|Year : 2016 | Volume
| Issue : 2 | Page : 114-118
A 15-year pathologic review of testicular and para-testicular tumours in Kano, Northern Nigeria
Sule Alfa Alhaji1, Abubakar Abdulkadir2, Haruna Muhammad Sanusi3
1 Department of Pathology, Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Nigeria
2 Urology Unit, Department of Surgery, Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Nigeria
3 Department of Morbid Anatomy and Forensic Medicine, Usmanu Danfodiyo University, Sokoto, Nigeria
|Date of Web Publication||1-Aug-2016|
Haruna Muhammad Sanusi
Department of Morbid Anatomy and Forensic Medicine, Usmanu Danfodiyo University, Sokoto
Source of Support: None, Conflict of Interest: None
Background: Testicular and para-testicular tumours are envisaged as being rare in our setting. However, there is no published report on their statistics from Kano, Northern Nigeria despite the reported gradual increase over the past decades in many communities. Aim: The purpose of this study, therefore, is to determine the prevalence among other tumours, the frequency and the morphological patterns of testicular and para-testicular tumours in Kano, Northern Nigeria. Materials and Methods: This was a 15-year retrospective study of all cases of testicular and para-testicular tumours histologically diagnosed at Aminu Kano Teaching Hospital, from January 2001 to December 2015. Where necessary, new tissue sections were reprocessed from the formalin-fixed, paraffin-embedded blocks. Results: There were a total of 31 cases of testicular and para-testicular tumours recorded during the study period with an average incidence of 2 cases per year; 41.9% of these were testicular tumours and 58.1% para-testicular tumours. The youngest patient was 3 years old, whereas the oldest was 49 years. Among the para-testicular tumours, 27.8% were adenomatoid tumours mostly presenting in the fourth decade of life; followed by the embryonal rhabdomyosarcomas in 16.7% of cases all in children. Conclusion: This study attested to the low prevalence of testicular and para-testicular tumours in our environment and the findings conforms with studies from other African, the Caribbean and Asia communities but shows divergence to the western societies where a much higher prevalence was reported.
Keywords: Para-testicular, testicular, tumours
|How to cite this article:|
Alhaji SA, Abdulkadir A, Sanusi HM. A 15-year pathologic review of testicular and para-testicular tumours in Kano, Northern Nigeria. Niger J Basic Clin Sci 2016;13:114-8
|How to cite this URL:|
Alhaji SA, Abdulkadir A, Sanusi HM. A 15-year pathologic review of testicular and para-testicular tumours in Kano, Northern Nigeria. Niger J Basic Clin Sci [serial online] 2016 [cited 2022 Jan 26];13:114-8. Available from: https://www.njbcs.net/text.asp?2016/13/2/114/187360
| Introduction|| |
Testicular and para-testicular tumours are envisioned as being rare in our setting. The literature revealed a remarkable geographical variation in their prevalence and a steady increasing incidence in the affluent societies since the middle of the twentieth century. The highest reported incidence was 8–10/100,000 in Scandinavia, but usually <2/100,000 cases in African, Caribbean and Asian communities.
Testicular tumours are a heterogeneous group of neoplasm with distinct biological behaviour, diverse histology and variable prognosis. They are divided into germ cell and non-germ cell tumours. The vast majority of the testicular tumours (95%) arise from germ cells or their precursors in the seminiferous tubules. The germ cell tumours are the most common cancer in men aged 15–44 and are further classified as seminiferous and non-seminiferous germ cell tumours. The testicular non-germ cell tumours include gonadoblastoma, sertoli cell and Leydig cell tumours. In addition, the spermatic cord structures, epididymis, testicular tunics and vestigial remnants could be a source of a mass within the scrotal sac in <5% of cases. Adenomatoid tumours are the most common tumours of testicular adnexa.,
The aetiology of the testicular and para-testicular tumours remain poorly understood but is believed to be the reciprocation of the congenital and acquired factors., There is no documented detailed statistic on testicular or para-testicular tumours in Kano, Northern Nigeria. The purpose of this study, therefore, was to examine the distribution and Histo-morphological patterns of testicular and para-testicular tumours in our set up.
| Materials and Methods|| |
This was a 15-year retrospective study from January 2, 2001 to December 31, 2015 of all testicular and para-testicular tumours diagnosed at the pathology department of Aminu Kano Teaching Hospital, Kano (AKTH). The hospital is the sole health institution that offers histopathological services in Kano State; the most populous state in Nigeria as declared in the 2006 census report with the populace of 9,383,682. Hence, AKTH receives the histopathological specimen from the whole state and some of the neighbouring states. All testicular and para-testicular specimens were routinely fixed in 10% formal saline then processed for paraffin embedding. Microtome sections were cut at 4 µ and stained with haematoxylin and eosin.
