1/11. Malignant mesothelioma of the tunica vaginalis: a case with an unusually indolent course following radical orchidectomy and radiotherapy.Malignant mesothelioma (malignant adenomatoid tumour) of the tunica vaginalis testis is a very rare neoplasm with highly aggressive biological behaviour. Treatment is difficult, and widespread local invasion and/or metastatic disease at presentation are associated with a poor prognosis. In this case report we describe for the first time a patient who, despite presenting with locally advanced disease, remains well 10 years after diagnosis and treatment with radical orchidectomy and high dose radiotherapy.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
2/11. Solitary delayed contralateral testicular metastasis from renal cell carcinoma.We report a 60 year old male presenting with contralateral testicular metastasis 7 years following radical nephrectomy for renal cell carcinoma. Testicular metastases from renal cell carcinoma reported in literature are predominantly ipsilateral and invariably on the left side. Usually these are present simultaneously with the renal primary or precede the diagnosis of renal tumors. Delayed contralateral testicular metastatic has not been reported to the best of our knowledge. The case highlights the unique behaviour of renal cell carcinoma with an unusual site of recurrence. The clinical presentation, pathogenesis and management of this rare presentation along with review of recent literature are discussed.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
3/11. Malignant Sertoli cell tumour--a case report.Sertoli cell tumours are rare sexcord stromal tumours of testis. Malignant behaviour is observed in one tenth of such tumours. A malignant sertoli cell tumour is reported here in a 70 years old man. The tumour was of large size and showed necrosis, marked celllar pleomorphism, and mitotic figures.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
4/11. Testicular sertoli cell tumours and relative sub-types. Analysis of clinical and prognostic features.INTRODUCTION: Sertoli cell tumours have a rare (0.4-1.5% of all testicular neoplasms) and heterogeneous pathology. The aim of this paper is to analyse the histological classification of Sertoli cell tumours, in order to assess if the three different histotypes--classic type, large cell calcifying Sertoli cell tumour (LCCSCT) and sclerosing Sertoli cell tumour (SSCT)--really present distinctive clinical and prognostic features. MATERIALS AND methods: The current literature was reviewed; Sertoli cell tumour clinical series and single case reports were searched and analysed. Hence, more than 200 classic Sertoli cell tumours, 48 LCCSCTs and only 12 SSCTs were found. The thirteenth SSCT has been found by us in a 34-year-old man. RESULTS: Every single sub-type presents clinical specific characteristics regarding age of onset, bilaterality, focality, abnormal hormone production, correlated systemic symptoms. Ultrasonographic findings, size and--above all--malignant potential. CONCLUSIONS: The precise classification of these tumours is not important only histologically: the currently recognised variants really differ in clinical presentation and course. Moreover, LCCSCTs can be further divided in two subgroups with very different clinical behaviour, those in older patients and those associated with well-known syndromes. These clinical and prognostic variables are of great importance when deciding on the therapeutical approach.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
5/11. testis sparing enucleation of a Leydig-cell tumour in a boy.Testicular tumours are very rare in paediatric age, accounting only for 1% of all paediatric tumours. Testicular tumours can originate either from germ cells (77.4%) or from stromal cells (7.1%) or from other cells. Leydig-cell tumours account for 1% of all testicular tumours and 39% of gonadal stromal tumours and in the prepubertal male are responsible for causing precocious pseudopuberty. In the past, orchiectomy has been considered the treatment of choice, but in consideration of the fact that Leydig Cell tumours in children invariably show a benign behaviour, in recent years some authors have suggested a more conservative approach. In the herein reported case, a decision was made to simply enucleate the tumour leaving the testis. After one year, imaging shows a normal testis with no sign of recurrence.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
6/11. Testicular sex cord-stromal tumours: the Edinburgh experience 1988-2002, and a review of the literature.AIMS: sex cord-stromal tumours of the testis are uncommon tumours, accounting for around 5% of testicular neoplasms. Treatment is primarily surgical, with no adjuvant therapy of proven benefit. We present a single-centre experience over a period of 15 years. MATERIALS AND methods: From 1988 to 2002, 18 patients with a diagnosis of sex cord-stromal tumour were referred to our centre. A retrospective analysis of their case notes was made and a pathological review undertaken. RESULTS: Sixteen were Leydig-cell tumours and two were Sertoli cell. For the Leydig-cell tumours, the median age at presentation was 42 years, 50% presented with a testicular mass and 31% with gynaecomastia. Two patients followed a malignant course: one revealing disease dissemination at initial