[Bilateral testicular cancer of different histological types]

Four cases are presented. The first cancer was in a non-seminomatous location while the second tumor was a seminoma in all four patients, one being of mixed origin. A literature review demonstrated reports on 30 similar cases. Biopsy of the contralateral testis to detect a possible cancer in situ in no way modifies treatment as a function of findings, these patients being followed up because of the first cancer. A possible role evaluated is that of chemotherapy for the first cancer, but this is unconfirmed and 30% of patients had not received chemotherapy. It is difficult to determine lymph node extension during development of the 2nd tumor if radiotherapy or lymph node resection has been performed. Assay of tumoral markers in spermatic veins blood is a useful exploration. Surveillance of these castrated patients, with frequently elevated LM, can be assisted by selective assay of beta-HCG. Therapy must be by chemotherapy, to replace lymph node excision and radiotherapy which cannot be repeated.