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Bilateral Seminoma 34 Years After Orchiopexy
Vol. 118, November Printed in U.SA.
THE JOURNAL OF UROLOGY
Copyright © 1977 by The Williams & Wilkins Co.
BILATERAL SEMINOMA 34 YEARS AFTER ORCHIOPEXY RICARDO ANGULO, LUIS CABALLERO
AND
PEDRO MEJIA
From the Urology Service, Naval Medical Center, Callao, Peru
ABSTRACT
A case of bilateral seminoma in a 59-year-old patient who had undergone bilateral orchiopexy 34 years previously is presented. To our knowledge this is the longest interval between an orchiopexy and diagnosis of bilateral malignancy. A 59-year-old patient was hospitalized with a 4-month history of progressive bilateral testicular enlargement associated with mild pain. Bilateral orchiopexy had been done when he was 25 years old. Physical examination revealed bilateral testicular enlargement, with an irregular surface and hard consistency (part A of figure). The prostate was within normal limits. Complete blood count, urinalysis and chest x-ray were normal. Bilateral orchiectomy was done on November 29, 1973. The pathology report was bilateral testicular seminoma (part B of figure). Cobalt therapy, consisting of 2,500R, was given to the retroperitoneal, mediastinal and supraclavicular nodes. Excretory urography and chest x-ray were normal in June 1974 and in March 1977. DISCUSSION
From a review of the literature we noted that several authors agree on the influence of cryptorchidism upon testicular tumors when the orchiopexy is performed after the patient is 5 years old. In biopsies of 42 undescended and contralateral normal testes Robinson and Engle found that the development of the seminiferous tubules was impaired in the undescended testes beginning at age 5 years. 1 From 20 biopsies of surgically descended testes only 1 was normal. Martin and Menck confirmed these findings. 2 Grove found that of 1,422 malignant testicular tumors 11.6 per cent originated from undescended testicles. 3 In a report on the incidence of testicular tumors in patients who underwent orchiopexy Sumner noted that the average age at which orchiopexy was done was 13 years. 4 He also reported on a patient who underwent orchiopexy at age 14 years. A right testicular seminoma was discovered 23 years after the bilateral orchiopexy as well as a teratocarcinoma of the left testis 4 years later. Altman and Malament believe that testicular atrophy predisposes metaplasia and emphasize that tumor development is enhanced by testicular atrophy. 5 Gehring and associates reviewed 37 cases of tumors associated with undescended testes and did not find testicular tumors in patients who had undergone orchiopexy before they were 6 years old. 6 Rioult and associates reported a case of testicular tumor 23 years after orchiopexy, which had been done when the patient was 7 years old. 7 Jimenes reported 6 cases of tumors following late orchiopexy. 8 Hinman presented a case of testicular tumor 31 years after unilateral orchiopexy and recommends that biopsy of the undescended testicle at the time of orchiopexy will help to determine potential fertility. 9 We agree with Campbell and Harrison, 10 who suggest that orchiopexy be performed before the patient is 5 years old, since Accepted for publication June 10, 1977.
882
we are convinced that late orchiopexy predisposes to atrophy and malignancy. Our case is noteworthy because bilateral orchiopexy was done when the patient was 25 years old and simultaneous bilateral seminoma occurred 34 years later, the longest interval reported to date. REFERENCES
1. Robinson, J. N. and Engle, E. T.: Some observations on the
cryptorchid testis. J. Urol., 71: 726, 1954. 2. Martin, D. C. and Menck, H. R.: The undescended testis: management after puberty. J. Urol., 114: 77, 1975. 3. Grove, J. S.: The cryptorchid problem. J. Urol., 71: 735, 1954. 4. Sumner, W. A.: Malignant tumor of testis occurring 29 years after orchiopexy: case report and review of the literature. J. Urol., 81: 150, 1959. 5. Altman, B. L. and Malament, M.: Carcinoma of the testis following orchiopexy. J. Urol., 97: 498, 1967. 6. Gehring, G. G., Rodriguez, F. R. and Woodhead, D. M.: Malignant degeneration of cryptorchid testes following orchiopexy. J. Urol., 112: 354, 1974. 7. Rioult, J., Colin, G. and Bauchart, J.: Le cancer du testicule apres orchidopexie. Ann. d'Urol., 5: 193, 1971. 8. Jimenes, J. F.: Criptorquidia y tumor de testiculo. Anales de la Fundaci6n Puigvert., 6: 90, 1976. 9. Hinman, F.: Panel discussion: anomalies of external genitalia in infancy and childhood. J. Urol., 93: 1, 1965. 10. Campbell, M. F. and Harrison, J. H.: Urology, 3rd ed. Philadelphia: W. B. Saunders Co., vol. 2, p. 1639, 1970.
