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Microsurgical Onco-Testicular Sperm Extraction in a Patient With Testicular Cancer and Congenital Unilateral
Yuki Matsumoto1, Toshiyasu Amano1, Mamoru Hachiya1
1Department of Urology Nagano Red Cross Hospital Nagano Japan.
Introduction:
Testicular cancer primarily affects men of reproductive age. Therefore, fertility preservation is important in managing testicular cancer. In patients with a solitary testis, oncological testicular sperm extraction (onco-TESE) is used to retrieve sperm from tumor-bearing testis.
Case Presentation:
A 39-year-old man with congenital absence of the left testis presented with a 4-month history of progressive right testicular swelling. Laboratory tests showed elevated β-human chorionic gonadotropin and follicle-stimulating hormone concentrations, and ultrasonography showed a heterogeneous hypoechoic mass with microcalcifications. A seminal analysis showed azoospermia with AZFc partial deletion. Following orchiectomy, microsurgical onco-TESE was performed. Motile sperm were successfully retrieved from preserved seminiferous tubules. A pathological examination demonstrated a pure seminoma. In preserved seminiferous tubules, the Johnsen score was 9-10, and partial tubular hyalinization and microcalcifications were observed.
Conclusion:
Microsurgical onco-TESE is for retrieving sperm in patients with testicular cancer with a solitary testis, even in the presence of impaired spermatogenesis.
Insights
Oncological testicular sperm extraction (onco-TESE) successfully retrieved motile sperm from a solitary, tumor-bearing testis in a patient with seminoma and impaired spermatogenesis, aiding fertility preservation.
Area of Science:
- Reproductive Medicine
- Oncology
- Urology
Background:
- Testicular cancer impacts men of reproductive age, necessitating fertility preservation strategies.
- Patients with a solitary testis require specialized sperm retrieval techniques if diagnosed with cancer.
Purpose of the Study:
- To evaluate the efficacy of microsurgical oncological testicular sperm extraction (onco-TESE) in retrieving viable sperm from a tumor-bearing testis in a patient with a solitary testis and azoospermia.
Main Methods:
- A 39-year-old man with a solitary testis and suspected testicular cancer underwent diagnostic evaluations, including hormone assays and ultrasonography.
- Following orchiectomy for a confirmed pure seminoma, microsurgical onco-TESE was performed on the tumor-bearing testis.
- Sperm retrieval from preserved seminiferous tubules was assessed using the Johnsen score.
Main Results:
- Elevated tumor markers and ultrasound findings indicated a testicular mass.
- Microsurgical onco-TESE successfully retrieved motile sperm from the seminoma-bearing testis.
- Histological examination of retrieved tubules showed a high Johnsen score (9-10), despite partial tubular hyalinization and microcalcifications.
Conclusions:
- Microsurgical onco-TESE is an effective fertility preservation method for testicular cancer patients with a solitary testis.
- Successful sperm retrieval is possible even with impaired spermatogenesis and testicular tumors.
