Volume 21, Number 2Reviews in UrologyMassive Intra-abdominal Germ Cell Tumors: A Case Series and Review of LiteratureNirmish SinglaAditya BagrodiaDaniel G WongIntra-abdominal testes are at increased risk of malignant transformation and can manifest as large abdominal masses with a wide variation in presenting symptoms. In the setting of cryptorchid or nonpalpable testes, large abdominal masses are highly suspect for germ cell tumors. Without standard guidelines, management can vary extensively. Surgical management may not be trivial and can entail a major abdominal operation in the context of a multimodal approach. The use of biopsy and serum tumor markers may effectively guide sequence of management based upon expected histology. In advanced cases, neoadjuvant chemotherapy may be pursued, and retroperitoneal lymph node dissection may be accomplished at the time of orchiectomy to minimize morbidity. The development of these massive late stage tumors reaffirms current guidelines on the early correction of cryptorchidism. [Rev Urol. 2019;21(2/3):136–140] © 2019 MedReviews®, LLCTesticularSeminomaNonseminomatous
Volume 22, Number 2Case ReviewFirst Do No Harm: A Cautious, Risk-adapted Approach to Testicular Cancer PatientsNirmish SinglaAditya BagrodiaHersh M TrivediJohn LafinDavid FetzerPayal KapurCurrent guidelines regarding treatment for germ-cell tumors (GCTs) emphasizes cautious progression focusing on stage-specific treatments. Presented herein is the case of a 30-year-old man who, through monitoring of serum alpha-fetoprotein (AFP) levels and surveillance imaging, avoided excessive treatment. This case demonstrates how an experienced clinician, familiar with natural history of GCTs, can appropriately classify level of risk and allow a patient to preserve natural fertility. Furthermore, we highlight the potential for miRNA analysis in staging and management of GCTs. This case serves to underscore the importance of acting with caution in the pursuit of the best outcome for our patients. [Rev Urol. 2020;22(2):85–89] © 2020 MedReviews®, LLC