BACKGROUND: The aim of this study was to evaluate the impact of tumour size and rete testis invasion in progression free survival of our patients with stage I testicular seminoma. A literature review is also made.
METHODS: A retrospective observational study was performed. We included patients with stage I seminoma between January 2010 and July 2022. Patients without factors of poor prognostic -Group A- were compared with patients with factors of poor prognostic -Group B-. Kaplan-Meier curves and log-rank testing were used to compare progression free survival (PFS) between these groups. Statistical significance was considered at P≤.05.
RESULTS: 55 patients were included in this study. 20 patients (36.4%) were of good prognostic -Group A- and 35 (63.6%) had factors of poor prognostic -Group B-. The mean age was similar in both groups (mean±standard deviation), 38.62±9.04 years. The mean follow-up time was 63.5±33.6 months. All the patients in group A and 25.7% of the patients in group B underwent active surveillance (AS). 26 patients (74.3%) of the patients in Group B were treated with one cycle of adyuvant carboplatin. Three patients suffered a relapse with retroperitoneal lymph nodes (10.3%), all of them were treated with three cycles of BEP, with a complete response of the disease. No statistical significant differences were found in PFS between Group A and B (log Rank P=.317).
CONCLUSIONS: Individualization of adjuvant treatment in stage I seminoma is important, avoiding the adverse effects derived from them.

OBJECTIVE: Active surveillance (AS) and adjuvant chemotherapy (AC) with carboplatin are valid alternatives for managing stage I seminoma, and most relapses can be cured with cisplatin-based chemotherapy. However, some reports suggest that AC may modify the classical pattern of recurrences.
METHODS: We analyzed all relapses observed in a series of 879 patients with stage I seminoma included in 4 consecutive studies of the Spanish Germ Cell Cancer Group. After a median follow-up of 67 months, recurrences were detected in 56/467 (12%) low-risk cases on AS and 13/412 (3%) high-risk cases after AC (p < 0.001). The objective was to describe clinical features, treatment and outcome. Univariate comparisons were performed between both groups.
RESULTS: No significant differences were found between relapses on AS and those after AC in terms of time to relapse (13 vs 17 months), size (26 vs 27 mm), location (retroperitoneum in 88% vs 85%), and method of detection (computed tomography in 77% vs 69%). Treatment consisted of chemotherapy (etoposide + cisplatin ± bleomycin) in 89% and 92%, respectively. Late relapses (after > 3 years) were seen in 11% vs 7.7% (p = NS) and second or successive recurrences in 1.8 vs 23% (p < 0.05). With a median follow-up of 130 moths, two patients died of seminoma-unrelated causes (AS group) and the rest are alive and disease-free.
CONCLUSIONS: In the setting of a risk-adapted treatment of stage I seminoma, the administration of two courses of AC in patients with tumor size > 4 cm and/or rete testis invasion is associated with a higher incidence of second recurrences but does not significantly modify the pattern of relapses or their outcome.

OBJECTIVE: The aim of this study was to assess a risk-adapted strategy for stage I seminoma guided by the presence of rete testis invasion.
METHODS: Between January 2013 and December 2015, a total of 135 consecutive patients with stage I seminoma from 18 Spanish tertiary hospitals were included in a prospective multicenter study. Median patient age was 38 years (range 22-60). Preoperative beta-human chorionic gonadotropin was elevated in 9.6% of patients. Rete testis invasion was present in 47.4% of patients. After orchiectomy, subjects with rete testis invasion were treated with 2 courses of adjuvant carboplatin (area under the curve of 7, with 21-day interval). Those without this risk factor were managed by surveillance. Disease-free survival (DFS) and overall survival (OS) were estimated with the Kaplan-Meier method.
RESULTS: After a median follow-up time of 33 months, only 6 relapses were recorded (5 on surveillance, 1 after carboplatin). These cases were rescued with BEP or EP chemotherapy, and all 135 patients are currently disease free without sequelae. Three-year DFS was 92.0 and 98.2% for patients on surveillance and after carboplatin, respectively. Three-year OS was 100%.
CONCLUSIONS: A risk-adapted approach based on rete testis invasion as a single risk factor is feasible and yielded an excellent outcome with a 3-year DFS of 94.9%.

