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Introduction: Genitourinary cancers constitute a heterogeneous and increasingly frequent group of malignant tumors that have the potential to derive directly, or indirectly from the treatment applied, in a series of neurological complications that negatively impact on the quality of life of the patients who suffer them., Aims: To report the most relevant data on the main neurological complications of genitourinary cancers., Development: We conducted a PubMed search for articles, latest books, leading clinical practice guidelines, and scientific societies, regarding the appearance of such complications., Conclusions: Neurological complications of genitourinary cancers generate a significant burden of morbidity and mortality in cancer patients. In a paradoxical manner, owing to the raised survival of these patients, the likelihood of metastatization at the nervous system level and/or adverse effects related to the treatment received, especially due to chemotherapy, is also increased. Currently, diagnosis and management of neurological complications associated with genitourinary cancers represent a very important area of growing interest for the development of research projects that allow to improve the prognosis and quality of life genitourinary cancers subjects and their relatives and/or caregivers. For this purpose, it is necessary to know more about the etiopathogenesis and pathophysiology that leads to the occurrence of these type of complications in genitourinary cancers individuals, in particular paraneoplastic syndromes. Moreover, on the other hand, to carry out further well-designed randomized controlled clinical trials that expand the therapeutic arsenal with new chemotherapeutic drugs that possess a better antineoplastic effectiveness and improve the safety related to the neurotoxic side effects.

Introduction: The curing of a testicular tumour is currently feasible in more than 95% of patients, and in 80% of those with metastases. Until now, there has been no study or series of cases that describe the ocular changes of the posterior segment associated with testicular cancer., Objective: To evaluate patients with a diagnosis of testicular cancer in order to determine the presence of changes in the posterior segment and the relationship to the stage., Material and Method: An observational, cross-sectional, and descriptive study was conducted on 21 male patients (42 eyes) with a diagnosis of testicular cancer. Age, histological type, time of evolution, stage, treatment, and comorbidities were recorded, as well as visual acuity measurement (LogMAR), biomicroscopy of the anterior segment, and photographic records of the posterior pole and peripheral retina., Results: The mean age was 29 years (18-43 years). All (100%) of the patients were treated surgically. The most frequent histological type was classic seminoma (42.8%), followed by the mixed germinal tumour (38.0%). At the time of evaluation, 42.8% of patients had a stage II, and 23.8% had distant metastasis. The changes in the posterior segment were: vascular tortuosity (14.2%), retinopathy associated with cancer (9.5%), choroidal metastasis (9.5%), pigmentary changes of the retinal pigment epithelium (9.5%), and retinal metastasis (4.7%)., Conclusions: It is possible to find changes at the level of retinal pigment epithelium, as well as vascular tortuosity, retinopathy associated with cancer, and choroidal and/or retina metastases., (Copyright © 2018 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: There is the possibility of diagnosing azoospermia in cases of testicular tumours in patients who wish to preserve fertility. Our objective is to present a technique for obtaining spermatozoa from testicles with ex vivo tumours in order to preserve fertility in these patients., Material and Methods: A 34-year-old patient was referred for azoospermia. The physical examination revealed a node in the lower pole of the left testicle. In the scrotal ultrasound, the testicle presented disperse microcalcifications and a 1-cm hypoechoic mass in the lower pole. The tumour markers were negative, and the CT showed no distant disease. Left radical orchiectomy was performed, along with the placement of a testis prosthesis. Bench surgery was then performed, with extraction of the seminiferous tubules in the upper pole., Results: Of the submitted samples, 4 progressive and 1 nonprogressive motile spermatozoa were identified per field. Two samples were cryopreserved. The pathological report indicated the presence of a seminoma measuring 1.3 × 1 cm, with free margins and with no invasion of the rete testis (stage I). An assisted reproduction technique (intracytoplasmic sperm injection) was performed on the patient's partner with the frozen spermatozoa, which resulted in pregnancy and the subsequent birth of a healthy child., Conclusion: We propose this technique as the method of choice for obtaining spermatozoa from patients who simultaneously present azoospermia and testicular tumours and who wish to preserve their fertility., (Copyright © 2015 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Epidemiological studies treat testicular germ cancer as a single disease, the behavior of the two histological types of cancer; seminoma and nonseminoma have differences in reproductive hormone secretion and impair fertility differently., Objective: To demonstrate that the serum concentration of pituitary hormones involved in fertility and spermatogenesis in the affected male is different in the two histological types., Methods: Were determined by radioimmunoassay or inmunoradiometric assay, luteinizing hormone, follicle stimulating hormone, total testosterone, prolactin, estradiol, human chorionic gonadotropin and alpha fetoprotein in 37 patients with germ cell cancer (15 seminoma and 22 nonseminoma) and 35 controls. We analyzed the semen of patients, and were questioned about paternity before the cancer diagnosis., Results: Age was higher in patients with seminoma cancer, showed decreased luteinizing hormone, follicle stimulating hormone, and testosterone and increased estradiol and prolactin in nonseminoma compared with seminoma. In patients with nonseminoma they had 9 children, 5 were oligozoospermic, 3 azoospermic and 6 normal concentration, 8 did not provide sample, seminoma group they had eight children, only one azoospermic, nine normal concentration, and 5 did not provide sample ., Conclusions: The hormonal behavior is different in men with nonseminoma compared with seminoma, so that the negative impact on the reproductive axis and fertility is higher in cases of non-seminoma.

