蔡仕傑1、黃志賢1, 2, 3
Onco-testicular sperm extraction of a metachronous bilateral testicular cancer patient: a case report
Shi-Jie Tsai1, William J.S. Huang1, 2, 3
1 Department of Urology, Taipei Veterans General Hospital, Taiwan
2Department of Urology, School of Medicine, and 3Shu-Tien Urological Science Research Center, National Yang-Ming University, Taipei, Taiwan
Testicular cancer is the most common cancer in young man. Fertility preservation for these patients may become challenging if testicular cancer presented bilaterally or the patient was azoospermic. Here we report a case of onco–testicular sperm extraction (onco-TESE) from a single testis with metachronous bilateral testicular cancer.
This 36-year-old unmarried Taiwanese man presented to our clinic due to self-palpable right testis mass. He had past history of mixed germ cell tumor of left testis and already undergone left radical orchiectomy at age of twelve. No adjuvant chemotherapy nor radiotherapy were performed. He had discontinued follow-up since several years ago. Twenty-four years after left orchiectomy, right testis enlargement without tenderness for months was noticed. Scrotal sonography revealed a 7 x 3.7 cm heterogeneous echogenicity in right testis with increased vascularity. Computed tomography disclosed scan disclosed mass lesion at right testis with engorged testicular venous plexus, and no evidence of retroperitoneum lymph node nor obvious metastases. Laboratory test showed elevated beta-HCG (41.8mIU/ml), elevated LDH (242U/L), and normal AFP (1.15ng/ml). Semen analysis revealed azoospermia. Due to concerns of future fertility, the right radical orchiectomy with simultaneous testicular sperm extraction(TESE) was performed. After right testis resected, it was immediately moved to the bench table and exposed with vertical incision upon the non-tumor part. Testicular tissue was examined and samples were extracted under microscopy. Touch print smear showed presence of sperm and the samples were sent for cryopreservation. The pathology of testis tumor revealed seminoma, pT1N0M0. The patient recovered well after the operation. Further follow-up and androgen replacement therapy will be arranged at outpatient settings.
Testicular cancer is the most common cancer in 20 to 35-year-old men. On the other hand, bilateral testicular germ cell tumor was relatively rare, which only accounts for 0.5% to 5% of cases of testicular cancer. Among these man, about 35% present with synchronous tumors, and 65% present with metachronous tumors. Sperm banking prior to treatment should be considered due to the possibility of loss of fertility. Nevertheless, these patients might be azoospermic when testicular cancer was diagnosed. It is well known that testicular cancer is associated with higher prevalence of azoospermia, accounting for about 6.6% of all testicular cancer patients. TESE is the alternative way for these patients to preserve fertility. For our patient, who presented with a rare and challenging situation of metachronous bilateral testicular cancer with azoospermia, we successfully retrieved sperm by onco-TESE. In conclusion, for azoospermic bilateral testicular cancer patients who are willing to preserve fertility, onco-TESE is feasible and should be considered as one of the treatment options.