Adenomatous hyperplasia of the rete testis (AHRT) is an uncommon abnormality first described by Nistal and Paniagua in 1988. Congenital and acquired forms of AHRT are recognized. We present a case of AHRT in a patient who underwent bilateral orchiectomy for penile carcinoma; he had received chemotherapy for Hodgkin lymphoma 18 years prior. Proposed causes for this disorder include developmental, hormonal, and paracrine induction by adjacent testicular tumors and exposure to chemicals, based on clinical contexts but without experimental support. We performed immunohistochemical studies using markers of cell cycle (cyclin D1, p16), proliferation (Ki-67), apoptosis (bcl2), senescence (γ-H2AX), and androgen receptors to try to provide scientific support for or refute existing hypotheses. Our results indicate that, in this case of acquired AHRT after chemotherapy, the process is neither adenomatous nor hyperplastic but rather represents abnormal accumulation of rete testis cells with acquired senescence.

OBJECTIVE: To explore the correlation between ectasia of the rete testis (ERT) and the volume of seminal vesicle cyst (SVC) in the epididymal head by ultrasonography.
METHODS: This study included 36 cases of ERT diagnosed by color Doppler ultrasonography and complicated with SVC in the epididymal head (case group), and another 44 SVC cases without ERT (control group), all confirmed by surgery or fine-needle aspiration. We analyzed the differences in nationality, age, volume of SVC and resistance index of the afferent artery in the diseased testis between the two groups of patients.
RESULTS: No statistically significant differences were observed between Chinese Uighurs and Hans (P > 0.05), nor in the mean age between the two groups of patients (P > 0.05). There were significant differences in the mean volume of SVC between the case and control groups ([2.081 +/- 1.147] cm3 vs [1.009 +/- 0.848 ] cm3, P < 0.01), but not in the resistance index of the afferent artery in the diseased testis (0.644 +/- 0.099 vs 0.608 +/- 0.116, P > 0.05).
CONCLUSIONS: The volume of seminal vesicle cyst in the epididymal head plays a significant role in the formation of ectasia of the rete testis.

The ductuli efferentes and rete testis of the guinea pig were isolated by micro dissection, fixed in cold buffered osmium tetroxide, and sectioned for examination with the light and electron microscopes. Proximal and distal segments of the ductuli efferentes were identified and their respective cytological organizations characterized. The cytological components of the rete testis are briefly described and figured. Non-ciliated and ciliated cells are found in both segments of the ductuli efferentes. The non-ciliated cells have a microvillous border, mitochondria, a Golgi complex, an ubiquitous endoplasmic reticulum, and numerous cytoplasmic vacuoles. The ciliated cells contain more mitochondria, an endoplasmic reticulum with a relatively sparse distribution, and few, if any, cytoplasmic vacuoles. A regional difference exists in proximal and distal segments based on the distribution, size, number, and electron opacity of the cytoplasmic vacuoles. Attention was paid to the disposition of the endoplasmic reticulum and its relation to the system of cytoplasmic vacuoles. These findings are interpreted as suggesting that the continuity of the vacuolar system with elements of the endoplasmic reticulum represents a pathway for transfer of large quantities of fluid, an activity which has long been ascribed to the epithelium of the ductuli efferentes. Periductular capillaries possess pore-like apertures in their endothelia similar to those in other tissues known to engage in fluid transfer.