staging, and a second 12 months after potentially curative orchidectomy. Salvage retroperitoneal lymphadenectomy in the latter patient proved unsuccessful. Clinical outcome correlated strongly with the presence of adverse pathological features described previously in the literature. After a median follow-up of 46 months, two patients have developed progressive disease, and two patients have died, one of metastatic Leydig-cell tumour. No patient defined as being of low malignant potential on pathological examination has relapsed outside our review period of 2 years. CONCLUSION: We confirm the overall excellent prognosis for most of the patients with sex cord-stromal tumours of the testis. Compared with most previous reports, pathological features seem to predict with reasonable accuracy the risk of malignant behaviour, and can adequately inform the subsequent review policy.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
7/11. Extra-renal Wilms' tumour--is it different?Nephroblastomas (Wilms' tumour) are the most common solid malignancies in childhood, but extra-renal Wilms' tumours are rare entities, and the diagnosis is made only after surgical intervention. However, the embryogenesis and the exact mechanism of occurrence of primary ERWTs is controversial, thereby presenting a number of unanswered questions of great theoretical interests. We present three well-proven cases of extra-renal Wilms' tumour together with a review of the literature based on its histogenesis, its behaviour and its management policies.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
8/11. Testicular sex cord stromal tumour with granulosa cell differentiation: detection of steroid hormone receptors as a possible basis for tumour development and therapeutic management.A testicular sex cord stromal tumour with granulosa cell differentiation, typical of granulosa cell tumours of the adult type, was investigated immunohistologically on snap frozen and paraffin wax embedded material. The predominance of vimentin and the additional expression of cytokeratin subtypes 8 and 18, as well as the negative staining for epithelial membrane antigen, accorded with results previously reported, for ovarian granulosa cell tumours; the lack of expression of desmoplakin, however, was a distinctive feature. Together with negative staining for leucocyte common antigen, the antigen pattern facilitates the differential diagnosis between granulosa cell tumour and undifferentiated carcinoma or gonadal lymphoma, although its suitability for differentiating within the group of gonadal stromal tumours seems to be limited. The small growth fraction, shown by the monoclonal antibody Ki-67, is typical of the clinical behaviour of granulosa cell tumours. The expression of oestrogen and progesterone receptors, also recently found in testicular Leydig cell tumours, may provoke new approaches to the management of testicular granulosa cell tumours, as well as a new hypothesis on the development of these tumours.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
9/11. Paratesticular rhabdomyosarcoma in adult patients: 16-year experience at Institut Gustave-Roussy.BACKGROUND: Children with paratesticular rhabdomyosarcoma (RMS) have both a good prognosis and a high survival rate. The clinical behaviour and outcome of the disease in adults is not well described. patients AND methods: We reviewed retrospectively our experience with paratesticular RMS in patients older than 16 years during a 16-year period (1975-1991). RESULTS: Thirteen adult patients with paratesticular RMS are reported. Median age was 21 years (range 16 to 31). Presentation characteristics were scrotal mass in 11 cases, lumbar pain and weight loss in 5 cases, hypercalcemia in 3 cases and thrombocytopenia in 3 cases. There were 5 patients with stage IV, 2 with stage IIB and 6 with stage IA (IRS classification). The 5 stage IV patients are reported in detail, with initial bone marrow infiltration encountered in 4 of them. Objective response to chemotherapy was achieved in all 6 patients with measurable disease (2 CR 4 PR). Two of 7 patients who received adjuvant chemotherapy relapsed at 7 and 11 months. After a median follow-up of 90 months, 8 patients (5 stage IV, 3 stage IA) died from disease progression. CONCLUSION: Metastatic disease with bone marrow involvement at presentation and aggressive behaviour seem to be more relevant in adult paratesticular RMS patients compared with children.- - - - - - - - - - ranking = 2keywords = behaviour (Clic here for more details about this article) |
10/11. Continuing clozapine despite neutropenia.BACKGROUND: A 40-year-old chronic schizophrenic patient whose psychosis and associated violent behaviour resolved on clozapine, required chemotherapy for a testicular teratoma with pulmonary metastases. His treatment was initially delayed due to refusal to consent. TREATMENT: The patient finally agreed to orchidectomy and cytotoxic therapy, and following agreement by the CPMS, clozapine continued to be dispensed despite neutropenia and 'red alert' status on full blood count. DISCUSSION: This is the only patient to continue clozapine despite 'red alert' status, and as such is an exceptional case, but may open the way for such patients in the future.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
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