Objective: To present a case of synchronous bilateral seminoma and perform a bibliographic review about this rare presentation of testicular neoplasia, with important physical and psychological consequences., Methods: 25-year old man with bilateral multifocal testicular neoplasias and azoospermia. We performed a bilateral inguinal radical orchiectomy, with the pathologic exam diagnosing bilateral seminoma. Adjuvant lumbar-aortic radiotherapy was initiated. More than a year after the surgery the patient is asymptomatic and without evidence of disease, although dependent of testosterone supplement., Results: Germ cell testicular neoplasias are more frequent in young men between 15 and 35 years old. There is a 2-3% incidence of bilateral neoplasm, either synchronous or metachronous. Bilateral radical orchiectomy remains as standard of treatment, rendering the patient infertile and depending on exogenous androgens, which causes several psychological problems. However, a testis-sparing surgery could be performed in selected cases; our patient, having multiple bilateral neoplasias, was not eligible for this procedure. With a great incidence of carcinoma in situ on spared testicular parenchyma, scrotal radiotherapy is indicated. In spite of infertility, this treatment presents very good oncological results with androgen independence and consequent physical and psychological advantages., Conclusion: Bilateral orchiectomy still remains as "gold-standard" treatment for bilateral seminoma. However, there are other possibilities of treatment, such as partial orchiectomy, feasible in selected cases of small volume testicular tumours in solitary testis / bilateral tumour in men without preoperative androgen deficiency and who could be object of close clinical and imaging follow-up. This way you could avoid additional loss of quality of life, without any prejudice on oncological results.

Objectives: Atypical lymphatic spread of germ cell tumors to inguinal lymph nodes has been reported mostly related to prior surgical involvement of the inguinoscrotal region, as in orchiopexy., Methods: A patient with cryptorchidism and failed orchiopexy in his childhood was diagnosed with a testicular neoplasm. Inguinal orchiectomy was performed., Results: Pathological analysis showed classical seminoma spreading into a subcutaneous adjacent lymph node. Further metastatic disease was not found. Patient was treated with adjuvant chemotherapy., Conclusions: We emphasize the need for accurate staging and a multidisciplinary approach when dealing with onco-urological patients presenting with atypical disease.

