No abstract

Background Primary pure angiosarcoma of the testis is an exceptionally rare testicular malignancy, which is poorly understood. We present the fifth and youngest case in the current medical literature. Additionally, all cases of angiosarcoma of the testicle, both occurring with associated germ cell tumour and without, were compared in an extended tabular format. Case presentation A 56-year old man presented with unilateral scrotal pain, swelling and erythema. Ultrasonography revealed two testicular lesions with a high suspicion of malignancy but serum tumour markers were negative. A radical orchidectomy was performed with clear surgical margins. Diagnosis of primary pure angiosarcoma of the testis was confirmed on subsequent histopathology. Conclusions Primary pure angiosarcoma is a rare testicular neoplasm. We present the fifth case in the literature. Clinical and radiological features are non-specific. The diagnosis is purely histological, with the pathologist choosing immunohistochemistry based on abnormal morphology. Local invasiveness is variable but metastatic sites are typical for extra-gonadal angiosarcomas. Primary pure testicular angiosarcoma diagnosis confers a relatively better prognosis compared to angiosarcoma arising in the context of a testicular germ cell tumour. While extra-gonadal angiosarcomas are associated with high rates of local recurrence following resection, in all cases of testicular angiosarcoma there were no local recurrences following radical orchidectomy. Surgical resection remains the most effective treatment for both subtypes of testicular angiosarcoma.

Over the last decade, a vast YouTube-based ‘market’ of child-produced content involving sexualised behaviour has developed. Children-performers produce videos featuring implicit sexual imagery to satisfy the demands of an adult fan base, and in exchange for a digital reward. We first report the discovery of several YouTube keywords leading to such content, outlining their remarkable interconnectedness via analysis of search trends over the last decade. Following, we investigate audience-child interactions by semantic analysis of n=1398 comments mined from n=30 videos, revealing the occurrence of collective grooming. We then demonstrate how this phenomenon is sustained and enhanced by YouTube search algorithms. Following, we detail a model framework to contextualise our findings. Finally, we propose specific amendments to the 2018 Online Harms White Paper that might tackle this phenomenon. Our results reveal a new form of child abuse, as of yet undescribed, wherein the core features of online grooming are translated to social media, the fundamental principles of which act as a powerful incentive. Because the victim’s manipulation is enacted collectively, we believe that responsibility ultimately rests with society as a whole. The principal aim here is to raise awareness of this issue, in an attempt to kick-start discussion of its causes, implications and potential solutions.