A Conservative Approach to Bilateral Testicular Germ Cell Tumors

Abstract

We report on 6 patients with bilateral testicular germ cell tumors treated by organ sparing surgery. Tumors 6 to 30 mm. in diameter were enucleated, and biopsies of the tumor bed and peripheral parenchyma were taken. Histological examination revealed seminoma in 4 cases, embryonal carcinoma in 1 and a Leydig cell tumor in 1. All patients underwent testicular radiation therapy with 20 Gy. for carcinoma in situ. A testicular biopsy was performed 6 months postoperatively to evaluate therapeutic success. Median followup was 43 months, all patients were free of disease and there was no local recurrence. Luteinizing hormone and testosterone were within the normal range and no androgen substitution was necessary. Our study suggests that organ sparing surgery for bilateral testicular germ cell tumors represents a new therapeutic approach with endocrinological and psychological advantages. In our experience conservative surgery is possible under certain prerequisites, including organ confined tumor without infiltration of the rete testis, obtaining multiple biopsies of the tumor bed and peripheral parenchyma, associated carcinoma in situ treated by radiation therapy and close followup of patients.

Bilateral germ-cell tumours: 22-year experience at the Institut Gustave Roussy

“…It is well known that having a TGCT is the major risk factor for developing a second TGCT in the contralateral testis with the second tumour occurring in 1 -5% of patients (Bokemeyer et al, 1993;Dieckmann et al, 1993Dieckmann et al, , 1999Dieckmann et al, 2002Heidenreich et al, 1995Heidenreich et al, , 1997Heidenreich et al, , 2000Gerl et al, 1997;Tekin et al, 2000;Geczi et al, 2001;Ondrus et al, 2001;Che et al, 2002;Ohyama et al, 2002). The first published series by Gilbert and Hamilton (1942) included 1466 consecutive patients and found an incidence of 1.6%.…”

“…The adjuvant treatments were different and were according to pathological findings and at the physician's discretion. Testis-preserving surgery is more and more widely used for patients with BGCT (Heidenreich et al, 1995(Heidenreich et al, , 1997(Heidenreich et al, , 2000Mearini et al, 1996;Fernandez Aparicio et al, 2000;Kirkali et al, 2001). A 20 Gy irradiation dose to the remaining testis has been reported to be a safe approach (Petersen et al, 2002).…”

“…Several risk factors for developing a TGCT have been identified, uppermost among which is a previous TGCT (Osterlind et al, 1991). The incidence of bilateral testicular germ-cell tumour (BGCT) ranges between 1 and 5% in previously published large series (Bokemeyer et al, 1993;Dieckmann et al, 1993Dieckmann et al, , 1999Dieckmann et al, , 2002Heidenreich et al, 1995Heidenreich et al, , 1997Heidenreich et al, , 2000Gerl et al, 1997;Tekin et al, 2000;Geczi et al, 2001;Ondrus et al, 2001;Che et al, 2002;Ohyama et al, 2002). The charts of 2383 consecutive patients treated at the Institut Gustave Roussy over a 22-year period were analysed to estimate the incidence of BGCT, to identify potential risk factors and to evaluate the long-term survival of patients with BGCT.…”

Metachronous Bilateral Leydig Cell Tumor in a Male Adult Aged 20

“…Furthermore, the patient clearly expressed the desire to remain fertile whenever possible. In the literature, testis-sparing surgery is suggested for unifocal and peripheral testicular tumors which are limited to the organ (without infiltration of the rete testis), and which are !3 cm in size [12,17]. Regular clinical and radiological follow-ups are recommended.…”

Ten-Year Follow-Up in a Boy with Leydig Cell Tumor after Selective Surgery

“…Most authors favor radical inguinal orchiectomy [20], whereas others suggest testis-sparing surgery [5, 21], especially if there is bilateral occurrence [22]. So far long-term outcomes after selective removal of Leydig cell tumors in children are not well known, although in adults recurrence has been reported [23].…”