Charles C. Higgins

Malignant tumors of the testicle

Abstract 1. 1. Malignant tumors of the testicle are comparatively rare. 2. 2. They may be divided into the homologous and heterologous types of tumor. The former is comprised mainly of the sarcomata and seminomata, the latter consisting of the mixed tumors of adult and embryonal tissue. 3. 3. Testicular tumors occur most frequently between the ages of 20 and 50. 4. 4. The etiology remains unsolved. There was a history of previous trauma in 19.4 per cent of the cases in this series. 5. 5. The incidence of testicular tumors is higher in cryptorchids than in normal individuals. 6. 6. Bilateral testicular tumors are rare. Neoplastic disease seems to involve the right testicle more often than the left. 7. 7. There are no pathognomonic signs, painless swelling of the testis being the first symptom in the vast majority of cases. 8. 8. Gumma, tuberculosis, hydrocele, hematocele, and orchitis must be considered in the differential diagnosis. 9. 9. The hormone test for prolan a is valuable in diagnosis, prognosis, and treatment. 10. 10. Metastasis takes place by way of two routes, namely: lymphatic extension and blood stream dissemination. The majority of lesions metastasize first to the retroperitoneal lymph nodes. The lungs and supraclavicular glands are also frequent sites of metastases. 11. 11. Simple castration, castration followed by x -ray or radium, radical operation, Coleys serum and x -ray or radium alone are the usual types of treatment. 12. 12. Results of treatment are discouraging. The best results are obtained in cases without clinical evidence of metastasis. In our series a combination of castration and x -ray seemed to give the longest survival. In Hinmans hands, the radical operation in selected cases gives comparatively good results. Dean also reports good results with radiation therapy alone.

PANEL DISCUSSION ON URINARY OBSTRUCTION

PANEL DISCUSSION ON URINARY OBSTRUCTION* Moderator: CHARLES C. HIGGINS, M.D., Chief, Department of Urology, The Cleveland Clinic Foundation, Cleveland, Ohio. Panelists: GRAYSON CARROLL, M.D., Associate Professor of Clinical Urology, St. Louis University, School of Medicine, St. Louis, Missouri; ORMOND S. CULP, M.D., Associate Professor of Urology, University of Minnesota Graduate School, Rochester, Minnesota; RUBIN H. FLOCKS, M.D., Professor of Urology, State University of Iowa, College of Medicine, Iowa City, Iowa; WILLIAM L. VALK, M.D., Professor of Urology, University of Kansas, School of Medicine, Kansas City, Kansas.