Onco-testicular sperm extraction (Onco-TESE) from a single testis with metachronous bilateral testicular cancer: a case report

Abstract

BackgroundAlthough oncologic testicular sperm extraction (onco-TESE) has been increasingly practiced, the evidence of onco-TESE performed in patients with testicular cancer is insufficient. Furthermore, in bilateral testicular cancer, accounting for 0.5%–1% of testicular cancers, onco-TESE is more challenging and has been insufficiently reported.Case presentationHere we report the case of a 25-year-old man who underwent onco-TESE from his residual single testis with a nonseminomatous germ cell tumor that occurred 5 years after orchiectomy of the contralateral testis. A second orchiectomy and simultaneous TESE from the noncancerous testicular tissue were performed. The pathological diagnosis was germ cell tumors, tumors of more than one histological type (embryonal carcinoma, immature teratoma, yolk sac tumor, seminoma, and choriocarcinoma; pT1N0M0). The patient subsequently married and hoped for fatherhood 3 years later. Whereas histological diagnosis of the normal testicular tissue was Johnsen score 6 (maturation arrest), morphologically normal and motile sperms were successfully retrieved from thawed TESE samples and used for multiple cycles of intracytoplasmic sperm injection. Although the conception has not been succeeded to date, ICSI attempts have been continuing.ConclusionThis case demonstrates the effectiveness of onco-TESE for challenging cases such as bilateral and nonseminmatous testicular cancer.

Differences in semen characteristics between patients with testicular cancer and other malignancies using various cut‐off values

“…The resection of normal testicular tissue was macroscopically carried out immediately after the orchiectomy. Morphologically normal and motile sperm were successfully retrieved from the thawed TESE samples and used for multiple cycles of ICSI, although conception has not been achieved to date . This case might suggest the clinical implication of onco‐TESE for TC patients with azoospermia before cancer treatment.…”

Testicular sperm extraction (TESE) outcomes in the context of malignant disease: a systematic review

“…Eleven retrospective studies 26 29 30 31 32 33 34 35 36 37 38 and 8 case reports or case series 39 40 41 42 43 44 45 46 reported results for postgonadotoxic treatment TESE. The case reports and case series mainly reported TESEs that allowed for spermatozoa retrieval, while the retrospective studies reported between 33.3% and 76.2% positive TESEs ( Table 3 ).…”

A case of congenital single testis with testicular cancer patient and azoospermia who was able to collect spermatozoa with ipsilateral Onco‐TESE

“…16 However, assisted reproductive technology has improved in recent years, and these patients may be able to preserve their fertility using cryopreserved sperm. 17,18 Several groups 6,[19][20][21] have reported that Onco-TESE is possible in patients with azoospermia and testicular cancer, which may allow the cryopreserved sperm to be used with assisted reproduction to achieve the birth of a healthy baby. However, we are not aware of any reports that have described this strategy in a patient with testicular cancer involving a congenital single testis.…”