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Seminoma

Testicular cancer is a type of cancer that develops in the testicles, a part of the male reproductive system. In the United States, about 8,000 to 9,000 diagnoses of testicular cancer are made each year. Over his lifetime, a man's chance of getting testicular cancer is roughly 1 in 250 (four tenths of one percent). It is most common among males aged 15–40 years. Testicular cancer has one of the highest cure rates of all cancers: in excess of ninety percent; essentially one hundred percent if it has not spread. more...

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Medicines

Even for the relatively few cases in which the cancer has spread widely, chemotherapy offers a cure rate of at least fifty percent.

Symptoms and early detection

Because testicular cancer is curable when detected early, experts recommend regular monthly testicular self-examination after a hot shower, when the scrotum is looser. Men should examine each testicle, first feeling for lumps and then compare the testicles to each other together to see whether one is larger than the other.

Symptoms may include one or more of the following:

  • a lump in one testicle
  • pain and tenderness in the testicles
  • blood in semen during ejaculation
  • build-up of fluid in the scrotum
  • enlargement or tenderness of breasts
  • a dull ache in the lower abdomen or groin
  • an increase, or significant decrease, in the size of one testicle.

Men should report any of these to a doctor as soon as possible.

The extent of testicular cancer and whether the cancer is present are ascertained by ultrasound (of the testicles), X-rays, and/or CT-scans, which are used to locate tumors. For nonseminomas (see below), a blood test is used to identify and measure tumor indicators that are specific to that type of testicular cancer.

Pathology

Testicular cancer can be caused by any type of cell found in the testes, but more than 95% of all cancers are from germ cells. (Germ cells produce sperm. They are not pathogenic; i.e., they are not to be confused with the "germs" (viruses, bacteria) that cause illness.) In general, the remainder of this article discusses germ-cell testicular cancer.

Germ-cell tumors are classified as either seminomas or nonseminomas. Seminomas are slow-growing, immature germ cells. Seminomas, when found, tend to be localized (i.e., only in the testicles), simply because they spread relatively slowly. Nonseminomas, on the other hand, are more-mature germ cells and spread more quickly. (Nonseminomas are classified as one of three or four subtypes; their rate of spread varies somewhat, but they are treated similarly.) When seminomas and nonseminomas are both present (which is not unusual), the cancer is classified as nonseminoma.

A case of testicular cancer is categorized as being in one of three stages (which have subclassifications). Stage one is that in which the cancer remains localized to the testicle. In stage two, the cancer has spread to the nearest lymph nodes, which are small, bean-shaped structures that produce and store infection-fighting cells, in the abdomen. In stage three, the cancer has spread farther, to locations that may include the kidneys, liver, bones, lungs, or brain. The majority of cases are stage 1 when first identified; stage 3 is relatively rare.

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Lepromatous orchitis associated with seminoma
From International Journal of Leprosy and Other Mycobacterial Diseases, 9/1/98 by Ebenezer, Gigi J

Testicular involvement in leprosy is well known. Atrophy of the testes is a fairly common condition in patients with lepromatous leprosy. Acute painful orchitis is the most common sign of testicular damage in leprosy and usually occurs during a type 2 reaction. Azoospermia and sterility have also been known to occur in patients with leprosy. 1-3 We came across a borderline lepromatous leprosy patient who presented with a hard painful swelling of the scrotum that was diagnosed as a seminoma. Examination of the histopathological sections of this tumor displayed some interesting features that are reported in this paper.

CASE REPORT

A 64-year-old man presented with painful swelling of the right scrotum of 1-year duration. A year earlier he was diagnosed as having borderline lepromatous leprosy with skin smears showing an average bacterial index (BI) of 3.25+ for acid-- fast bacilli (AFB). A chest X-ray showed evidence of pulmonary tuberculosis and three consecutive sputum examinations were consistently positive for AFB. An ELISA for HIV antibody was negative.

Examination of the scrotum showed a hard swelling posterior to the right testis with minimal hydrocele. A high orchidectomy was done and the excised tissue was sent for histopathological examination.

The testis showed atrophied and hyalinized seminiferous tubules with interstitial tissue infiltrated by lymphocytes and foamy macrophages which on acid-fast staining showed intracellular bacilli. The nerves coursing the testicular tissue also showed many acid-fast organisms (Fig. 1). Histologically the tumor showed the characteristic appearance of a seminoma (Fig. 2). The tumor cells infiltrated blood vessels and nerves, and tumor emboli were seen within the lymphatics. Granulomatous inflammation composed of epithelioid cells, lymphocytes and Langhans' giant cells was also seen in the tumor (Fig. 3). A diagnosis of borderline lepromatous leprosy with borderline lepromatous orchitis, pulmonary tuberculosis and seminoma was made.

DISCUSSION

Orchitis, a complication of lepromatous infection, consists of tubular atrophy and sclerosis resulting from diffuse interstitial infiltration of foamy macrophages.4 The granulomatous inflammatory infiltrate found in the tumor composed of epithelioid cells, lymphocytes and Langhan's giant cells could very well be a feature of the seminoma.5 Since Mycobacterium leprae were found in the nerve coursing through the tumor and in the granuloma, the organisms are most probably part of the borderline lepromatous disease in this patient. This case is presented because it is a rare instance of borderline lepromatous leprosy with associated lepromatous orchitis and seminoma.

1 Job, C. K. Gynaecomastia and leprous orchitis; a preliminary study. Int. J. Lepr. 29 (1961) 423-441.

2 Kumar, B., Raina, A., Kaur, S., Dash, R. J., Samuel, E. and Daka, B. N. Clinicopathological study of testicular involvement in leprosy. Lepr. India 54 (1982) 48-55.

3 Nigam, P., Mukhija, R. D., Kapoor, K. K., Kumar, A., Sarkari, N. B. S., Gupta, A. K. and Mishra, S. D. Male gonads in leprosy-a clinicopathological study. Indian J. Lepr. 60 (1988) 77-83.

4 Ridley, D. S. and Job, C. K. The pathology of leprosy. In: Leprosy. 2nd edn. Hastings, R. C., ed. Edinburgh: Churchill Livingstone, 1994, p. 217.

5 Wee, Y. Q., Hang, Z. B. and Liu, K. F. In situ observation of inflammatory cell-tumor cell interaction in human seminomas (germinomas); light, electron microscopic, and immunohistochemical study. Hum. Pathol. 23 (1992) 421-428.

-Gigi J. Ebenezer, M.D.

Head

Department of Histopathology

Schieffelin Leprosy Research and Training Center

Karigiri 632 106, Vellore District

Tamil Nadu, India

-Lionel Gnanaraj, M.S., M.Ch.

Reader

Department of Urology

Christian Medical College and Hospital

Vellore 632 004

Tamil Nadu, India

-Mannam Ebenezer, M.S.

Associate Surgeon

Department of Surgery

Charles K. Job, M.D.,

F.R.C.Path., F.A.M.S.

Emeritus Scientist

Schieffelin Leprosy Research and

Training Center

Karigiri 632106, Vellore District

Tamil Nadu, India

Copyright International Leprosy Association Sep 1998
Provided by ProQuest Information and Learning Company. All rights Reserved

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