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An epithelioid trophoblastic tumor is a rare form of gestational trophoblastic neoplasia that mostly affects the uterus and endocervix in female patients of the reproductive age group. The tumor is believed to arise from chorion leave-type intermediate trophoblast. The epithelioid trophoblastic tumor in men is extremely rare and mostly described in association with mixed germ cell tumors of the testis. It is more commonly identified at the metastatic sites than in the testis. The epithelioid trophoblastic tumor should be differentiated from placental site trophoblastic tumor and squamous cell carcinoma. The distinctive morphology and characteristic immunohistochemical staining pattern help differentiate epithelioid trophoblastic tumors from other neoplasms. Only 7 male patients with epithelioid trophoblastic tumors have been described to date. Of these 7 patients, 4 were in metastatic sites, 2 in the testis, and 1 in the lung without the involvement of the testis or retroperitoneum. The proportion of epithelioid trophoblastic tumors was only 5% in the 2 patients with testis involvement. Here, we report the third patient with a primary testicular epithelioid trophoblastic tumor in a young man. Further, this is the first report to document epithelioid trophoblastic tumor as dominant histology in a testicular germ cell tumor.

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INTRODUCTION AND IMPORTANCE: Epidermoid cysts (ECs) of the testicle are rare benign lesions that can mimic more serious testicular masses. Accurate diagnosis is essential for proper management, often requiring surgical intervention to confirm the nature of the mass. CASE PRESENTATION: A 21-year-old male presented with chronic pain in his right scrotum. Physical examination revealed a firm mass within the right testis. Ultrasound and MRI findings were consistent with an intratesticular EC. The patient underwent partial orchidectomy for further evaluation and treatment. CLINICAL DISCUSSION: Histopathological analysis confirmed the diagnosis of an epidermoid cyst, characterized by a well-defined lesion with keratin-filled cystic spaces. The differential diagnosis for testicular masses includes both benign and malignant conditions. Imaging alone may not be sufficient to distinguish between these possibilities, making surgical exploration and histopathological examination necessary for definitive diagnosis. CONCLUSION: This case highlights the importance of considering epidermoid cysts in the differential diagnosis of testicular masses in young males. Surgical intervention, such as partial orchidectomy, not only provides a definitive diagnosis but also serves as a therapeutic measure. The patient had an uneventful postoperative recovery, emphasizing the efficacy and safety of the surgical approach in such cases.

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Gonadectomy in dogs is associated with changes in risks of a variety of non-infectious health conditions, but few studies have examined its effects on infectious disease outcomes. The objectives of our study were to estimate the causal effect of gonadectomy on the incidence rate of babesiosis diagnosis, and on the risk of severe babesiosis in diagnosed cases, in dogs 6 months and older seen at a veterinary academic hospital in South Africa from 2013 through 2020. To estimate the effect of gonadectomy on the incidence rate of babesiosis diagnosis in dogs, we conducted a case-control study with incidence density sampling of dogs seen through the hospital's primary care service, adjusting for sex, age, breed category and weight. We identified 811 cases and selected 3244 time-matched controls. To estimate the effect of gonadectomy on disease severity in dogs with babesiosis, we conducted a retrospective cohort study among all dogs with a diagnosis of babesiosis (n=923), including these 811 cases and a further 112 referred to the hospital, also adjusting for sex, age, breed category and weight. Gonadectomy substantially reduced the incidence rate of babesiosis (total effect incidence rate ratio [IRR] 0.5; 95 % confidence interval [CI] 0.41-0.60) and the risk of severe babesiosis among diagnosed dogs (total effect risk ratio [RR] 0.72; 95 % CI 0.60-0.86). Tipping point sensitivity analysis shows that these effect estimates are robust to unmeasured confounding bias. There was no evidence for modification of the effect of gonadectomy by sex, with effect estimates qualitatively similar for males and females for both outcomes. Compared to females, males had a higher incidence rate of babesiosis (IRR 1.74; 95 % CI 1.49-2.04) and a higher risk of severe disease (RR 1.12; 95 % CI 0.98-1.28). In conclusion, our study shows a robust protective effect of gonadectomy on the incidence and severity of babesiosis in both male and female dogs 6 months of age and older, and contributes important evidence to the debate on the overall risks and benefits of gonadectomy to dogs in this population.

