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Seminoma Testis and X-Ray Therapy: Case Report
THE JOURNAL OF UROLOGY
Vol. 87, No. 6 June 1962 Copyright © 1962 by The Williams & Wilkins Co. Pl'inted in U.S.A.
SEMINOMA TESTIS AND X-RAY THERAPY: CASE REPORT L. E. PIERSON
AND
J. A. McFARLANE
A tumor of the testis in an abnormally situated gonad should be viewed with alarm. Therefore, consideration of any peculiar therapeutic sensitivity of the type of tumor present becomes of value. A case of intra-abdominal seminorna will be described to illustrate the sensitivity of this tumor to deep x-ray therapy. CASE REPORT
A 48-year-old man was first seen January 30, 1940. His chief complaint was a gradually increasing lower abdominal swelling. His general
of the right renal outline by an intra-abdominal mass. On cystoscopy, the bladder was negative. A size 5 catheter was passed up the right ureter without meeting obstruction. Retrograde pyelography (fig. 2, r1 and B) revealed marked hydronephrosis with anteromedial deviation of the ureter, apparently due to pressure by a large abdominal mass. A chest x-ray (fig. 3, A.) was normal. The diagnosis was tumor in an abdominal testis.
Fm. 1
health was satisfactory and he had no symptoms referable to the urinary or gastrointestinal tracts. Examination revealed a symmetrical, smooth and firm abdominal enlargement resembling a 7 month pregnancy. The only significant finding, otherwise, was absence of the right testis which could not be palpated in the scrotum or inguinal canal. The red blood count was 3,250,000; white blood count 4,900; hemoglobin 65 per cent; urinalysis was normal; blood pressure 150/100. A plain x-ray (fig. 1, A) revealed a large abdominal mass. Excretory urography (fig. 1, Band C) showed a bifid left renal pelvis and obliteration Accepted for publication October 3, 1961. 914
The abdomen was opened through a right rectus incision. A large, smooth and homogeneous mass presented itself and tissue removed for biopsy was diagnosed seminoma testis (fig. 4). The abdomen was closed without further manipulation. Under deep x-ray therapy, the mass disappeared rapidly. Six weeks later, another chest x-ray (fig. 3, B) was free of metastases. Under general anesthesia, the iliac fossa was opened and, upon retracting the peritoneum, a small fibrous testis was found and removed. The specimen showed marked sclerosis and necrosis with no evidence of malignancy. Three weeks later, just before dismissal from
SEMINOMA TESTIS
915
FIG. 2
Fm. 3
the hospital, excretory urography (fig. 5, A) revealed fair function of the right kidney, with hydronephrosis. Six years later a retrograde pyelogram (fig. 5, B) revealed some remaining hydronephrosis. The patient had no symptoms referable to the urinary tract. Chest x-ray 6 years later (fig. 5, C) continued to show no evidence of metastases.
Subsequent treatment consisted of another course of deep x-ray therapy 1 month after operation. For the subsequent 12 years, the patient was examined by us once a year and at no time was any evidence of recurrence present. In 1954, he was reported to have died from virus pneumonia but we were unable to verify the cause of death.
916
L. E. PIERSON AND J. A. MCFARLANE
FIG. 4
FIG. 5 DISCUSSION
Of all testicular tumors, those which arise from the germinal epithelium, such as pure seminoma, are the most sensitive. These are simple unicellular tumors, as compared to those which result from somatic cells to form teratoma, or from trophoblastic cells to form chorioepithelioma. For many years, statistics have suggested and, according to some authors, have proven that ectopia predisposes to malignancy. Hinman,1 in a study of 40,000 male hospital admissions, found it to occur more frequently by 20 to 1. However, 1 Hinman,_F: and Benteen, F. H.: Relationship of cryptorch1d1sm to tumor of the testis. J. U rol.
35: 378-381, 1936.
'
in 1949, Carroll2 approached this question from another angle and reached another conclusion. Questionnaires 1Yere sent to members of the American Urological Association and of 662 replies, 503 or 76 per cent had never seen a malignant intra-abdominal testis, nor even a malignant, imperfectly descended testis. Only 159 members, or 24 per cent of those who replied, had seen a total of only 285 malignant cryptorchids. Carroll concluded that "the potentiality of its malignancy cannot be used as an indication for either orchiopexy or orchiectomy." In our opinion, this statement does not neces2 Carroll, W. A.: Malignancy in cryptorchidism. .T. Urol., 61: 396-404, 19-±9.
917
SEMINOMA TESTIS
sarily imply that an intra-abdominal testis should be left in the abdomen. Delay in diagnosis, due to lack of early symptoms so markedly reduces the chances of permanent cure that such a risk should never be advised. Even if no malignancy develops, the lack of gonadal development in ectopia is enough indication for its removal or relocation.
CONCLUSIONS
Testicular seminoma, regardless of its location, is sensitive to deep x-ray therapy. No ectopic, and especially an intra-abdominal testis should be allowed to remain in its abnormal location. Davidson Bldg., Sioux City 1, Iowa (L. E. P.)