Introduction: Testicular microlithiasis (TM) is an infrequent finding in testicular ultrasound and its clinical importance has not been completely defined. We analyzed the ultrasounds of patients with testicular germ cell tumors in order to analyze the correlation between TM, histological findings and clinical variables., Methods and Materials: Fifty-seven patients with germ cell tumors and radical orchiectomy were included. Clinical, pathological, and echographic data were analyzed., Results: TM was observed in 27 men (48.27%) and was absent in 30 (52.6%). Patients with TM had a greater likelihood of nonseminomatous germ cell tumors (NSGCT) vs seminomatous (55.6% vs 30%, p=0.05), stage II/III testicular cancer (51.8% vs 16.7%, p=0.005), positive surgical margins (18.5% vs 0%, p=0.021), and spermatic cord invasion (14.8% vs 0%, p=0.048). No significant difference was found in respect to other histopathological variables., Conclusion: This study showed that TM in testicular tumors is associated to NSGCT, advanced clinical stage, positive surgical margins, and spermatic cord invasion.

We describe a case of phlegmasia cerulea dolens secondary to venous thrombosis due to compression of inferior vena cava, in a 31-year-old man with a germ cell tumour. He was treated with systemic thrombolytic agents, intravenous heparin and urgent chemotherapy He presented a complete tumoral response and complete revascularization of the vena cava and right femoral vein.

Mediastinal sarcoidal reaction in follow up for seminoma. Testicular germ cell tumors constitute a model for curable neoplasia. Long-term complications are well-known and follow-up includes not only awareness of relapse, but also of the development of secondary tumors and treatment sequelae. In the last two decades, an increase in sarcoidosis incidence has been described in cured patients, who at follow-up present lung nodules or mediastinal lymph nodes. A 28 year-old patient who, on clinical follow up of a semi-nomatous tumor, presented mediastinal lymph nodes on CT scan and chest x-ray, without evidence of disease in pelvis or abdomen is presented. His other testicle was normal and he had negative tumor markers. Because of this rare presentation, a mediastinoscopy was performed and sarcoidosis like reaction was diagnosed. During follow-up of patients with testicular germ cell tumors, the presence of mediastinal lymph nodes requires a histological diagnosis and sarcoidosis should be considered as differential diagnosis.

Objectives: Oncological therapies, either surgery, radiotherapy or chemotherapy, may cause irreversible subfertiliy/infertility. Both chemotherapy and radiotherapy have cytotoxic effects on gametogenesis and there are not preventive alternatives currently available. The objective of this article is to review current criteria for semen cryopreservation and its usefulness as a method for preservation of fertility in patients with cancer., Methods/results: We reviewed a large group of recent original articles and systematic reviews on the issue with a common feature: evaluation of fertility status after oncological therapy., Conclusions: Every male patient in fertile age who could wish future fatherhood should be offered the option to storage cryopreserved semen samples before starting oncological therapies, with the exception of patients with azoospermia at the time of diagnosis.

Objectives: To report one case of isosexual precocious pseudopuberty in a 4-year-old boy caused by an interstitial cell testicular tumor., Methods: Physical exam, blood tests, hormonal determinations, adrenal suppression tests, bone age, orchiectomy and pathologic study of the specimen were performed., Results: Physical examination showed a boy with muscle development, acne; body, sexual and face hair corresponding to an older boy; with increased volume of the left testicle and infantile contralateral testicle. Urinary 17-ketosteroids were elevated and did not decrease after dexametasone. Bone age corresponded to an 11-year-old standard. Pathologic study showed an interstitial cell tumor. Puberty changes disappeared after orchiectomy., Conclusions: This diagnosis should be taken into consideration in every case of accelerated sexual development in a boy with testicular tumor and without maturation of the contralateral testicle.

Objectives: To report one case of Sertoli cell testicular tumor of the large cell calcifying type, a rare presentation, and to perform a medical literature review on the topic., Methods: Our case report is based on the patient's medical history and images of the diagnostic tests and pathology. We perform a bibliographic review of the available literature in MEDLINE., Results: The case is reported with the diagnostic tests and pathology report. We present a comprehensive review of the medical literature on the topic., Conclusions: The large cell calcifying Sertoli cell tumor is a rare testicular tumor of benign behaviour. Due to its benign behaviour, treatment of this kind of tumor should be conservative with resection of the lesion, preserving the testicle.

