Testicular seminoma with pagetoid spread into the vas deferens: A rare histopathological presentation

Andrologia ◽  
2021 ◽  
Author(s):  
Francesca Ambrosini ◽  
Andrea Di Stasio ◽  
Tiziana Borra ◽  
Barbara Cavallone ◽  
Carlo Terrone ◽  
...  
Author(s):  
Thomas Charles

Objective: Evaluation of the efficacy of robotic vasovasostomy post-vasectomy. Patients and methods: We present a retrospective study of four patients aged from 36 to 51 years, who were operated of a vasovasostomy between September 2007 to July 2009. The same surgeon performed a robotic-assisted vasovasostomy, bilateral for three of them and only left unilateral for the last patient who underwent orchidectomy for right testicular seminoma. These patients had a preoperative semen analysis confirmed the absence of sperm after vasectomy. All patients had an outcome of spermatozoa on testicular deferens side in per-operative. The permeability of the distal vas deferens was systematically checked. The success criterion was the presence of spermatozoa in semen control three months. The paternity post vasovasostomy without medically assisted procreation due to father sterility was a secondary endpoint. Results: Four patients had between 0.6 and 27 million sperm per mL in postoperative semen analysis. Three to seventeenth months after the vasovasostomy, the wives of four patients have started a pregnancy between. Conclusion: The robotic vasovasostomy surgery is a technique that enabled this small group of patients having good results in regard to deferential recanalization and to recovery of secondary spontaneous fertility. A larger cohort needs to be evaluated. The medical and economical aspects of this method should be compared to those of usual technics, in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).


Author(s):  
D. Marsh

As a result of vasectomy, spermatozoa are confined to the epididymis and vas deferens, where they degenerate, releasing antigens that enter the circulation or are engulfed by macrophages. Multiple antigens of the sperm can elicit production of autoantibodies; circulating anti-sperm antibodies are found in a large percentage of vasectomized men, indicating the immunogenicity of the sperm. The increased prevalence of macrophages in the liomen of the rhesus monkey testicular efferent ducts after vasectomy led to further study of this region. Frozen sections were used for evaluation of immunopathological status by fluorescence microscopy with fluorescein-conjugated antibody. Subsequent granular deposits of immune complexes were revealed by positive immunofluorescence staining for complement. The immune complex deposition in the basement membrane surrounding the efferent ducts implies that this region is involved in antigen leakage (Fig. 1).


Author(s):  
Kazuma Nakano ◽  
Gen Sukegawa ◽  
Yuji Tsuji
Keyword(s):  

Medicine ◽  
2019 ◽  
Vol 98 (11) ◽  
pp. e14843 ◽  
Author(s):  
Jigang Jing ◽  
Hua Zhuang ◽  
Yan Luo ◽  
Huijiao Chen ◽  
Yaping Rao
Keyword(s):  

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Kaitlin J. Mayne ◽  
Emma Lewis ◽  
Lewis Vickers

Abstract Background Clinical guidelines do not recommend further investigation for occult malignancy in the scenario of unprovoked venous thromboembolism in the absence of additional clinical features suggestive of malignancy. We present the case of a young gentleman with pulmonary embolism who was diagnosed with testicular seminoma despite lack of symptoms or signs suggestive of malignancy. This is a unique case describing a scenario not well documented in existing literature where contravention of clinical guidelines had a potentially advantageous outcome for the patient. Case presentation A 37-year-old white male presented with seemingly unprovoked acute pulmonary embolism with right heart strain. He did not have any predisposing factors for venous thromboembolism and did not have any symptoms or signs suggestive of malignancy. Clinical guidelines do not recommend further investigation to screen for malignancy in this scenario. Despite this, our young, otherwise healthy patient proceeded to computed tomography scanning, resulting in the diagnosis of localized testicular seminoma. Testicular ultrasound described normal-sized testes (despite a discrete lesion in the right testis), suggesting this was not detectable by the patient or clinician on routine examination. The patient was anticoagulated and had an inferior vena cava filter inserted to facilitate orchidectomy followed by adjuvant radiotherapy. Conclusions This case highlights the importance of considering malignancy in seemingly unprovoked venous thromboembolism and the availability of guidelines to direct further investigation. Our patient’s treatment was not in line with clinical guidelines and was considered a “lucky find.”


2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii282-iii282
Author(s):  
Rafael Moleron ◽  
Sara Stoneham ◽  
Thankamma Ajithkumar ◽  
Justin Cross ◽  
James Nicholson ◽  
...  

Abstract INTRODUCTION Patients with localised CNS-germinoma have excellent survival. More recently, intensive inpatient chemotherapy (carboPEI=carboplatin/etoposide/ifosfamide in Europe) has been effectively employed to reduce radiotherapy fields and/or dose. Current research priorities focus on reducing treatment burden and long-term sequelae. Of note, outpatient-based single-agent carboplatin chemotherapy is associated with excellent outcomes in metastatic testicular seminoma (an identical pathology) [Alifrangis,EJC,2020]. Recently, successful vinblastine monotherapy was reported in localised CNS-germinoma [Murray,Neurooncol-Adv,2020]. METHODS Due to the COVID-19 pandemic, adapted UK guidelines for germ-cell-tumour management were distributed, including potential non-standard treatment options that would reduce hospital visits/admissions. A 30-year-old patient presented with a 32mmx30mmx35mm diameter solid+multi-cystic localised pineal CNS lesion, consistent radiologically with a germ-cell-tumour with prominent teratoma component. Investigation revealed negative AFP/HCG markers and biopsy-proven pure germinoma. After appropriate consent, the patient commenced 12-week induction with weekly vinblastine monotherapy (low-grade-glioma dosing [Lassaletta,JCO,2016]), with wk6&12 MRI re-assessment prior to definitive radiotherapy. RESULTS Vinblastine was well-tolerated. After initial 4mg/m2 test-dosing (wk1), standard 6mg/m2 was delivered for wk2, but resulted in asymptomatic neutropenia (nadir 0.3x10^9/l) and missed dosing at wk3. Subsequent doses were 4mg/m2, with no further neutropenia. As expected, MRI showed moderate 40% tumour volume reduction by wk12. Surgical resection of the residual presumed teratoma component was undertaken prior to radiotherapy. CONCLUSION Patients with CNS-germinoma have excellent outcomes and reduction of treatment-effects remains a priority. The exquisite chemosensitivity of germinoma, excellent results from monotherapy for metastatic testicular disease, and early promise of vinblastine monotherapy lend itself to further exploration for CNS-germinoma.


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