THE JOURNAL OF UROLOGY
Copyright © 1977 by The Williams & Wilkins Co.
BILATERAL SEMINOMA 34 YEARS AFTER ORCHIOPEXY RICARDO ANGULO, LUIS CABALLERO
AND
PEDRO MEJIA
From the Urology Service, Naval Medical Center, Callao, Peru
ABSTRACT
A case of bilateral seminoma in a 59-year-old patient who had undergone bilateral orchiopexy 34 years previously is presented. To our knowledge this is the longest interval between an orchiopexy and diagnosis of bilateral malignancy. A 59-year-old patient was hospitalized with a 4-month history of progressive bilateral testicular enlargement associated with mild pain. Bilateral orchiopexy had been done when he was 25 years old. Physical examination revealed bilateral testicular enlargement, with an irregular surface and hard consistency (part A of figure). The prostate was within normal limits. Complete blood count, urinalysis and chest x-ray were normal. Bilateral orchiectomy was done on November 29, 1973. The pathology report was bilateral testicular seminoma (part B of figure). Cobalt therapy, consisting of 2,500R, was given to the retroperitoneal, mediastinal and supraclavicular nodes. Excretory urography and chest x-ray were normal in June 1974 and in March 1977. DISCUSSION
From a review of the literature we noted that several authors agree on the influence of cryptorchidism upon testicular tumors when the orchiopexy is performed after the patient is 5 years old. In biopsies of 42 undescended and contralateral normal testes Robinson and Engle found that the development of the seminiferous tubules was impaired in the undescended testes beginning at age 5 years. 1 From 20 biopsies of surgically descended testes only 1 was normal. Martin and Menck confirmed these findings. 2 Grove found that of 1,422 malignant testicular tumors 11.6 per cent originated from undescended testicles. 3 In a report on the incidence of testicular tumors in patients who underwent orchiopexy Sumner noted that the average age at which orchiopexy was done was 13 years. 4 He also reported on a patient who underwent orchiopexy at age 14 years. A right testicular seminoma was discovered 23 years after the bilateral orchiopexy as well as a teratocarcinoma of the left testis 4 years later. Altman and Malament believe that testicular atrophy predisposes metaplasia and emphasize that tumor development is enhanced by testicular atrophy. 5 Gehring and associates reviewed 37 cases of tumors associated with undescended testes and did not find testicular tumors in patients who had undergone orchiopexy before they were 6 years old. 6 Rioult and associates reported a case of testicular tumor 23 years after orchiopexy, which had been done when the patient was 7 years old. 7 Jimenes reported 6 cases of tumors following late orchiopexy. 8 Hinman presented a case of testicular tumor 31 years after unilateral orchiopexy and recommends that biopsy of the undescended testicle at the time of orchiopexy will help to determine potential fertility. 9 We agree with Campbell and Harrison, 10 who suggest that orchiopexy be performed before the patient is 5 years old, since Accepted for publication June 10, 1977.
882
we are convinced that late orchiopexy predisposes to atrophy and malignancy. Our case is noteworthy because bilateral orchiopexy was done when the patient was 25 years old and simultaneous bilateral seminoma occurred 34 years later, the longest interval reported to date. REFERENCES
1. Robinson, J. N. and Engle, E. T.: Some observations on the
cryptorchid testis. J. Urol., 71: 726, 1954. 2. Martin, D. C. and Menck, H. R.: The undescended testis: management after puberty. J. Urol., 114: 77, 1975. 3. Grove, J. S.: The cryptorchid problem. J. Urol., 71: 735, 1954. 4. Sumner, W. A.: Malignant tumor of testis occurring 29 years after orchiopexy: case report and review of the literature. J. Urol., 81: 150, 1959. 5. Altman, B. L. and Malament, M.: Carcinoma of the testis following orchiopexy. J. Urol., 97: 498, 1967. 6. Gehring, G. G., Rodriguez, F. R. and Woodhead, D. M.: Malignant degeneration of cryptorchid testes following orchiopexy. J. Urol., 112: 354, 1974. 7. Rioult, J., Colin, G. and Bauchart, J.: Le cancer du testicule apres orchidopexie. Ann. d'Urol., 5: 193, 1971. 8. Jimenes, J. F.: Criptorquidia y tumor de testiculo. Anales de la Fundaci6n Puigvert., 6: 90, 1976. 9. Hinman, F.: Panel discussion: anomalies of external genitalia in infancy and childhood. J. Urol., 93: 1, 1965. 10. Campbell, M. F. and Harrison, J. H.: Urology, 3rd ed. Philadelphia: W. B. Saunders Co., vol. 2, p. 1639, 1970.