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Paratesticular tumours are rare malignancies that are frequently misdiagnosed on presentation. We present a case of an elderly male with a six-month history of painless, progressively increasing left inguinal swelling. On preliminary examination and investigation, the swelling was misdiagnosed as a lymph nodal mass. Subsequently, a magnetic resonance imaging study detected a lesion that was not distinct from the spermatic cord. Biopsy testing of the said lesion was suggestive of poorly differentiated spindle cell neoplasm. The patient then underwent a high inguinal orchidectomy. Histopathological examination confirmed the diagnosis of a high-grade paratesticular dedifferentiated liposarcoma with rhabdomyoblastic differentiation. Due to the rarity of such tumours, the need for adjuvant chemotherapy and radiotherapy is debated.

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INTRODUCTION: High cord radical orchidectomy (HRCO) is accepted as the standard surgical approach in testicular cancer, however low cord orchidectomy (LCRO) can reduce the morbidity of operation without worsening the oncological outcomes. METHODS: We retrospectively re-examined the specimens of men to determine the level of spermatic cord invasion (SCI). Men who had proximal SCI with negative surgical margins after HRCO were assumed to have de-novo residual tumour if LCRO was performed. Others were assumed as oncologically similar. We examined the relation between pre-operative variables and SCI and proximal SCI to determine whether prediction of proximal SCI is possible. RESULTS: 196 patients were included. 22 (11%) had SCI and ten (5%) had proximal SCI. Four patients with proximal SCI had positive surgical margins even after HRCO and didn't require additional local treatment. Six patients were assumed to have de-novo residual tumour if LCRO was performed. All six patients were metastatic and had systemic chemotherapy. High platelet count, tumour size, N stage, S stage and M stage were all significantly related with both SCI and proximal SCI (p < 0.05). CONCLUSION: Due to low probability of SCI, we think LCRO can safely be performed to reduce morbidity in Stage 1 patients. Although there is a risk for residual tumour in Stage 2-3 patients, currently there is no data that residual tumour would impair the success of systemic chemotherapy. Therefore we can not assume that these patients would be negatively affected. Pre-operative data can be useful to predict the presence of proximal SCI and select appropriate patients for LCRO.

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Radical orchidectomy has been the standard surgery for testicular tumours. While a straightforward routine surgery, there are several finer points in the surgical technique and perioperative care that urologists should be familiar with. This mini-review discusses modifications to the conventional surgical approach such as organ-sparing surgery and the subinguinal approach, and practice points regarding prostheses and sperm banking that are pertinent to early management of a patient with a testicular tumour. PATIENT SUMMARY: We reviewed the evidence for surgical removal of a testicle for testicular cancer. There are a number of different techniques to minimise the extent of surgery. Surgeons should also discuss sperm banking and options for a testicular prosthesis with their patients.

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We report the case of a 23-year-old male presenting with right testicular swelling, post-coital pain, and fever. Initial MRI and local examination suggested testicular carcinoma. Elevated serum alpha-fetoprotein (AFP) and lactate dehydrogenase (LDH) levels were observed. Biopsy confirmed a mixed germ cell tumor (MGCT). Concurrently, the patient was diagnosed with an infection and treated with antibiotics. Remarkably, following antibiotic therapy, fever resolved, and tumor marker levels significantly decreased. Subsequent orchidectomy confirmed the diagnosis of MGCT. This case underscores the importance of recognizing and treating concurrent infections, which may influence both clinical presentation and tumor marker levels in testicular germ cell tumors.

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Well-differentiated neuroendocrine tumors of the testis are exceedingly rare. Here, we report the case of a 47-year-old male patient complaining of cardiac symptoms with a right testicular mass. A right radical orchiectomy was performed. The histopathological findings showed a well-differentiated neuroendocrine tumor with positive synaptophysin and chromogranin A immunostains.

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Para-testicular liposarcoma develops from the fatty tissue surrounding the spermatic cord and covers the testicle and epididymis. It is an extremely rare pathological entity. We report the case of a 58-year-old african man who presented with a tumor mass developed from the right spermatic cord. Right orchidectomy with wide excision of the tumor was challenging due to the significant size of the mass. The histological examination of the surgical specimen favored a paratesticular liposarcoma.

