Polycythemia and steroid overproduction in a gonadotropin-secreting seminoma of the testis

Article Abstract:

A seminoma is a tumor of the male sex cells. Recently, an unusual case was seen in which hormones secreted by a seminoma produced unusual signs and symptoms in the patient. The patient was a 25-year-old man whose only obvious symptom was impotence. A routine physical examination revealed polycythemia, a excessive production of red blood cells. Further examination found a mass in his left testicle. Prior to the removal of the testicle, a full laboratory analysis of the patient's hormones was conducted. Erythropoietin (EPO) was elevated, as were both testosterone and estradiol, important male and female sex hormones. Human chorionic gonadotropin (hCG), a hormone normally secreted by embryonic tissues during pregnancy and undetectable in men, was also elevated. When the left testicle was removed, histopathologic examination under the microscope revealed a typical seminoma. However, in the region of the testis adjacent to the tumor, there was hyperplasia of the Leydig cells; the Leydig cells appeared normal at further distances from the tumor. Hyperplasia is an overgrowth of normal cells; in this case the overgrown cells were the Leydig cells, which are responsible for secreting male sex hormones in the normal individual. Immunocytochemical staining techniques indicated that the tumor was producing chorionic gonadotropin. Within one month of the removal of the testis, the hormonal abnormalities of the patient went away. The authors suggest the following sequence of events: The production of hCG by the tumor stimulated hyperplasia in the Leydig cells, which resulted in alterations in the sex steroid hormones. The increase in the sex steroids then influenced the production of erythropoietin and the subsequent overproduction of red blood cells. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Germ cell tumors, Germinoma, Gonadotropin, Gonadotropins, Hormones, Sex, Sex hormones, Leydig cells, Polycythemia

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Testis cancer: ichthyosis constitutes a significant risk factor

Article Abstract:

Ichthyosis is the accumulation of fish-like scales on the skin, and may result from a number of different causes. The most common ichthyoses are the inherited autosomal dominant ichthyosis and the recessive X-linked ichthyosis. (Autosomal chromosomes do not include the X or Y sex chromosomes. Dominant and recessive refer to the expression of a gene.) Recently, six men were seen who had both ichthyosis and testicular cancer. Their cases raised the question of whether there might be some relation between the two conditions. Recessive X-linked ichthyosis has previously been reported to be associated with testicular disorders such as cryptorchidism, in which the testes fail to descend into the scrotal sac during fetal development. Since cryptorchidism is also known to be associated with increased risk of testicular cancer, it is possible that the two conditions may share some common predisposing factor. Investigation of the six patients revealed that three were without measurable activity of the enzyme steroid sulfatase; this finding is characteristic of recessive X-linked ichthyosis. Previous research has shown that more than 80 percent of patients with recessive X-linked ichthyosis have a deletion of genetic material on the X chromosome. Consequently, the disorder may result not from the enzyme deficiency itself, but from some other gene that is closely linked to the enzyme. While three men had deficiencies of this enzyme, the remaining three men had normal levels, suggestive of autosomal dominant ichthyosis. The molecular basis of the autosomal dominant ichthyosis is not understood, however, and so it is impossible at present to determine why these two skin diseases seem to be associated with testicular cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Risk factors, Genetic disorders, Ichthyosis

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Orchidectomy alone for Stage I seminoma of the testis

Article Abstract:

The principle behind adjuvant therapy in cancer is to beef up the success rate of the primary therapy. In the case of Stage I seminoma of the testis, the primary treatment is surgical removal of the testis, or orchidectomy. On the chance that a few cancerous cells might be left behind, adjuvant radiotherapy is usually applied to the paraaortic lymph nodes, and the pelvic lymph nodes on the side of the cancer. However, such adjuvant therapy exacts its own price in terms of side effects. The value of adjuvant therapy is therefore determined by whether the chance of extending survival is great enough to justify the additional side effects of the radiation. In the case of 113 patients, close surveillance for relapse was chosen over adjuvant radiotherapy. Thirteen patients suffered a relapse; the actuarial risk of relapse at three years was calculated to be 15.8 percent. The rate of relapse was found to be significantly slower than for nonseminomatous tumors, in which four of five relapses will occur within the first year. Although close surveillance is an alternative to adjuvant radiotherapy, it requires prolonged observation and is quite costly, without providing exceptional benefit. The use of adjuvant radiotherapy should still be regarded as the standard method of management for cases of early stage seminoma of the testis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Surgery, Cancer, Orchiectomy

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