The ultrastructure of the developing extratesticular rete testis, the efferent ductules and the establishment of the urogenital junction were studied in bovine embryos and fetuses of 41 through 95 days post conceptionem. The efferent ductules originate as a new set of secondary mesonephric tubules from the dorsal aspect of the nephric giant corpuscle and grow in the direction of the Wolffian duct. Cytological differentiation of the efferent ductules proceeds in a proximo--distal direction. At about 50-60 days, the simple columnar epithelium of the proximal portions of the efferent ductules already consists of the two typical cell types, i.e. reabsorptive principal cells with an endocytotic apparatus and a brush-border and ciliated cells. The lumen of the proximal portion is temporarily filled with intraductular blood vessels and perivascular tissue which may represent vestigial rudiments of glomeruli associated with the efferent ductules. At 50 to 60 days, the extratesticular rete still has a blastema--like appearance and consists of irregular cells with abundant glycogen. Extensions of the extratesticular rete come into contact with the efferent ductules and create the first end-to-side anastomoses with the latter. Somewhat later, the separating basal laminas vanish and invading rete cells intermingle with the epithelium of the efferent ductules, thus establishing the urogenital junction.

Caprine efferent ductule epithelium contains ciliated and nonciliated cells. The latter cells are divided into three types: type II cells contain PAS-positive granules, type III cells contain PAS-negative vacuoles, and type I cells lack both granules and vacuoles (Goyal and Williams, Anat. Rec. 220:58-67). The objectives of this study are i) to determine when the epithelium differentiates into ciliated and nonciliated cells, ii) to determine when nonciliated cells acquire characteristics typical for type II and type III cells, and iii) to relate developmental changes in the epithelium with those in the testis. Testes and efferent ductules were examined at the light and electron microscopic levels in goats from 1-25 weeks of age. Efferent ductule epithelium contained ciliated and nonciliated cells as early as week 1. While ciliated cells were differentiated at week 1, differentiation of nonciliated cells did not occur until week > or =15. Differential features in ciliated cells included the presence of cilia at the apical border and an aggregation of mitochondria in the apical cytoplasm. Those in nonciliated cells included the presence of i) an endocytotic apparatus at week > or =15, ii) PAS-positive granules at week > or =15, and iii) PAS-negative vacuoles at week > or =25. The seminiferous tubules developed lumens at 12-15 weeks. Hence, while differentiation of ciliated cells occurred much before lumen formation in the seminiferous tubules, that of nonciliated cells coincided with, or occurred soon after, lumen formation, suggesting a role for testicular fluid contents in their differentiation. The goat efferent ductules can be characterized morphologically mature by 25 weeks.

OBJECTIVE: Previous studies demonstrated that F4/80 antigen (murine macrophage-specific antigen)-positive cells in testes of normal adult mice accumulate particularly in the interstitium adjacent to the tubuli recti and rete testis (i.e., the central region). However, it remains unknown whether this accumulation is a congenital or acquired phenomenon.
METHODS: The distribution of F4/80-positive cells on frozen sections of testes obtained from various aged mice was immunohistochemically examined to determine when the positive cells specifically accumulate in the central region.
RESULTS: F4/80-positive cells were homogeneously distributed throughout the testicular interstitium with no specific accumulation until 2 weeks of age. However, at 3 weeks of age, the density of positive cells in the central region became slightly, but significantly, higher than that in the interstitium between the seminiferous tubules. Between 3 and 4 weeks of age, the cell density in the central region increased rapidly, the density at 4 weeks of age reaching the level of the mature testes of 8-week-old mice.
CONCLUSIONS: These results demonstrate that the specific accumulation of F4/80-positive cells in the central region is an acquired phenomenon, which starts and ends before puberty.

The aim of this study was to show the US findings in mode B and color Doppler duplex of the dilatation of the rete testis, in order to analyze its association with other scrotal processes and to confirm their inclusion into the benign testicular lesions. We present seven diagnosed cases (mean age 61 years) of dilatation of the rete testis to which a clinical control and US was accomplished up to 1 year. The scrotal sonography study was carried out with a linear probe of 7.5 Mhz. In the US examination we observed in all cases an intratesticular image located in the mediastinum testis constituted by anechoic and serpiginous tubular structures, which do not show any blood flow with the color Doppler. In one case the mentioned observations were bilateral. Five cases had cysts in epididymis and the last case showed an increase in size in the epididymis head. Color Doppler duplex examination did not detected flow dots in the seven patients. The dilatation of the rete testis is a benign entity frequently associated with pathology in epididymis, with specific US findings which permit avoidance of invasive tests.