Koichiro Isurugi

Seminoma in Klinefelter's syndrome with 47 XXY, 15s+ karyotype

A 32‐year‐old man was found to have seminoma of the right testis which had been subjected to orchiopexy for cryptorchism 14 years earlier. The left testis was small and firm, and the patient was further studied for hypogonadism. Chromosome analysis revealed a karyotype of 47, XXY, 15s+ with an extra X chromosome and enlarged and fluorescent satellites on chromosome 15. The satellites were also found in the mother as well as in two sisters and one brother out of his four siblings. Endocrine studies, histological pictures of the biopsied left testis and dermatoglyphic analysis were compatible with Klinefelters syndrome. To our knowledge this is the first reported case of seminoma associated with the syndrome. Several implications are discussed for the rare occurrence of a germinal cell tumor in Klinefelters syndrome.

Endocrine Effects of Cyproterone Acetate in Patients with Prostatic Cancer

Cyproterone acetate was given to patients with stages C and D prostatic cancer and its effect on endocrine parameters was studied. At a daily oral dose of 100 mg. cyproterone acetate induced marked reduction in the size and consistency of tumor, while it caused moderate suppression of serum luteinizing hormone, follicle-stimulating hormone and testosterone levels. Elevation of serum prolactin levels was observed after treatment with cyproterone acetate but was to a lesser degree than that caused by estrogens.

Endocrine Studies in Sertoli-Cell-Only Syndrome

Pituitary-gonadal endocrine functions were studied in 15 patients with Sertoli-cell-only syndrome and a comparison was made with other testicular diseases, such as Klinefelters syndrome. Elevated levels of serum luteinizing hormone as well as follicle stimulating hormone and lowered levels of serum testosterone suggested the existence of Leydig cell failure in addition to germ cell failure. However, the degree of these endocrinological abnormalities in patients with Sertoli-cell-only syndrome was mild compared to that in patients with Klinefelters syndrome. Reserve capacity of Leydig cells in patients with Sertoli-cell-only syndrome was considered to be preserved as suggested by the human chorionic gonadotropin stimulation test.

Studies On Pituitary-Gonadal Endocrine Function In XYY Men

Serum luteinizing and follicle-stimulating hormones and testosterone levels were studied in 11 patients with 47-XYY chromosomes and a comparison was made to normal men and patients with other testicular diseases, including Klinefelters syndrome. Serum follicle-stimulating hormone levels in patients with XYY chromosomes were elevated significantly in comparison to those in normal men but lower than those in men with Sertoli cell only syndrome and Klinefelters syndromes. Serum luteinizing hormone levels were somewhat elevated and serum testosterone levels were somewhat low in comparison to normal men, although the difference was not significant. Results of the short-term human chorionic gonadotropin stimulation test suggested almost normal Leydig cell reserve capacity in patients with XYY chromosomes.

Effects of estrogens on the testosterone levels of peripheral and spermatic vein blood in patients with prostatic cancer.

The mean testosterone levels of peripheral and spermatic vein blood in 16 patients with prostatic cancer who did not have estrogen therapy were 418.2 plus or minus 30.8 ng./dl. (mean plus or minus standard error) and 39.7 plus or minus 5.6 micrograms/dl., respectively. There were 13 patients with prostatic cancer who received estrogen therapy with daily doses of 30 mg. hexesterol or 300 mg. diethylstilbestrol diphosphate and who had decisive decreases of testosterone levels in peripheral (90.1 plus or minus 23.2 ng./dl.) and spermatic vein blood (3.3 plus or minus 1.2 migrogram/dl.). The rate of reduction of testosterone by estrogen therapy was one-tenth in the spermatic vein blood, while that in the peripheral blood was one-fifth. These data indicate that continuation of oral estrogens of these doses is sufficient to suppress the testicular androgens. On the other hand, the spermatic testosterone concentration was about 40 times higher than the peripheral testosterone concentration in patients receiving estrogen treatment. This result suggests that testosterone still is secreted from the testes under large therapeutic doses of estrogens.

Infantile XX male: a case report.

A case of infantile XX male syndrome with bilateral scrotal testes and penoscrotal hypospadias is presented. No evidence of XX/XY mosaicism or Y chromatin was obtained in preparations from cultures of the peripheral blood, skin fibroblast, or other tissues. Although true hermaphroditism was suspected, exploration of the bilateral gonadal structures failed to detect the presence of ovarian structures, either grossly or microscopically. Furthermore, exploratory laparotomy revealed no Mullerian structures. The difficulty of early diagnosis of XX males in infancy is emphasized.

Carcinoma in Situ of Germ Ceils and Subsequent Development of an Invasive Seminoma in a Hyperprolacti-naemic Man

A 25-year-old man was first seen complaining of impotence and found to have a pituitary tumour and hyperprolactinaemia. Both testes were small and atrophic, but a testicular tumour was not apparent. Biopsy of the right testis was performed, and the pathology report described thickening of the seminiferous tubule walls and impaired spermatogenesis. The patient refused to undergo an operation for his pituitary tumour and was lost to follow-up. 5 years later, the same patient presented with enlargement of his right testis, and this and the pituitary tumour were excised. The testicular tumour was classified as seminoma, and the pituitary tumour as an adenoma with low malignancy. Re-examination of the previous specimen of his right testis revealed foci of carcinoma-in-situ. This is an additional example of the growth of an invasive germ cell tumour from non-invasive carcinoma-in-situ of the testis.