lJ4

esticular tumours in Trinidad

G C Raju*, Vijay Naraynsingh t and Neville Jankey*

Te ·ticular tumours are reported to he rare in Negroes and Indians. Our experience of testicular cancer in a predominantly Negro and Indian population in Trinidad confirmed this observation. Paratesticular sarcomas arc comparatively more frequent in the Negro; though the reason for this is unknown, it is possible that genetic and or environmental factors predispose the adnexal structures to neoplastic change, particularly in the Negro.

Testicular cancer is rare and Its incidence varies in different populations I. Data from Waterhouse ('/ af show that tUlllours of the testis are relatively common in Caucasians. but that the disease is rare in Negroes and Indians". We have reviewed our experien~e of testicular tUlllours in Trinidad, whose population is pre­dominantly Negro (41%) and Indian (40%), with less than 1'1r, Cauc;:lsian.

Materials and methods A retrospective review of the surgical pathology regis­ter of the Port of Srain General Hospital. TrinidJd. over a period of 12 years (1c)72-1l)~3) revealed 13 cases of m,i1ignant testicular tUlllours. The relevant clinical details were noted from the patients' charts and pathol­ogy files. Histological material from these cases WJs re-examined to verify the diagnosis. using special stains which included periodic acid schiff (PAS). phospho­tungstic aciel haematoxylin (PATH) and reticulin stains to supplement the routine haem<ltoxylll1 and eosin pre­parations.

Results Testicular neoplasms comprised about 0.75% of all malignant tumours in males. with a erude annual inci­dence of 0.3 per 100,000 males.

Details of the 13 patients with testicular cancer are summarised in Table I. The presenting symptom was a painless scrotal mass in all cases, and the average duration of symptom was 5 months (range 1-18 months) before diagnosis. None of the patients had a history of testicular trauma, and none of the tumours occurred in undescended testes.

'Departments of P<1lhology and tSlIrgery. General Hospilal. Port of Spain, Trinidad, West Indies. Correspondence to Mr G C Rajll. Department of Pathology. National University of Singapore. National University Hospit· al. Lower Kent Ridge Road. Singapore 0511.

Fig I (0) Photomicrograph of para testicular rhabdomyosarcoma from case 13 (H&E x250) (b) Higher magniAcatioll (H& E XSOO). Inset shows cross striations. (H&Ex 1200)

7 patients had germ cell tumours: 3 seminoma: J embryonctl carcinoma (2 infantile and 1 adult type): and one was a mixed germ cell tumour showing teratoma with seminoma. There were 6 non-germ cell tumours: 5 paratesticular rhabdomyosarcoma (Fig Ia, b); and one was a malignant non-Hodgkins lymphocytic lymphoma initially presenting as testicular neoplasm with no extra­testicular involvement at the time of diagnosis.

The patients were treated on conventional lines bv orchiectomy followed by radiotherapy and/or chema'­therary. All the patients with paratesticular rhabdo­myosarcoma had metastatic disease at presentation, and all but one died of the disease despite all modes of therapy.

lOLiTl/ll1 of {he Royal College of S/lrgeons of Edlnbargh

l~~\ rcon13 Ex5IX)).

oma; 3 )e); and 'ratoma lours: 5 Ind one Iphoma ) extra­

ines by cbenw­habdl)­1tation. odes of

G C le·\ II', \'1.1,·\ Y "',\I{,\ YN.'iIi'iCd I /\,'iJ) NI.\·II.I.I I,\NKLY

TABLE 1 Case details of testicular tumours in Trinidad (1972-1983)

COS('I/O. Ilg!' (1'('(11'.1) !<occ Sidc f-1isIO!og.1 !)urt'il'll! lill1C

I 7 Ill". Negro left Em[lryon;1! Cl 7 months. died with dl'iedSe 2 II) 11)(1. Negro righl Emhryolldl Cl n mOlllhs. died with dise;lse

41 Illdi,ln left SelTlinOm,1 4S months. died wilh dise,lse -\ 4.' Negro right Serninomd Not knowll ) 5.\ Negro right ScminolTl,1 NO! kllown (I 21 Illdidil lefl Emhryoll;ll Cd 7 months. died with disedse 7 2LJ White right Seminom;1 & terdtomd Not known S (,.\ Negro right Non-Hodgk iIls/Iym rhom,1 .\ months. died with ,iise~sc

(widc~prcad ) <J 21 Negro left Rhabdomyosa rcom,l 13 months. died with disedsc

III 2S Negro right Rh,1 bdolll yos,1 rcom;) 16 months. died wilh disease I J IlJ Negro right RhahdomyoS;lrcomCi 36 month~. died with disease 12 21 Negro left RhabdolTlyos;1 rcom;l 2-\ months. died with disease 1.\ IS Negro right Rhabdomyos,1 reoma .\2 months. alive with disease

Discussion In Ti!lidad. as in many developing countries, there is a in Blacks ll1