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The incidence of undescended testicles torsion in a 7-year-old is rare, making it a clinically unusual occurrence. Emphasizing the importance of thorough urogenital assessments in children, particularly in underserved communities, is critical to prevent serious complications like testicular gangrene.

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INTRODUCTION: Testicular torsions in elderly individuals are rare occurrences that are often managed surgically. CASE PRESENTATION: We present the first reported case of a successful manual detorsion in a 70-year-old male patient, resulting in clinical and radiological improvement. CLINICAL DISCUSSION: In this case report we discuss the role of manual detorsion alone in elderly without the need for surgery. CONCLUSION: Observation of our patient for 24 h post-detorsion ensured stability before discharge.

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Inflammatory pseudotumour of the testis is a rare but important clinical entity to be recognised by the surgical trainee. We present a case of a 30-year-old gentleman who presented with a hard painless testicular mass. Ultrasound scrotum revealed a diffuse paratesticular swelling arising from the tunica vaginalis with a normal-appearing testis. Germ cell tumour markers were normal. Exploration through an inguinal approach confirmed it to be arising from the tunica vaginalis. Wide excision of the tumour along with a cuff of adherent tunica albuginea was done. Final histopathology revealed a diffuse fibrous pseudotumour of the tunica vaginalis confirming its benign nature.

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Objective: The study aims to assess current international clinician attitudes, practices and barriers towards fertility assessment and preservation in patients undergoing radical inguinal orchidectomy (RIO) for testicular cancer. Materials and methods: An international online survey of urologists and urologists in training who perform RIO for testicular cancer was developed by the British Association of Urological Surgeons (BAUS) Sections of Andrology and Oncology and the British Urology Researchers in Surgical Training (BURST). The recruitment process used social media and the emailing lists of national urological societies. Responses were collected between 10/02/2021 and 31/05/2021 and stored using password-protected Research Electronic Data Capture (REDCap) database software. The primary outcome was the proportion of urologists who routinely offer semen cryopreservation prior to RIO. The study was reported according to the Checklist for Reporting Results of Internet E-Surveys platform. Results: A total of 393 respondents took part in the online survey; of these, the majority were from the United Kingdom (65.9%), with the remaining international respondents (34.1%) from six different continents, which included 45 different countries. Of the respondents, 57.1% reported that they would routinely offer semen cryopreservation to all patients undergoing RIO for testicular cancer. In addition, 36.0% of urologists routinely performed pre-operative semen analysis, and 22.1% routinely performed pre-operative testicular serum hormone profile. Of the respondents, 14.4% performed expedited RIO within 48 h; 31.2% of respondents reported that they considered no delay to RIO to allow for semen cryopreservation to be acceptable. Conclusions: A significant proportion of international urologists do not offer pre-operative fertility assessment and preservation in men undergoing RIO for testicular cancer. Surgery is performed in an expedited fashion within 1 week in the majority of patients. Urologists perceive there to be a lack of access and availability to fertility services, and that delay to RIO to allow for fertility preservation is often not acceptable.

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BACKGROUND: Early diagnosis of prostate cancer is key to achieving a cure and its proper management leads to a good prognosis. In Ghana a large percentage of patients present with advanced disease and unusual presentations in these patients result in greater delay in the diagnosis thus worsening the outcomes. CASE PRESENTATION: We present three African males with advanced prostate cancer who had delayed diagnosis. The first patient, a 64 year old male presented with ascites of 2 years duration with weight loss and no lower urinary tract symptoms, the second, a 69 year old man with end stage renal failure of 6 months duration and was receiving dialysis, the third case, an 87 year old man was managed for pulmonary tuberculosis after he presented with chronic cough and lower urinary tract symptoms. All patients eventually had a prostate specific antigen done which were elevated. Further investigations including prostate biopsies, abdominopelvic CT scans for case 1, abdominopelvic ultrasound, prostate biopsies and blood urea and electrolytes for case 2, prostate biopsies, chest and lumbosacral showed a diagnosis of metastatic prostate carcinoma, and all patients were managed with androgen deprivation. The second patient received additional radiotherapy. CONCLUSION: A lack of knowledge of prostate cancer symptoms including unusual symptoms, can result in delayed diagnosis especially in regions of the world where a large number of patients present with advanced disease.

