Bilateral Testicular Germ Cell Tumors in Turkey: Increase in Incidence in Last Decade and Evaluation of Risk Factors in 30 Patients

PurposeThe relative risk of germ cell testicular tumor is significantly higher in patients with a testicular tumor history. We reviewed histological and clinical features in 30 patients with bilateral tumors treated at 2 academic centers in Turkey.Materials and MethodsOf 987 patients with testicular germ cell tumors 30 (3.0%) were diagnosed with bilateral disease. Data on clinical information, histopathology and followup records were reevaluated. Contralateral testis biopsy was not performed in any patient at initial orchiectomy.ResultsOf 30 patients 24 had sequential tumors at a median interval of 75 months (range 3 to 260) and 6 (20.0%) had synchronous tumors. Mean age at presentation was 32.3 and 26.7 years, respectively. The second tumor occurred within 2 and 5 years in 20.8% and 41.7% of patients, respectively. Patients with seminoma were at significantly higher risk for bilateral disease (4.5% vs 2.3%), whereas patients with nonseminoma had more advanced disease at presentation. Synchronous tumors had similar tumor histology on each side and more advanced stage at presentation than metachronous tumors. Most patients with metachronous tumors had stage 1 disease, including 81% originally and 95.2% subsequently. Primary tumors were significantly larger than secondary tumors (4.78 vs 2.59 cm). Median time after the first and second germ cell tumors was 128 and 47 months, respectively. At last followup all patients had no evidence of disease.ConclusionsThe risk of contralateral testicular germ cell tumor in patients with seminoma was 2 times higher than in those without a history of tumor. Synchronous tumors present at advanced stage and have similar histology on each side. Clinical outcome is excellent with appropriate treatment. Contralateral testis biopsy at initial diagnosis is not mandatory.