The histology slides were retrieved and reviewed by the authors. Fresh sections from archival paraffin blocks were obtained when original slides could not be retrieved. The biodata on all cases was retrieved from records. Collated results were presented in the form of a table and the tissue microscopy presented as photomicrographs.
| Results|| |
A total of 31 cases of testicular and para-testicular tumours were processed with an average incidence of 2 cases per year out of the total 15,500 tumours diagnosed during the 15 years study period. Right-sided testicular and para-testicular neoplasms were 19 (61.3%) and the rest were left-sided. Out of the 31 cases, 13 (41.9%) constituted the testicular tumours and 18 (58.1%) were para-testicular tumours.
[Table 1] depicts the relative frequency and age distribution of different histologic subtypes. The distribution of the testicular tumours by histological type showed 10 (76.9%) germ cell tumours, 2 (15.4%) sex cord-stromal tumours and one mixed germ cell with the stromal tumour component. Germ cell tumours were the most common among the testicular tumours with 4 cases of seminomas, 2 cases each of embryonal carcinomas, yolk sac tumours and benign cystic teratomas. Most of the testicular tumours occurred within the second to fourth decade, the youngest patient was 3 years old whereas the oldest was 49 years old.
|Table 1: Histological types and age distribution of testicular and para-testicular tumours in Kano|
Click here to view
Of the 18 para-testicular tumours, 5 (27.8%) were adenomatoid tumours and occurred mostly in the fourth decade. The embryonal rhabdomyosarcomas comprised 3 (16.7%) cases; all diagnosed in children within the first decade of life. There were 12 mesenchymal tumours: Four neurofibromas, 3 leiomyomas, 1 lipoma, 2 leiomyosarcomas, 1 liposarcoma and one infantile fibrosarcoma. Only one case of secondary deposit to the testis was seen in the period.
[Figure 1],[Figure 2],[Figure 3],[Figure 4],[Figure 5],[Figure 6] show the Gross morphology of embryonal rhabdomyosarcoma and the photo-micrographs of seminoma, adenomatoid tumour, yolk sac tumour, embryonal rhabdomyosarcoma and neurofibroma.
|Figure 4: Embryonal rhabdomyosarcoma of the para-testicular adnexa (H and E, ×40)|
Click here to view
| Discussion|| |
A total of 31 cases of testicular and para-testicular tumours were seen during the study period with an average of 2 cases per year and a prevalence of 0.33/100,000 population. These represented 0.2% of the entire tumours histopathologically analysed in Kano during the review period. This prevalence was akin to the findings of most other sub-Saharan African and Asian populations studied,,,, but in contrast to those in the western world.,, This finding affirmed the low incidence of these tumours in our domain as well and the variability in the regional and ethnic prevalence.
Out of the 13 cases of testicular tumours in this study, 10 (76.9%) are germ cell tumours, a finding that is similar to that seen in other regions of Nigeria, Ghana, South Africa, India and the United States.,,,, While seminoma was the most common sub-type in our series, yolk sac tumour was the most predominant in Ilorin. The overall age range of patients with testicular tumours in this series was 3 to 49 years, peaked in the third to fifth decade, which is in agreement with the report that cancers of the testis affects young men in the third and fourth decades of life. This study showed a dominance of right-sided testicular neoplasm over left which concurs with other reports believed to be as a consequence of higher prevalence of undescended testis on the right side.
Adenomatoid tumours were the most common para-testicular tumours accounting for 5 (27.8%) cases in this study and mostly occurred in the fourth decade, this is in conformity with the findings in the literature., Only one case of metastasis from the kidney to testis was observed in this series. Secondary deposits in testis though rare, are reported in the literature. Tumours of prostate, lungs, colon, kidney, stomach, pancreas and melanoma are reported to metastasise to testis and testicular swelling may be the only presenting clinical feature in an occult primary from these sites.
Our review is not free from constraint ingrained in most retrospective hospital-based studies; the insufficient clinical, laboratory and the treatment outcome data that may be of prognostic importance are best to appraise with structured prospective studies. Only six patients (19.4%) were managed primarily in our centre. The overall survival rates for malignant lesions were poor because of the advanced disease state at presentation. Nearly 80% of our patients were initially managed by non-specialist in peripheral centres; often Patients presents at AKTH following a relapse and hence, higher cancer-specific mortality was observed. The benign tumours, however, have an excellent prognosis.
The very low prevalence could also per harps be that not all the tissues get to our centre considering the vastness of the study area and added cost that histology incurred, however, considering its 0.2% of the tumour diagnose in the centre suggests very strongly the low overall prevalence.
| Conclusion|| |
The incidence of testicular and para-testicular tumours is low in our environment. In this study, germ cell and adenomatoid tumours are the predominant testicular and para-testicular tumours, respectively. We front for prospectively framed studies with long-term follow-up to fathom further risks and prognostic makers of these tumours in Nigeria.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Bergström R, Adami HO, Möhner M, Zatonski W, Storm H, Ekbom A, et al.