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Paratesticular rhabdomyosarcoma (PRMS) is a rare and aggressive soft tissue tumour that can mimic testicular sarcoma on initial imaging studies, leading to diagnostic ambiguity and treatment delays. In this case report, we present the case of a 45-year-old male who came to our department and was evaluated under ultrasound imaging along with colour Doppler. The patient underwent further examination under a multi-slice CT machine, which provided additional information, and finally underwent a 1.5T MRI scan. After a provisional diagnosis was made, the patient underwent surgery, and the specimen was sent for histopathology and relevant immunohistopathological markers. This case underscores the diagnostic challenges posed by PRMS and emphasizes the need for a multidisciplinary approach involving radiologists, oncologists, and surgeons for timely diagnosis and optimal management. We discuss the clinical implications, imaging characteristics, differential diagnosis, and therapeutic considerations for PRMS to guide clinicians in similar diagnostic dilemmas.

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Appendicectomy, or the removal of the appendix, is an emergency procedure following symptomatic acute appendicitis. Diagnosis is made on clinical examination but can be confirmed on imaging if other abnormalities are suspected. A few variants of appendix anatomical position exist that can be difficult to manage. In addition, secondary findings during surgery can come unexpectedly. We report a case of a 14-year-old male, who presented to the emergency department at our government institution with abdominal pain and vomiting. Examination revealed an empty right scrotum, which was unnoticed by the patient and never examined previously due to residence in an area of limited healthcare access. Ultrasound done elsewhere was inconclusive. The surgical intervention showed a retrocecal appendix attached to an ascending colon terminating at hepatic flexure. The procedure was further complicated by the presence of the right intra-abdominal testis located below the cecum. Excised samples were sent for histopathology, and the patient was followed with biopsy reports. This case highlights the challenges encountered during routine appendicectomy with unusual findings.

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Paratesticular myxoid liposarcoma is an exceedingly rare malignancy originating from the spermatic cord or paratesticular tissues. We report a unique case of a 75-year-old male patient who presented with a painless scrotal swelling that had been growing for four years. Imaging investigations, including ultrasonography (USG) and contrast-enhanced computerized tomography (CECT), revealed characteristics consistent with paratesticular myxoid liposarcoma. The orchidectomy specimen confirmed a grade 2 right paratesticular myxoid liposarcoma. Despite its rarity, clinicians must consider this tumor in the differential diagnosis of painless scrotal swellings. Accurate diagnosis and comprehensive management, encompassing surgical resection with wide margins and potential adjuvant therapies, are pivotal. This case underlines the importance of collaborative research and long-term follow-up in understanding and managing paratesticular myxoid liposarcomas.

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INTRODUCTION AND IMPORTANCE: Tuberculosis is prevalent in African countries especially in sub-Saharan Africa where HIV/AIDS is common. While Testicular tuberculosis is uncommon in the young as well as the elderly, pulmonary tuberculosis is commonly observed in these populations. History, physical examination, scrotal ultrasonography, and fine needle biopsy are important in diagnosis of suspected cases of testicular tuberculosis. Anti-TB therapy is the mainstay of treatment to ensure complete resolution of the lesion. However, in a few cases, orchidectomy is required for both diagnosis and treatment. When treating testicular tuberculosis, it is crucial to do a thorough assessment and investigations to exclude testicular malignancy because tuberculosis can present similarly to a testicular tumor. CASE PRESENTATION: We report a rare case of right sided isolated testicular tuberculosis in a 45-year-old male who came with right sided testicular pain and swelling. Blood workups and testicular tumor markers were all normal, scrotal ultrasound reported right heterogenous testicular mass with avascular areas of necrosis and septated fluid collections in the tunica vaginalis with features suggestive of testicular tumor. Right orchiectomy through inguinal approach was done, findings included testicular mass with pus pockets and caseous necrosis occupying the whole testis. Specimen was sent for histopathology which revealed chronic granulomatous inflammation, most likely tuberculosis, and ZN stain confirmed the diagnosis of testicular tuberculosis. In accordance with national TB guidelines, the patient had anti-TB medication for six months, and after 12-months serial follow-up, the patient had completely recovered. CLINICAL DISCUSSION: Genitourinary tuberculosis is the second most common form of extrapulmonary TB after lymph node tuberculosis. 0.5 % of genitourinary TB involves the testes; On the other hand, isolated testicular TB as presented in our patient, is extremely uncommon, thus may mimic other testicular conditions including testicular tumor, so the diagnosis is challenging. It is important to accurately diagnose testicular TB and differentiate it from other scrotal pathologies especially testicular malignancy as the management is totally different. Testicular tuberculosis is diagnosed by tissue Cytology using FNAC or after an orchidectomy. It requires early, regular, full course combined anti-tuberculosis treatment. The drug treatment method uses three to four anti-tuberculosis drugs for 6-9 months. Surgical treatment is necessary if there is no response to drug treatment or in cases of abscess formation. CONCLUSION: Testicular TB is a curable disease, but its diagnosis remains challenging. It is often missed owing to its non- specific symptoms. Thus, testicular TB should be suspected in patients with a notion of contagion or history of tuberculosis. Some of the radiological features are highly suggestive of testicular TB. FNAB could prevent unnecessary orchidectomy. In our case, the presentation was typically mimicking a testicular cancer and the patient underwent trans inguinal orchiectomy, and histology and ZN stain confirmed the diagnosis followed by subsequent six-month anti TB therapy.

