title: Contralateral testicular cancer in spite of TIN-negative double biopsies and interval cisplatin chemotherapy.
abstract: BACKGROUND
  Current models of tumorigenesis postulate that testicular germ cell cancer uniformly develops through a preinvasive lesion termed testicular intraepithelial neoplasia (TIN). An open testicular biopsy is a simple and highly sensitive method to diagnose TIN, and this procedure constitutes the basis for curative treatment of TIN. Patients with testis cancer carry a significantly increased risk of developing contralateral testicular tumors. Therefore, a contralateral biopsy has been recommended in these patients. A negative biopsy was assumed to exclude the risk of a subsequent germ cell cancer in the testis due to the high sensitivity of the method. Reports on false-negative biopsies gave rise to the idea that TIN is not uniformly distributed throughout the testis. Consequently, double biopsies are thought to increase the diagnostic sensitivity.
  
  
  METHODS
  A 24-year-old patient with nonseminomatous testis cancer is reported. The patient had TIN-negative double biopsies in the contralateral testis. He received three cycles of standard PEB (cisplatin, etoposide, bleomycin) chemotherapy for visceral metastasis. 1 year after treatment the patient developed a nonseminomatous contralateral testis cancer which was treated by partial orchiectomy and subsequent local radiotherapy with 20 Gy.
  
  
  CONCLUSIONS
  The case presented here highlights some clinically important aspects: a) even double biopsies of the testis may fail to detect TIN. b) Systemic cisplatin-based chemotherapy may fail to prevent contralateral testicular germ cell cancer. c) A metachronous contralateral testis cancer may-in contrast to common clinical perception-develop even soon after the diagnosis of the first testis tumor. Furthermore, the case could foster the hypothesis that testicular germ cell tumors may in some cases develop without a preceding stage of TIN.
authors: Department of Radiation Oncology, AKH Hagen gGmbH, Hagen, Germany. souchon@akh-hagen.de
authors: Rainer
authors: R
authors: Souchon
authors: Ulrich
authors: U
authors: Gertenbach
authors: Klaus-Peter
authors: KP
authors: Dieckmann
authors: Eugen
authors: E
authors: Hahn
authors: Markus
authors: M
authors: Ruwe
authors: Christos
authors: C
authors: Stambolis
authors: Volker
authors: V
authors: Loy
authors: Johannes
authors: J
authors: Classen