: however, the racial variation in incidence lacf l)f full statistical information all many diseases. persists throughout the different socio-econOllllc Rnd this causes difficulty in assessing the true Illcidence strata II. The relative importance of environmental or of testicular cancer. genetic factors in the aetiology of these neoplasms is

Based on the estimated population, the crude annual difficult to assess. incidence of testicular tumours was UJ per !OU,UUO Germ cell tumours which form the bulk of testicular males, which concurs with the generally accepted low cancers. are more COmmon in Whites than in Blacks!c; incidence in Negroes ilnd Indiansc, In the predomin­ this is probably the reason for the lower overall inci­antly Caucasian population of Europe and the USA, the dence of testicular tUlllours in the latter. The relatively incidence of testicular tumours is about 2 per IOU.OOO greater number of adnexal tumours we observed in the males'", whereas the incidence is less than I per Negro has been reported by others. In a review of the 101"I)() m,lles in India and Africa". Reporting from relative frequencies of testicular tumoUI's in different Ug"nda, Davis ('I II! found only :I cases of testicul,1r African centres, about 20';;, of the intrasCrOl<ll malig­tumours during the perioJ 1~<J7-1<J57", Comparing nancies were adnexal tUlllours l2

, Over one-third of our different populations. Tulinius CI (I! noted that testicu­ tumours were rh,ibdomyosarcomas, and all were in lar tumours occurred twenty times Illore frequently in Negroes. The reason for this observation is not known. Whites than in Negroes7 Viruses have been implicated in the aetiology of

The reason for the lower incidence of testicular some malignant tumours of connective tlssues l .'. It IS

tumours in Blacks and related people is unknown. The possible that viral diseases, prevalent in our popula­lower incidence of cryptorchidism in Blacks h,lS been tion, may, in association with genetic or other factors, suggested as a reason'. but this has been disputed') predispose the adnexal structures to neoplastic change. Thc'ugh cryptorchidism is not rare In our population, We conclude that. despite the rarity of testicular we, Ive not seen cancer developing in an undescended tumours in Negroes and Indians, a greater awareness of testis. Socio-economic differences hilVe been post­ these tumours in a population such as ours might lead ulated to explain the lower incidence of this neoplasm to their eilrlier recognition and a better rate of survival.

References 1 PUGH ReB. Pathology of the testis. Oxford: Blackwell 1976 2 WAT"RHOUSE J. MUIR C. SHr\N~IUCiAJ{ATN,\M K. POWELL J. eds. Cancer incidence in five continents. Vol 4. Lyon.

France: IARC 19R2. 3 DIXON F S. MOORE R A. Tumours of the testis. In: Tumours of the male sex organs. Fasc 31,32. Atlas of tumour pathology.

Washington: AFI 195253-55 4 ;'..\RK B G. The relative frequency ~nd age incidence ofprincip;)[ urological disease. Journa! of Uro!ogy 197698701-705. 5 IU'Plll. Testicular cancer in Finland. Ac/(/ Palho!ogica, Microbio!ogica, ellmmunologica Scandinavia (Supp!ement) 1973

238 41. 6 DAVIES J N P. ELMES S. HUT! M Rei a!. Cancer in an African community. Brilish Medica! Journa! 1964 1259-264. 7 TULINIUS H. DAY N, MUIR C S Rarity of testis cancer in Negroes, Lancel 1973 I 35-3n,

April 1987 Volume 32 Number 2. Prillleel ill Creal Brilaill

96

~ 111'NI)I'I('iilN BE, [kN ICl." fl, JIN(; J el III. Risk factors ror callcer of the testis ill youn~ mell. IlIlerllllliolla! jOllrllll! O(CIIIICC'/' IlJ7') 23 )lJ~-()lI2.

I) KI.l.l.IcK A Z Testicular callcers ill BI;lcks ;Ind White, hy celltYres, 1;lter;llity. survivorshir anJ a~l' jOllrllll! ofilll! Nliliolla! tv!e,{iw! Assucialioll IlJ7-1 /i/i 4lJ-)1

I () G I{,\I 1,\,\1 S, GIIlSO, R, WISI D L l'l al. ErilJcmiology of callcer or the lest is in up,t;lle Ne\\ York. jounlll! of I!le Nliliol/ a! Clillcer IIISliiLIle 1')77 58 12-')5-11111.

II MlIST:\(Ult P, MII.I./l-IClIU'. D. Racial and occuf1<1tiol1,i1 \',lri,1tillIlS ill cancer or the te'tis: 5,111 Fr'lllcisco. IlJ)6-6). joun/(/! of Ihe Nalio/1I1! Clillcer IlIslilllle 1')76 5/i 717-no

11 JlI' ,\11) T A. Tumour, or the te,ti, ill Ih;rJ;Jn. igeri<l. Rriti\!I juurlla! uf Uro!o~r IlJ~1 5-l-1 11--1 1-1. 13 HI~I'i C f\etiology of bone Grllcer allJ sorne other Gllll'Crs in the young. Rri/ish JUUrl/II! of ClI/lcer 1'J76 2/i 1()~-11-1.

Journal of th~ Royal Co"~g~ of SlIrgeolls of Edillhllrg"