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Testicular and Para-Testicular Tumors in South Western Nigeria

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Testicular and Para-Testicular Tumors in South Western Nigeria Testicular and para-testicular tumors in south western Nigeria Salako A A1, *Onakpoya U U 1, Osasan SA2, Omoniyi-Esan G O 2 1Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria 2Department of Morbid Anatomy and Histopathology, Obafemi Awolowo University Teaching Hospitals Complex, Ile- Ife, Nigeria Abstract Background: Tumors of the testis and paratesticular tissues are rare, especially in men of African descent. In recent reviews however, the incidence is rising among the Caucasians and black Americans. We set out to determine the incidence in South- Western Nigeria and to examine the histopathologic variants. Methods: A retrospective study of patients who had histopathologically confirmed testicular and para-testicular tumours between 1989 and 2005 (17 years). Their records were documented at the Ife-Ijesha cancer registry which serves 4.7 million men residing in three states of South-Western Nigeria. Results: There were 26 cases of testicular and para-testicular tumors with an average incidence of 1.5 cases per year. The incidence of testicular cancer in our study was 0.55 per 100,000 population (95% CI, 0.52- 0.57) and accounted for 1.1% of all male cancers. Rhabdomyosarcomas were the most common variety (70% of the paratesticular tumors and 26.8% of all tumors of the testis). Seminomas comprised 50% of the germ cell tumors and 15.4% of all testicular tumors in this series. Conclusion: There still remains a low incidence of testis cancer in the South Western Nigeria. The reduction in the incidence of seminomas makes rhabdomyosarcomas the most predominant tumor in South Western Nigeria. Key words: testis, tumors, Nigeria African Health Sciences 2010; 10(1): 14 - 17 Introduction Tumors of the testis and para-testicular tissues are incidence, clinical characteristics and the rare in men. However, they constitute the most histopathologic variants. common solid malignancies in men aged between 15 and 35 years 4, 5. With an incidence of 0.5 – 2% Methods of all malignancies 1- 3. The discrepancy in the This is a retrospective study including all patients who incidence of testicular tumors in the Caucasians had histopathologically confirmed testicular and para- compared to men of African descent has been well testicular tumors between 1989 and 2005 (17 years). described in previous studies with a marked lower Ethical clearance was obtained from the Institutional incidence in Africans 6- 11. Whereas the incidence is Ethical Clearance Committee. These patients had rising in the Western and Asian countries (over 60% their records consisting of age, sex, laterality, and and 40% increase in white and black Americans histologic variant listed in the Ife-Ijesha cancer registry respectively), reports from black populations of which serves 4.7 million men who reside in Ondo, 16 Africa and West Indies show persistently low Ekiti and Osun states of South-Western Nigeria . incidence 12- 15. These extracted records were analyzed using SPSS We review all testicular and para-testicular version 11.0. Patients with inconclusive tumours examined in the department of Morbid histopathologic reports were not included in the Anatomy and Histopathology, Obafemi Awolowo analysis. All the paraffin sections of the tumors University Teaching Hospital, Ile- Ife, South Western stained by haematoxylin and eosin were reviewed. Nigeria, which hosts the Ife- Ijesha cancer registry, Special staining was done where necessary. The over a seventeen year period to determine the tumors were classified using the Mostofi classification adopted by the WHO expert committee 17. *Correspondence author: Results Dr Uvie Ufuoma Onakpoya There were 26 cases of histopathologically Department of Surgery confirmed testicular and para-testicular tumors over Obafemi Awolowo University Teaching Hospitals the 17 year period the study covered, giving an Complex, PMB 5538, average incidence of 1.5 cases per year. The incidence Ile-Ife 22006, Osun state, Nigeria. of testicular cancer in our study was 0.55 per 100,000 E-mail: [email protected] population (95% CI, 0.52- 0.57). There were 2275 Phone number: +2348037194945 14 African Health Sciences Vol 10 No 1 March 2010 male malignancies in this period making testicular continuation of table 2 cancer to account for 1.1% of all cancers in men. Tumor Variant Number of cases Percentage (%) The median age was 20 years with a mean of Leydig cell tumor 1 3.9 26.8 ± 3.6 years. The age range was 4- 70 years. Sertoli-Leydig cell tumor 1 3.9 More than 65% of cases occurred in the 2nd and 3rd Lymphoid and Haemato poietic 5 19.1 decades as shown in Table 1. Non-Hodgkin’s Lymphoma 4 15.2 Plasmacytoma 1 3.9 Table 1: Age incidence of