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Open Access Case report

Sequential bilateral testicular tumours presenting with intervals of 20 years and more

Klaus-Peter Dieckmann1*, Petra Anheuser1, Florentine Sattler2, Tobias Von Kügelgen3, Cord Matthies4 and Christian Ruf4

Author Affiliations

1 Klinik für Urologie, Albertinen-Krankenhaus Hamburg, Suentelstr. 11a, D-22457 Hamburg, Germany

2 Institut für Hämatopathologie, Fangdieckstrasse 75a, D-22547 Hamburg, Germany

3 Praxis für Urologie, Rosengarten 5, D-22880 Wedel, Holstein, Germany

4 Bundeswehrkrankenhaus Hamburg, Abteilung für Urologie, Lesserstrasse 180, D-22049 Hamburg, Germany

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BMC Urology 2013, 13:71  doi:10.1186/1471-2490-13-71

Published: 9 December 2013

Abstract

Background

About 3 – 5% of all patients with testicular germ cell tumour (GCT) develop a contralateral cancer, the majority of which arise within 10–15 years. Little is known about the risk of second GCTs after more than two decades. Here we present 3 cases with very late presenting contralateral GCT and provide a summary of similar cases reported previously.

Case presentations

(1) This white Caucasian man underwent right-sided orchiectomy for a nonseminomatous GCT at the age of 22 years. Additional treatment consisted of retroperitoneal lymph node dissection (RPLND) and chemotherapy with 4 cycles of vinblastin / bleomycin. 36 years later, contralateral seminoma clinical stage 1 developed. Cure was achieved by orchiectomy. Histologically, testicular intraepithelial neoplasia (TIN; intratubular germ cell neoplasia) was detected in the tumour-surrounding tissue.

(2) This white Caucasian male had right-sided orchiectomy for nonseminomatous GCT at the age of 29 years. Pathological stage 1 was confirmed by RPLND. 25 years later, he received left sided orchiectomy for seminoma stage 1. Histologically, TIN was found in the tissue adjacent to seminoma. Two brothers had testicular GCT, too, one with bilateral GCT. (3) This 21 year old white Caucasian man underwent left-sided orchiectomy for nonseminomatous GCT. Pathological stage 1 was confirmed by RPLND. 21 years later, he received organ-preserving excision of a right-sided seminoma, followed by BEP chemotherapy for stage 3 disease. Histologically, TIN was found in the surrounding testicular tissue.

22 cases of bilateral GCT with intervals of 20 or more years have previously been reported, thereof three with intervals of more than 30 years, the longest interval being 40 years.

Conclusion

Apart from increased risks of cardiovascular diseases and non-testicular malignancies, patients with GCT face the specific probability of a second GCT in the long run. This risk persists life-long and is not eliminated by chemotherapy. Contralateral testicular biopsy can identify patients at risk by revealing precursor cells of GCT though false-negative biopsies may occur sporadically. However, in view of the multi-facetted late hazards of GCT patients, this minor surgical procedure might somewhat simplify the long-time care of these patients.

Keywords:
Testicular germ cell neoplasms; Bilateral tumours; Testicular biopsy; Seminoma; Familial germ cell tumours