Germinal cell tumors of the testis in cryptorchids

The medical records of 876 patients with germinal cell tumor of the testis seen at our hospital between 1984 and 1996 were analyzed; 25 (2.85%) were reported to have tumors in undescended testis. Twenty-one patients had unilateral involvement and four had bilateral. Cryptorchidism was corrected ipsilaterally in 7 patients with intrascrotal testicular cancer between 6 and 13 years of age. The primary tumor was in the abdominal testis in 11 patients and in the inguinal canal in 7 (28%) patients. Three patients had persistent Müllerian duct syndrome. One of the three patients with persistent Müllerian duct syndrome also had transverse testicular ectopia. Clinical staging showed 10 stage I, 8 stage IIC, 3 stage III and 4 stage IV. Tumor histologic types on orchidectomy showed seminoma in 20, non-seminoma in 3 and mixed tumors in 2 patients. According to stage and histologic findings all patients were treated with radiotherapy or chemotherapy. Overall, 3 and 5 years survival in seminoma patients was 100% while in non-seminoma and mixed tumor patients was 80% and 60%, respectively. Since orchidopexy offers only limited protection against future malignancy if performed after 2 years of age, the treatment of choice should be orchidectomy. Cryptorchid testes that descended spontaneously or by hormonal therapy should be followed lifelong by testicular ultrasound at least once a year for early detection of cancer. For bilaterally orchidectomised cases administration of androgens is mandatory to prevent sexual dysfunction and hot flushes.