Editorial Comment to A regressed germ cell tumor discovered secondary to azoospermia

In the infertile population, testicular tumors were reported to be 20‐fold more frequent than in the general population due to related pathologies such as cryptorchidism, Klinefelter syndrome, or gonadal dysgenesis syndrome. In this issue of IJU Case Reports, Tsujioka et al. reported a case of regressed germ cell tumor that was diagnosed during workup for azoospermia. ¹ As the regressed tumor occupied the whole testis, high orchiectomy for the affected testis and microdissection testicular sperm extraction (TESE) for the contralateral testis were performed. Although TESE could not retrieve sperm, his germ cell tumor was successfully treated with subsequent systemic chemotherapy. Their case is the first case in the literature of regressed germ cell tumor diagnosed due to azoospermia. Eifler et al. ² reported that 49 of 145 nonobstructive azoospermic men had an abnormality on sonography, however only 1 of 49 was malignant, suggesting that testicular tumors are still rare even in azoospermic men.

One treatment strategy for azoospermic testicular tumor patients is concomitant TESE at the time of orchiectomy, termed onco‐TESE, as performed in Tsujioka's case. Onco‐TESE can retrieve sperm before chemotherapy with limited additional morbidity and the reported successful retrieval rates approach 70%. ³ For small testicular lesions found during infertility work‐up, another possible strategy to avoid secondary infertility and androgen substitution therapy is testis sparing surgery. Lagabrielle et al. ⁴ performed testis sparing surgery for 32 patients diagnosed with testicular tumor during infertility workup and reported that 25% (8 of 32) of patients had malignant tumor. Those malignant tumors were then successfully managed by subsequent total orchiectomy or radiotherapy and none recurred. Given the low incidence of testicular cancer in azoospermic men, conservative management with testis sparing surgery could be proposed to avoid unnecessary orchiectomies, although this strategy should be performed in selected patients considering the oncological principles.

Conflict of interest

None declared.