testicular tumors at the Ife- Metastasis from Prostate Ijesha cancer registry 1989- 2005 Carcinoma 1 3.9 Age Range(Years) Frequency Percentage(%) Total 26 100 0- 9 2 7.7 10- 19 8 30.8 20- 29 9 34.7 Table 3: Age groups versus tumour variants 30- 39 2 7.7 40- 49 2 7.7 Age Group Variant Group Total 50- 59 1 3.8 PTT GCT GST L M 60- 69 1 3.8 less or equal 70- 79 1 3.8 to 15yrs 2 1 3 Total 26 100 % within variant 25% 20% group Para-testicular tumors occurred in ten patients 15- 44 yrs 8 6 2 2 18 % within variant (38.5%) with embryonal rhabdomyosarcoma group 80% 75% 100% 40% accounting for 70% of these (7 patients), others were 45- 64yrs Leiomyosarcoma (1 patient), Liposarcoma (1 % within variant 2 1 1 4 patient) and Fibroleiomyoma (1 patient). On the group 20% 20% 100% other hand, germ cell tumors were found in eight more than or men (30.7%). Of these, pure seminomas occurred equal to 65yrs 1 1 in 50% of the patients (4 men), Embryonal % within variant carcinoma in 25% (2 men), Teratomas in 12.5% and group 20% mixed germ celltumours in 12.5%. Tumors of Total 10 8 2 5 1 26 lymphoid tissues were seen in five patients (19.1%) PPT - Paratesticular tumours GCT- Germ cell tumours and were mostly non Hodgkins lymphomas (80%). GST- Gonadal stromal Two men had gonadal stromal tumors (7.8%) while L - Lymphoma there was one case of secondary metastasis to the M - Metastatic tumours testis (3.9%) from advanced prostate carcinoma as shown in Table 2. Discussion Fifteen of the tumours were on the right side Tumors of the testis and para-testicular tissues still (57.7%) while eight (30.8%) were left-sided. There remain relatively rare among native African men as was bilateral involvement in three cases (11.5%). demonstrated in our series where we had only 26 patients in a 17-year period showing an incidence Table 2: Histopathologic variants of Testicular tumors of 1.5 cases per year. This low incidence has in South- Western Nigeria remained unchanged over the past half a century 6- 8. Tumor Variant Number of cases Percentage (%) This contrasts with reports from the Western and Soft Tissue Parat esticular tumors 10 38.5 Asian countries where a much higher incidence has Rhabdomyosarcoma 7 26.8 been consistently noted R1. This high incidence in Leiomyosarcoma 1 3.9 Western nations has even be noted to be rising even Liposarcoma 1 3.9 further 18- 20. This has been attributed to higher Fibroleiomyoma 1 3.9 incidence of cryptorchidism, diets rich in oestrogen, Germ Cell Tumors 8 30.7 increasing environmental (industrial) pollution and Seminomas 4 15.2 genetic factors. 3 Teratomas 1 3.9 The low incidence observed in this study Mixed germ cell tumors 1 3.9 contrary to the rising incidence in the black Embryonal Carcinoma 2 7.7 Americans, may be attributed to absent cases of Gonadal Stromal Tumors 2 7.8 African Health Sciences Vol 10 No 1 March 2010 15 cryptorchidism (a major risk factor) 21. Also, patients descent. Is this low incidence even falling lower? The in this study were all native black Nigerian Africans reasons for this observed trend in our series is not in poorly industrialized locations. Genetic studies fully understood but may be due to dietary factors24 were not done on our patients with bilateral tumors since the population covered by the cancer registry as it is believed that many of such tumors may be is mainly agrarian with a low incidence of consuming hereditary in origin. refined food. This hypothesis may be confirmed if More than 65% of the men were in their 2nd other researchers studying men of African descent and 3rd decades of life with a peak age incidence in living in agrarian areas come up with similar findings the 3rd decade (Table 1). This is in keeping with most as ours. The confirmation of this decreasing incidence previous reports from Africa 6- 8. The most common of germ cell tumors by other workers may also age observed in the USA series was 30-34 years while open a new vista of research into new ways of the lowest rates were at 15-19 years. This lower cancer decreasing the incidence in Western and Asian age may be due to the difference in life expectancy countries and may result in a global reduction of in the two groupsR2. this disease in men. This is of particular social and Right sided involvement was seen in almost economic importance since all variants of testicular 60% of cases while there were three cases of bilateral tumours have their highest incidence in men aged testicular tumours. These occurred in a 60 year old between 16- 44 years of age (Table 3). man with metastatic adenocarcinoma of the prostate The patient who had bilateral testicular gland, a 38 year old man with Non-Hodgkins metastasis from advanced prostatic adenocarcinoma lymphoma and in a 37 year old man with Leydig was incidentally discovered when his orchiectomy cell tumor who also had primary infertility.
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