Vol. 87, No. 6 June 1962 Copyright © 1962 by The Williams & Wilkins Co. Pl'inted in U.S.A.
SEMINOMA TESTIS AND X-RAY THERAPY: CASE REPORT L. E. PIERSON
AND
J. A. McFARLANE
A tumor of the testis in an abnormally situated gonad should be viewed with alarm. Therefore, consideration of any peculiar therapeutic sensitivity of the type of tumor present becomes of value. A case of intra-abdominal seminorna will be described to illustrate the sensitivity of this tumor to deep x-ray therapy. CASE REPORT
A 48-year-old man was first seen January 30, 1940. His chief complaint was a gradually increasing lower abdominal swelling. His general
of the right renal outline by an intra-abdominal mass. On cystoscopy, the bladder was negative. A size 5 catheter was passed up the right ureter without meeting obstruction. Retrograde pyelography (fig. 2, r1 and B) revealed marked hydronephrosis with anteromedial deviation of the ureter, apparently due to pressure by a large abdominal mass. A chest x-ray (fig. 3, A.) was normal. The diagnosis was tumor in an abdominal testis.
Fm. 1
health was satisfactory and he had no symptoms referable to the urinary or gastrointestinal tracts. Examination revealed a symmetrical, smooth and firm abdominal enlargement resembling a 7 month pregnancy. The only significant finding, otherwise, was absence of the right testis which could not be palpated in the scrotum or inguinal canal. The red blood count was 3,250,000; white blood count 4,900; hemoglobin 65 per cent; urinalysis was normal; blood pressure 150/100. A plain x-ray (fig. 1, A) revealed a large abdominal mass. Excretory urography (fig. 1, Band C) showed a bifid left renal pelvis and obliteration Accepted for publication October 3, 1961. 914
The abdomen was opened through a right rectus incision. A large, smooth and homogeneous mass presented itself and tissue removed for biopsy was diagnosed seminoma testis (fig. 4). The abdomen was closed without further manipulation. Under deep x-ray therapy, the mass disappeared rapidly. Six weeks later, another chest x-ray (fig. 3, B) was free of metastases. Under general anesthesia, the iliac fossa was opened and, upon retracting the peritoneum, a small fibrous testis was found and removed. The specimen showed marked sclerosis and necrosis with no evidence of malignancy. Three weeks later, just before dismissal from
SEMINOMA TESTIS
915
FIG. 2
Fm. 3
the hospital, excretory urography (fig. 5, A) revealed fair function of the right kidney, with hydronephrosis. Six years later a retrograde pyelogram (fig. 5, B) revealed some remaining hydronephrosis. The patient had no symptoms referable to the urinary tract. Chest x-ray 6 years later (fig. 5, C) continued to show no evidence of metastases.
Subsequent treatment consisted of another course of deep x-ray therapy 1 month after operation. For the subsequent 12 years, the patient was examined by us once a year and at no time was any evidence of recurrence present. In 1954, he was reported to have died from virus pneumonia but we were unable to verify the cause of death.
916
L. E. PIERSON AND J. A. MCFARLANE
FIG. 4
FIG. 5 DISCUSSION
Of all testicular tumors, those which arise from the germinal epithelium, such as pure seminoma, are the most sensitive. These are simple unicellular tumors, as compared to those which result from somatic cells to form teratoma, or from trophoblastic cells to form chorioepithelioma. For many years, statistics have suggested and, according to some authors, have proven that ectopia predisposes to malignancy. Hinman,1 in a study of 40,000 male hospital admissions, found it to occur more frequently by 20 to 1. However, 1 Hinman,_F: and Benteen, F. H.: Relationship of cryptorch1d1sm to tumor of the testis. J. U rol.
35: 378-381, 1936.
'
in 1949, Carroll2 approached this question from another angle and reached another conclusion. Questionnaires 1Yere sent to members of the American Urological Association and of 662 replies, 503 or 76 per cent had never seen a malignant intra-abdominal testis, nor even a malignant, imperfectly descended testis. Only 159 members, or 24 per cent of those who replied, had seen a total of only 285 malignant cryptorchids. Carroll concluded that "the potentiality of its malignancy cannot be used as an indication for either orchiopexy or orchiectomy." In our opinion, this statement does not neces2 Carroll, W. A.: Malignancy in cryptorchidism. .T. Urol., 61: 396-404, 19-±9.
917
SEMINOMA TESTIS
sarily imply that an intra-abdominal testis should be left in the abdomen. Delay in diagnosis, due to lack of early symptoms so markedly reduces the chances of permanent cure that such a risk should never be advised. Even if no malignancy develops, the lack of gonadal development in ectopia is enough indication for its removal or relocation.
CONCLUSIONS
Testicular seminoma, regardless of its location, is sensitive to deep x-ray therapy. No ectopic, and especially an intra-abdominal testis should be allowed to remain in its abnormal location. Davidson Bldg., Sioux City 1, Iowa (L. E. P.)