Increase in testicular cancer incidence in six European countries: A birth cohort phenomenon. J Natl Cancer Inst 1996;88:727-33.
Obafunwa JO, Elesha SO, Odunjo EO. Tumours of the testis in Lagos, Nigeria. Niger Med Pract 1990;19:50-2.
Liu S, Semenciw R, Waters C, Wen SW, Mery LS, Mao Y. Clues to the aetiological heterogeneity of testicular seminomas and non-seminomas: Time trends and age-period-cohort effects. Int J Epidemiol 2000;29:826-31.
Kontos S, Fokitis I, Karakosta A, Koritsiadis G, Mitsios K, Koutsikos S, et al.
Adenomatoid tumor of epididymidis: A case report. Cases J 2008;1:206.
Pacheco AJ, Torres JL, de la Guardia FV, Arrabal Polo MA, Gómez AZ. Intraparenchymatous adenomatoid tumor dependent on the rete testis: A case report and review of literature. Indian J Urol 2009;25:126-8.
Garner MJ, Turner MC, Ghadirian P, Krewski D. Epidemiology of testicular cancer: An overview. Int J Cancer 2005;116:331-9.
Møller H. Clues to the aetiology of testicular germ cell tumours from descriptive epidemiology. Eur Urol 1993;23:8-13.
Junaid TA. Tumours of the testis in Ibadan, Nigeria. Br J Urol 1982;54:411-4.
Templeton AC. Testicular neoplasms in Ugandan Africans. Afr J Med Sci 1972;3:157-61.
Coleman MP, Esteve J, Damiecki P, Arslan A, Renard H. Trends in cancer incidence and mortality. IARC scientific publications. 1992;(121):1-806.
Forman D, Moller H. Trends in incidence and mortality of testicular cancer. Cancer Surv 1994;19-20:323-41.
Zheng T, Holford TR, Ma Z, Ward BA, Flannery J, Boyle P. Continuing increase in incidence of germ-cell testis cancer in young adults: Experience from Connecticut, USA, 1935-1992. Int J Cancer 1996;65:723-9.
dos Santos Silva I, Swerdlow AJ, Stiller CA, Reid A. Incidence of testicular germ-cell malignancies in England and Wales: Trends in children compared with adults. Int J Cancer 1999;83:630-4.
McGlynn KA, Devesa SS, Sigurdson AJ, Brown LM, Tsao L, Tarone RE. Trends in the incidence of testicular germ cell tumors in the United States. Cancer 2003;97:63-70.
Magoha GA. Testicular cancer in Nigerians. East Afr Med J 1995;72:554-6.
Klufio GO. A review of genitourinary cancers at the Korle-Bu teaching hospital Accra, Ghana. West Afr J Med 2004;23:131-4.
Deore KS, Patel MB, Gohil RP, Delvadiya KN, Goswami HM. Histopathological analysis of testicular tumours: A 4-year experience. Int J Med Sci Public Health 2015;4:554-7.
Mogbe KV, Agrawal RV, Junnerkar RV. Testicular tumours. Indian J Cancer 1970;7:90.
Haughey BP, Graham S, Brasure J, Zielezny M, Sufrin G, Burnett WS. The epidemiology of testicular cancer in upstate New York. Am J Epidemiol 1989;130:25-36.
Izegbu MC, Ojo MO, Shittu LA. Patterns of testicular malignancies in Ilorin, Nigeria. J Cancer Res Ther 2005;1:229-31.
Gill MS, Shah SH, Soomro IN, Kayani N, Hasan SH. Morphological pattern of testicular tumors. J Pak Med Assoc 2000;50:110-3.
Haupt HM, Mann RB, Trump DL, Abeloff MD. Metastatic carcinoma involving the testis. Clinical and pathologic distinction from primary testicular neoplasms. Cancer 1984;54:709-14.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
|This article has been cited by|
Review of Testicular Tumor: Diagnostic Approach and Management Outcome in Africa
| ||Ayun Cassell,Mohamed Jalloh,Medina Ndoye,Bashir Yunusa,Mouhamadou Mbodji,Abdourahmane Diallo,Oumar Gaye,Issa Labou,Lamine Niang,Serigne Gueye |
| ||Research and Reports in Urology. 2020; Volume 12: 35 |
|[Pubmed] | [DOI]|
||Testicular cancer at the University of Port Harcourt Teaching Hospital: A 10-year retrospective review
| ||V Abhulimen, EJ Raphael |
| ||Journal of West African College of Surgeons. 2019; 9(3): 21 |
|[Pubmed] | [DOI]|