The aim of this revision is to assess the relationship between testicular microlithiasis and malignant tumours. We reviewed 98 charts of patients with pathological diagnosis of testicular malignant tumour. Diagnosis of testicular tumour was made by ultrasound, and 6.02% (6 pts.) presented testicular lithiasis, and this finding makes us conclude that this is not a characteristic feature of this entity. We also reviewed bibliography related to this theme, and conclude that the management of microlithiasis remains being controversial.

Objective: To check the possible relationship between testicular microlithiasis and testicular carcinoma in a patient in the one which previously we discovered a sonographic image of this condition. The etiopathogenesis, incidence and attitude are discussed., Methods: A 23-year-old male with a psychomotor retardation secondary to a chromosomopathy presented with orchitis. Scrotal ultrasound discovered testicular microlithiasis, described as many hyperechoic images. Thirteen months later a testicular cancer was found in a new ultrasound. Radical orchiectomy was performed. Currently the patient is under intense follow-up., Results: The histopathological study showed mature teratoma and intratubular germ cell neoplasm., Conclusions: The testicular microlithiasis has been related with benign and malignant testicular pathology. However, this presence it is not sufficiently clarified and the urologist's attitude to a patient with testicular microlithiasis but asymptomatic is not enough studied.

We describe a 16-year-old boy with Leydig cell tumor who initially presented bilateral gynecomastia with increased estradiol concentrations, decreased testosterone concentrations and normal gonadotropin levels. Testicular ultrasonography showed a tumor in the left testicle, and orchidectomy was performed. Histopathological analysis revealed a Leydig cell tumor. Two months after surgery, the gynecomastia diminished gradually and estrogen levels returned to normal. No recurrences have occurred during a 2-year follow-up.

The rarity of both conditions and the precocity of its onset (4 years old) make the case of interest for pediatricians and pediatric surgeons. The finding of a testicular tumor poses same differences of criterium about its management.

Objective: To report a case of testicular tumor, classified as seminoma, with a very uncommon form of presentation since it presented as acute scrotum., Methods: The clinical features, treatment and outcome of this uncommon condition are presented., Results: A review of the literature showed that this form of presentation is rare although in the present case it is impossible to determine if testicular inflammation was due to tumor necrosis or infection from the associated hydrocele., Conclusions: Testicular tumor should be considered in all male patients aged 20 to 35 years with acute scrotum.

Objective: To describe an additional case of an uncommon variant of Sertoli cell testicular tumor., Methods/results: A 34-year-old male infected with the human immunodeficiency virus presented with a right testicular tumor he had noted one year earlier. A right inguinal orchidectomy was performed. Histological examination demonstrated sclerosing Sertoli cell tumor., Conclusions: Sertoli cell tumor is a rare variant of testicular tumor from sexual cords. Although it is uncommon, histological variants have been described: classical Sertoli cell tumor, large calcifying cells and the sclerosing variant. The case of sclerosing Sertoli cell tumor described herein is a variant of which 11 cases have been reported in the world literature. The fact that our patient is HIV-positive makes this case even rarer.

Leydig cell tumor is a testicular tumor with a low incidence characterized by a high estrogens secretion from the tumoral cells. Its more frequent clinical presentation is a testicular nodule with or without other endocrine manifestations due to estrogenic hypersecretion. We're reporting a case of a Leydig cell tumor with high plasmatic levels of estradiol, gynecomastia and inferior cava vein thrombosis, which hasn't been described among its clinical features up to now. Vascular thrombotic phenomenons have already been reported in other clinical situations with hiperestrogesism and they could also be associated with these tumors. Patients with Leydig cell tumors could be at a higher risk of developing thromboembolic phenomenons because of tumoral hyperestrogenism and could present thrombotic complications among the clinical findings.

