Scrotal recurrence of germ cell tumour in a non-violated scrotum

Abstract

Testicular cancer is the most common cancer diagnosis in males aged 15-30 years. For over a century, radical inguinal orchiectomy has been the standard of care for initial treatment of testicular cancer. This approach is preferred over trans-scrotal interventions, in an effort to avoid tumour seeding, spermatic cord invasion, and disturbance to lymphatic drainage. Scrotal violation is defined as any trans-scrotal intervention that may impact spread of disease in testicular cancer, including scrotal orchiectomy, fine-needle aspiration, and testicular biopsy. Studies have shown statistically significant differences in local recurrence rates between patients who undergo the standard inguinal surgical approach and cases with scrotal violation.Over 95% of testicular cancers are curative, often with surgery alone. Recurrence of disease is divided into two categories: local and distant sites. Local recurrence of testicular cancer involves the scrotal and inguinal regions, including superficial inguinal lymph nodes. More commonly, local recurrence is seen in cases of testicular cancer with scrotal violation. We describe a case of local recurrence of testicular cancer in a non-violated scrotum, a finding that has not been previously reported in the literature.

Case of testicular nonseminomatous germ cell tumor cancer soft tissue seeding after inguinal orchiectomy

“…Our case report and others 5 demonstrates the ability of testicular GCT to seed soft tissues when the tumor is violated. This case and other recently reported cases demonstrate two points to highlight, 1) GCT can seed tissues and 2) violation of oncologic principles is likely more important than surgical approach (open vs minimally invasive).…”

A Rare Case of Ipsilateral Scrotal Recurrence of Testicular Cancer After Radical Orchidectomy

“…Similarly, Li et al [10] presented a case of a local recurrence of testicular cancer in a non-violated scrotum.…”

Testis Sparing Surgery in Pediatric Testicular Tumors

“…If the tumor is restricted to one testicle, the standard of care has been a radical inguinal orchiectomy (RIO) of the affected testis [ 8 , 9 ]. Trans-scrotal intervention of any type, including fine-needle aspiration, open testicular biopsy, and scrotal orchiectomy, is often referred to as scrotal violation, which causes increased rates of local recurrence compared to RIO [ 10 , 11 , 12 ]. Testis sparing surgery (TSS) is increasingly being considered as an alternative surgical treatment strategy.…”