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Onco-testicular sperm extraction (onco-TESE) for bilateral testicular tumors: two case reports
- Sohgo Tsutsumi1, 2,
- Takashi Kawahara1Email authorView ORCID ID profile,
- Teppei Takeshima2,
- Sawako Chiba3,
- Koichi Uemura4,
- Masako Otani3,
- Kota Shimokihara1,
- Yutaro Hayashi1,
- Taku Mochizuki1,
- Daiji Takamoto1,
- Yusuke Hattori1,
- Jun-ichi Teranishi1,
- Yasuhide Miyoshi1,
- Masahiro Yao5,
- Yoshiaki Inayama3,
- Yasushi Yumura1 and
- Hiroji Uemura1
© The Author(s). 2017
Received: 17 February 2017
Accepted: 28 April 2017
Published: 17 May 2017
Most patients with testicular cancer are infertile; thus, the preservation of the sperm after surgery is an important factor to consider. We report two cases of bilateral testicular cancer in patients who underwent bilateral higher orchiectomy and simultaneous testicular sperm extraction.
Two Asian-Japanese men were referred to our hospital with bilateral testicular tumors. Both of the patients were preoperatively diagnosed with azoospermia and requested testicular sperm extraction at the time of higher orchiectomy. In one patient, sperm was successfully harvested and then frozen. In the other patient, sperm could not be retrieved from the patient’s testis. In both patients, the pathological diagnosis was seminoma. Testicular tumors often occur in patients of reproductive age. The preservation of sperm before chemotherapy or bilateral orchiectomy is necessary for patients with testicular tumors who wish to be fathers.
Onco-testicular sperm extraction might be an option for patients with testicular cancer and azoospermia or severe oligospermia.
The standard treatment for testicular tumors is higher orchiectomy. Adjuvant chemotherapy and radiation therapy are sometimes added. Most patients with testicular cancer are infertile; thus, preservation of their sperm after surgery is an important factor to consider. We report two cases of bilateral testicular cancer in patients who underwent bilateral higher orchiectomy and simultaneous testicular sperm extraction (onco-TESE). Sperm was successfully harvested from one of these patients.
Testicular tumors account for 1.0–1.5% of malignant disease in male patients, and they usually occur in men 15–35 years of age. Bilateral cases account for 1.0–2.0% of testicular tumors. Heterochronous bilateral testicular tumors are seen four times more frequently than simultaneous bilateral testicular tumors. Seminoma, which is the most common type of bilateral testicular tumor, is seen in 47% of heterochronous cases and 67% of simultaneous cases . Although bilateral cases require testosterone replacement therapy, the prognosis is almost the same as that in unilateral cases.
The risk of testicular tumors in male infertility patients is 20 times higher than that in patients who are not infertile. The higher incidence of testicular tumors in infertile patients was thought to be associated with the diminished spermatogenic function of the patients before the development of the tumor. This hypothesis is referred to as testicular dysgenesis syndrome. The syndrome is suggested to be a reason for the development of testicular tumors, a decrease in spermatogenic function, cryptorchidism, and hypospadia . For these reasons, male infertility patients should be screened for testicular tumors.
Onco-TESE is a procedure that allows sperm to be obtained from the normal testis of patients who do not emit sperm prior to cancer therapy. Onco-TESE can be applied to patients with azoospermia, severe oligospermia, or ejaculation disorder before chemotherapy or in cases involving bilateral testicular tumors. Sperm was frozen for a total of 168 cases at our institute from 2011 to 2016. Fifty-three (31.5%) of these cases involved patients with testicular tumors. Twenty-six (60.5%) of these cases involved patients with bilateral testicular tumors (bilateral, n = 6; unilateral, n = 20). Five of these patients were azoospermic, and one patient was dysspermic. We performed onco-TESE in three patients. Including our own patients, 43 cases of onco-TESE have been reported in the literature [3–6]. In 22 (51.2%) cases, sperm was successfully preserved, including 14 patients (53.8%) with testicular tumors. The previous reports noted that pregnancy was achieved in four cases using sperm extracted via onco-TESE, with a healthy child delivered in three of the four cases. A correlation between tumor size and spermatogenesis in patients with testicular tumors has been reported. Jeremy et al. reported that spermatogenesis was observed in 86%, 81%, and 57% of cases involving tumors of 1 cm, 2 cm, and 5 cm in size, respectively .
Although onco-TESE is useful, the number of institutes in which surgeons perform the procedure is limited. When these restrictions are cleared, onco-TESE will become an important option for preserving fertility. Regarding infertility, CT might have some effects. But, based on cancer control, CT examination should be recommended.
We describe two cases in which onco-TESE and resection were performed simultaneously in patients with bilateral testicular tumors.
Kimitou Kobayashi and Mizuki Yamamoto who are embryologists in Yokohama City University Medical Center, supported this study.
Grants were received from the Grants-in-Aid for Scientific Research Program (KAKENHI grant 16 K20152), from the Ministry of Education, Culture, Sports, Science and Technology of Japan, and from the 2016–2017 Research Development Fund (WJ2810) of Yokohama City University.
Availability of data and materials
Owing to ethical restrictions, the raw data on which this paper is based are available upon request from the corresponding author.
ST, TK, and YY conceived of and designed the experiments. ST, TK, YY, SC, and MO analyzed data. ST, TT, KU, KS, YH, TM, DT, YH, JT, YM, MY, YI, YY, and HU performed the experiments. ST, TK, SC, MO, and YY wrote the paper. All authors read and approved the final manuscript.
The authors declare that they have no competing interests.
Consent for publication
Written informed consent was obtained from the patients for publication of this case report and any accompanying images. Copies of the written consents are available for review by the Editor-in-Chief of this journal.
Ethics approval and consent to participate
The present study was approved by the institutional review board of Yokohama City University Medical Center, and written informed consent was obtained from the patients.
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