Igal Silber

Prepubertal Yolk Sac Testicular Tumors - Report of the Testicular Tumor Registry

In 1980 the Section on Urology of the American Academy of Pediatrics established a registry of prepubertal testicular tumors. A total of 181 yolk sac tumors has been reported to the registry. Complete followup is available for 154 of these 181 patients. Most of the patients presented with low stage disease. Radical orchiectomy without adjunctive retroperitoneal lymphadenectomy, chemotherapy or radiotherapy was sufficient therapy for most stage 1 cancer patients. alpha-Fetoprotein is a reliable marker for this tumor. Chest x-rays and abdominal computerized tomography are reliable for staging. When metastases appeared they did so within 14 months of presentation so that 2 years of followup after any evidence of disease seems to be adequate. Approximately two-thirds of the patients with metastases were salvaged by chemotherapy, radiotherapy and/or an operation.

Spermatocytic seminoma. II. Ultrastructural study.

Two cases of spermatocytic seminoma were examined by electron microscopy. The more important ultrastructural features were: prominent nucleolus with dispersed nucleolonema; occasional nuclei with die chromosomal configuration of the leptotene stage of meiotic prophase; marked development of die Golgi apparatus, with formation of a dense secretory product; basal bodies and ciliary rootlets; “lamellar bodies”; specialized cell junctions of the zonula adherens type; true intercellular bridges, identical to those normally found between spermatocytes and between spermatids; syncytial formations; and basal laminae (basement membranes). Comparison of these findings with those of classical seminomas suggests an origin from the same cell type but also indicates that spermatocytic seminoma is a tumor distinct from the former by virtue of its greater differentiation, as evidenced by its capacity to produce spermatocytes and possibly spermatids.

Spermatocytic seminoma. I. Clinicopathologic study of six cases and review of the literature

Six cases of spermatocytic seminoma are reported, and the literature on the subject is reviewed. This neoplasm occurs in elderly persons, is grossly characterized by a gelatinous appearance, and has distinctive microscopic characteristics. Its degree of differentiation is far greater than that exhibited by classical seminoma, a tumor from which it should be separated. It is exclusively limited to the testicle and is never associated with teratomatous elements. Claims that it has a less favorable prognosis than classical seminoma are refuted; instead it is shown that the reverse is probably true. The large majority of patients have been cured by orchiectomy, whether or not postoperative irradiation therapy had been administered.

Gonadal Stromal Tumors: A Report of the Prepubertal Testicular Tumor Registry

A total of 15 gonadal stromal tumors in prepubertal boys has been reported to the Prepubertal Testicular Tumor Registry of the Section on Urology of the American Academy of Pediatrics. Leydig cell tumors invariably are benign and patients usually present with precocious puberty when they are 5 to 9 years old. Other gonadal stromal tumors either present in infancy as a scrotal mass and exhibit a benign behavior or occur later in childhood and may be malignant.

Radiation therapy in the treatment of localized carcinoma of the prostate. Preliminary report using 22-MeV photons

Preliminary results are reported with radical irradiation using 22‐MeV p photons in 59 patients with carcinoma of the prostate localized to the pelvis. All but 6 of the patients had extracapsular tumor extension (Stage C). This treatment technique appears to be effective in locally controlling the tumor, with low morbidity. After the 2nd year following treatment, the survival, clinically free of disease, is 50–60%. Approximately 15% of the patients have shown evidence of prostatic recurrence, frequently associated with distant metastasis. Of 11 patients in which postirradiation histologic sections of the prostate were reviewed, only 3 showed persistent microscopic tumor. Patients with poorly differentiated tumors had an extremely poor prognosis, a high proportion developing distant metastasis. Even though, at the present time, no definite statement can be made as to the effectiveness of radical irradiation alone in prolongation of survival of patients with carcinoma of the prostate clinically localized to the pelvis, it is imperative that this method of treatment be evaluated in controlled clinical trials with an option in which hormonal therapy will be deferred until progression of the disease or distant metastases develop.