We report a case of mature testicular cystic teratoma in a 28-month old boy. Due to the characteristics of the palpation and its partial transillumination, it may be confused with a hydrocele. They emphasize on the rarity and benign nature of the peculiarities and refer to its prognosis, usually benign, when is diagnosed at about 2 years of age, providing that a very careful examination of the histological sections rules out the presence of anaplastic cells. A left inguinal orchiectomy was performed because it was not possible to establish a line of cleavage between the tumor and the normal tissue. The pathologic examination revealed a benign lesion. An adrenal choristoma in the caput epididymis was also observed. Postoperative course was satisfactory.

Over the last few years a number of testicular tumours in seropositive patients or patients with AIDS-diagnostic factors have been described in the literature with no clear relationship having been established between both conditions. Most authors believe management should not differ from that being given to non-immunodeficient patients. The paper presents one case of non-seminomatous germinal tumour in a 41-year old homosexual patient, HIV positive, with unfavourable evolution in spite of the treatment received.

Case report of a Leydig's cell testicular tumour associated to an epididymal cyst in a young adult. The literature revealed no relationship between both conditions. Review of diagnostic and therapeutical approaches.

Introduction: Leydig cell tumors may generate estrogen production and gynecomastia., Case Presented: A 32-year man asked for medical advice due to gynecomastia. He had raised estrogen levels and diminished testosterone/estradiol index. A testicular echogram showed a nodular image in the right testis. Orchidectomy was performed and the diagnosis of a Leydig cell tumor was confirmed. The gynecomastia diminished, and estradiol remained lightly elevated, with little response to HCG., Discussion: The more frequent hormonal manifestations of these tumors are high plasmatic and urinary estrogen levels, low serum testosterone, low testosterone/estradiol index, and FSH or LH low levels as well. The low response to HCG, the absence of metastasis and the good clinical evolution suggested the tumor was benign. Testicular echography is useful in the diagnosis of these tumors.

We report a case in which acute intestinal hemorrhage was the initial manifestation in the evolution of choriocarcinoma of the testis. The diagnosis of bleeding was difficult and required laparotomy. Metastatic lesion of the small bowel should be considered a possible cause of intestinal bleeding in patients with testicular choriocarcinoma.

Presentation of two cases of Leydig cell tumor in adult patients who presented with gynecomastia, and slightly abnormal hormonal profiles. One patient had a non palpable tumor. The pathophysiology of this entity is commented, as well as the importance of the different modalities in its diagnosis.

Objectives: An uncommon case of clinically occult Leydig cell tumor of the testis is described. The literature is reviewed with special reference to the difficulty encountered in making the diagnosis., Methods/results: The clinical data of a patient with occult Leydig cell tumor of the testis, whose only remarkable feature was a long history of gynecomastia, are presented., Conclusions: A hormonal study and scrotal ultrasound evaluation are essential in the diagnosis of this tumor type and should be performed even in the absence of testicular anomalies on palpation.

Presentation of one case of testicular Leydig's cells tumour in a young adult who presented with gynaecomastia. The clinical and diagnostic aspects of this entity in which, in the absence of confirmed metastasis, we lack the criteria to sustain a definite prognostic judgement are commented. Finally, the different therapeutic attitudes revealed in the literature are assembled.

Finding tumor cells in the fluid of hydrocele secondary to testicular tumor is rare and may be due to the fact that hydrocele fluid cytology has not been studied systematically. The presence of malignant cells in the hydrocele fluid may be ascribed to two mechanisms: retrograde lymphatic flow from the infiltrated retroperitoneal lymph nodes or from tumor directly invading the tunica albuginea and vaginalis testis, with cells passing into the cavity of the vaginalis. Only two cases of hydrocele secondary to testicular seminoma with vaginalis fluid cytology positive for malignant seminomatous cells have been previously reported in the literature. To our knowledge, the case reported herein is the third. These three cases are briefly discussed.