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Splenogonadal fusion is a rare, benign congenital malformation characterized by the association of splenic tissue and gonads (typically testicles). It is a condition of male predominance and can be classified into two types: continuous, if the spleen and gonad are united by a splenic cord or fibrous tissue, or discontinuous. Splenogonadal fusion is often associated with other congenital anomalies such as cryptorchidism, limb defects, and micrognathia. Differential diagnosis can be difficult and includes inguinal hernia, spermatic cord cyst, cryptorchidism, or testicular mass. Due to little knowledge of the pathology, unnecessary orchidectomies are often performed. A previously healthy five-year-old boy was sent to a pediatric surgery appointment due to testicular asymmetry. The physical examination showed a painless, nodular mass adhering to the upper pole of the left testicle, without any palpable inguinal masses. Tumor markers were negative, and a testicular ultrasound with Doppler revealed a mass suggestive of an accessory testicle. Left inguinal surgical exploration revealed the presence of a mass joined by fibrous tissue to the upper pole of the testicle, but no connection to the native spleen was found. Total excision was performed with the testicle's preservation. The anatomopathological analysis revealed morphological aspects compatible with splenic tissue with normal characteristics. The diagnosis of splenogonadal fusion is rare and complex, requires several differential diagnoses, and is often made intraoperatively.The prognosis is excellent as long as there are no associated malformations. A high level of suspicion for this pathology, with recognition of the anatomical structures, can avoid unnecessary orchidectomy.

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Testicular tumors include germ cell tumors, sex cord stromal tumors, and ovarian type epithelial tumors. Testicular mucinous tumors belong to ovarian type epithelial tumors and are extremely rare with only 31 cases reported in literature so far. Among those, mucinous adenocarcinoma constitutes only 9 cases. There are no standard treatment guidelines owing to their rarity. We report a case of primary testicular mucinous adenocarcinoma managed by orchidectomy, chemotherapy, and retroperitoneal lymph node dissection. A 44-year-old gentleman presented with right testicular tumor with infiltration and ulceration of scrotal skin. Tumor markers were within normal limits. Patient underwent orchidectomy with excision of involved scrotal skin. HPE suggested mucinous adenocarcinoma of testis. Patient was then administered chemotherapy but had progression of disease and hence taken up for retroperitoneal, bilateral pelvic, and bilateral inguinal lymph node dissection with revision of spermatic cord. Patient recovered uneventfully and is on regular follow-up 6 months now since surgery. There are no standard guidelines for the management of mucinous adenocarcinoma of testis. It is essential to rule out mucinous carcinoma of gastrointestinal tract metastasizing to testis before labeling as primary mucinous adenocarcinoma of testis. Surgery remains the mainstay of treatment in metastasis confined to retroperitoneal and inguinal lymph nodes. Further studies are needed to identify optimal chemotherapy regimen for metastatic and adjuvant scenarios.