapy or with platinum-based chemotherapy: A survey of the German Testicular Cancer Study Group

Diagnostic work-up of testicular masses should begin with a complete patient history and palpation of the testes with both hands. First-line imaging of the scrotum should be performed using multiparametric ultrasonography, that is the sequential use of grey-scale ultrasonography, colour Doppler ultrasonography (CDUS), and, if available, contrast-enhanced ultrasonography (CEUS) and real-time elastography (RTE). Increased vascularization--a characteristic of malignancy and inflammation--is visualized on CDUS and CEUS. RTE provides additional information for distinguishing between benign and malignant tissue by measuring tissue elasticity of lesions. MRI is another powerful modality, typically used for second-line imaging of intrascrotal disorders. MRI can provide images with a broad field of view of the scrotal contents. Cancerous lesions are identified on MRI by their signal enhancement after injection of contrast agent. Testicular germ cell tumours require treatment by inguinal orchiectomy. Testis-sparing surgery is advocated for benign tumours and in solitary testicles provided the tumour is <3 cm and the preoperative serum testosterone level is normal. For intraoperative decision-making with regard to testis-sparing surgery, frozen section histological examination can be used, which has a false-negative rate of <10%.

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“…If multifocality of GCT is ruled out, 113 adjuvant r adiotherapy is required to treat TIN in the remaining testis. 114 …”

Section: Surgical Exploration Of Testicular Massesmentioning

confidence: 99%

Contemporary diagnostic work-up of testicular germ cell tumours

Dieckmann

Frey

Lock³

2013

Nat Rev Urol

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“…A survey of the German Testicular Cancer Study Group reported a 2.5% failure rate after radiotherapy with a 30.8% of post-treatment hypogonadism, even if 22% of them had received additional chemotherapy [53]. …”

Section: Resultsmentioning

confidence: 99%

“…However, this protocol, which must be considered as experimental, did not take into account that recurrence can be seen even after chemotherapy, which is inactive on intraepithelial neoplasia [53, 55]. This aspect is the major drawback and limitation of this study.…”

Section: Resultsmentioning

confidence: 99%

Synchronous bilateral testis cancer: clinical and oncological management

Campobasso¹,

Ferretti

Frattini³

2017

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Synchronous bilateral testis cancer (SBTC) is a rare event. It represents only 0.5–1% of all new cases of testicular cancer. Patients with this disease require careful management for psychological, oncological, and medical problems.We performed a PubMed search for all series that reported SBTC. We considered only articles in English, reporting on more than three cases. We also performed an analysis of the reported evidence regarding testosterone replacement and surgical treatment.We found 10 studies satisfying inclusion criteria for a total of 73 patients. The majority are bilateral seminoma, which present with a low stage at diagnosis, and mixed histology tumours, both with a good overall survival. On the other hand, cases with bilateral non-seminoma histology are associated with poor prognosis and high stage at presentation.Testis-sparing surgery should be an eligible choice in selected cases, to preserve fertility and avoid testosterone deficiency. Multiple biopsies are recommended in these patients, and in the case of intratubular germ cell neoplasia (ITGCN) presence, scrotal radiotherapy is mandatory. Subcutaneous testosterone pellets guarantee higher patient acceptance and physiological testosterone levels. Lifelong follow-up and psychological support, with special care for infertility and erectile dysfunction, must be considered in this cohort of patients.

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“…6,8 Reduced response of TIN to chemotherapy compared with invasive testicular cancer is probably due to a genetically determined lower sensitivity, but the blood-testis barrier might also contribute to this phenomenon. 9 During early embryogenesis, primitive germ cells migrate from the yolk sac down to the dorsal mesentery of the hind gut and to the urogenital ridge, and they aggregate in the scrotum. Displacement and malignant transformation of germinal epithelium during midline migration of the body is one hypothesis for the development of EGCT; persistence of pluripotential cells in various organs differentiating to malignant germ cells represents another possible explanation.…”

Section: Discussionmentioning

confidence: 99%