Apart from infections, tumors are one of the manifestations of AIDS. Kaposi's sarcoma of the penis or scrotum is the most common urological tumor in patients with AIDS. Renal tumors and, to date, 56 testicular tumors have also been described. It remains unclear whether immunodeficiency is a decisive factor in the appearance of testicular tumors. However, these tumors present in the advanced stages, which is probably ascribable to changes in cellular immunity. Treatment is not unlike that of conventional therapy, the response being similar to that of patients without AIDS. We describe a case of germ cell carcinoma which manifested as multiple pulmonary metastases in a 26-year-old patient with AIDS.

Testis tumours usually emerge in young patients as a painless increase in the testis size accidentally noticed by the patient. Contribution of one case of non-seminomatous testis tumour which presented clinically as an acute scrotum. An exhaustive appraisal of the clinical data allowed to choose the most appropriate approach for the patient in an emergency situation.

Contribution of one patient with tetraparesic picture originated by a major sensory-motor neuropathy, due to paraneoplastic syndrome produced by a testicular seminoma. The patient underwent inguinal orchiectomy and radiotherapy, with favourable evolution of his neurological symptomatology. Review of the literature and confirmation of the extraordinary rarity of such clinical picture.

A 5-year-old boy with intrascrotal rhabdomyosarcoma arising from the epididymis is described. The patient was submitted to radical orchidectomy via the inguinal approach and high ligation of the spermatic cord. The anatomopathological examination revealed germ cell rhabdomyosarcoma of the epididymis with no testicular or spermatic cord involvement, which corresponded to stage I of the IRS classification (Intergroup Rhabdomyosarcoma Study). Its clinical and histological features and treatment are discussed.

The paraneoplastic syndromes in patients with malignant urological tumors are reviewed herein. Some general aspects of these syndromes are briefly described and discussed. Similarly, the different urological tumors in which paraneoplastic syndromes have been observed are briefly reviewed. These are very common in renal cancer and cancer of the prostate, uncommon in bladder cancer and rare in testicular cancer.

We report a case of interstitial cell or Leydig cell tumor, an uncommon tumor type, that presented with evident feminizing features and acute testicular inflammatory process which warranted hospitalization. The literature is reviewed highlighting the most important aspects of this condition.

Three cases of Leydig cell tumor are described. Patient ages were 27, 44 and 55 years, respectively. The first two patients consulted for a testicular mass and the third patient presented with gynecomastia, an incidental finding during the ultrasound work up of a hydrocele. Hormonal evaluation revealed a marked serum testosterone level in one case, whereas in another case it fell within the lower limits of normal ranges. No evidence of dissemination was observed in all patients. Treatment was by radical inguinal orchiectomy in all patients. The pathological analysis of the surgical specimens revealed Leydig cell tumor with no histologic evidence of malignancy. A follow-up of 32, 14 and 10 months, respectively, revealed no evidence of tumor recurrence in all patients. The clinical and histologic features and treatment of this disease process are described.

Ureteral triplicity is a rare abnormality of which there are less than a hundred cases reported up to date. The possible absence of clinical signs can explain why this malformation passes unnoticed specially when there are blind branches and dysplastic renal segments. The paper presents the case of a 43 year-old male, attending the clinic on a testicle tumour consultation, in which in spite of the previously mentioned circumstances a preoperative diagnosis of trifid ureter with ipsilateral ureterocele and renal dysplasia was reached owing to the use of C.A.T.

We report a case of paratesticular rhabdomyosarcoma that presented as a hydrocele. Because it was initially considered idiopathic, diagnosis of the underlying disease could not be made at the outset. The literature is reviewed, highlighting its diagnosis and treatment. It is concluded that all hydroceles warrant a careful analysis, particularly in young patients. These should not be initially classified as idiopathic as it might preclude adequate examination of important structures and the underlying condition may remain undetected.