title: Bilateral testicular germ cell tumors in Turkey: increase in incidence in last decade and evaluation of risk factors in 30 patients.
abstract: OBJECTIVE
  The relative risk of germ cell testicular tumor is significantly higher in patients with a testicular tumor history. We reviewed histological and clinical features in 30 patients with bilateral tumors treated at 2 academic centers in Turkey.
  
  
  METHODS
  Of 987 patients with testicular germ cell tumors 30 (3.0%) were diagnosed with bilateral disease. Data on clinical information, histopathology and followup records were reevaluated. Contralateral testis biopsy was not performed in any patient at initial orchiectomy.
  
  
  RESULTS
  Of 30 patients 24 had sequential tumors at a median interval of 75 months (range 3 to 260) and 6 (20.0%) had synchronous tumors. Mean age at presentation was 32.3 and 26.7 years, respectively. The second tumor occurred within 2 and 5 years in 20.8% and 41.7% of patients, respectively. Patients with seminoma were at significantly higher risk for bilateral disease (4.5% vs 2.3%), whereas patients with nonseminoma had more advanced disease at presentation. Synchronous tumors had similar tumor histology on each side and more advanced stage at presentation than metachronous tumors. Most patients with metachronous tumors had stage 1 disease, including 81% originally and 95.2% subsequently. Primary tumors were significantly larger than secondary tumors (4.78 vs 2.59 cm). Median time after the first and second germ cell tumors was 128 and 47 months, respectively. At last followup all patients had no evidence of disease.
  
  
  CONCLUSIONS
  The risk of contralateral testicular germ cell tumor in patients with seminoma was 2 times higher than in those without a history of tumor. Synchronous tumors present at advanced stage and have similar histology on each side. Clinical outcome is excellent with appropriate treatment. Contralateral testis biopsy at initial diagnosis is not mandatory.
authors.affiliation: Department of Urology, Hacettepe University, School of Medicine, Ankara and Tepecik Research and Training Hospital, Izmir, Turkey.
authors.forename: Bulent
authors.initials: B
authors.lastname: Akdogan
authors.forename: Akdogan
authors.initials: A
authors.lastname: Bulent
authors.forename: Rauf Taner
authors.initials: RT
authors.lastname: Divrik
authors.forename: Divrik Rauf
authors.initials: DR
authors.lastname: Taner
authors.forename: Tolga
authors.initials: T
authors.lastname: Tombul
authors.forename: Tombul
authors.initials: T
authors.lastname: Tolga
authors.forename: Sertac
authors.initials: S
authors.lastname: Yazici
authors.forename: Yazici
authors.initials: Y
authors.lastname: Sertac
authors.forename: Celik
authors.initials: C
authors.lastname: Tasar
authors.forename: Tasar
authors.initials: T
authors.lastname: Celik
authors.forename: Ferruh
authors.initials: F
authors.lastname: Zorlu
authors.forename: Zorlu
authors.initials: Z
authors.lastname: Ferruh
authors.forename: Haluk
authors.initials: H
authors.lastname: Ozen
authors.forename: Ozen
authors.initials: O
authors.lastname: Haluk
mesh_terms: D000328:Adult; D018240:Endodermal Sinus Tumor / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000453:epidemiology* / Q000473:pathology; D009378:Neoplasms, Multiple Primary / Q000453:epidemiology; D016609:Neoplasms, Second Primary / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D018239:Seminoma / Q000453:epidemiology; D013724:Teratoma / Q000453:epidemiology; D013736:Testicular Neoplasms / Q000453:epidemiology* / Q000473:pathology; D014421:Turkey / Q000453:epidemiology