University of Rochester Medical Center, Dept. of Urology
Introduction: An appreciation for the association between aberrant testicular descent and testicular cancer has developed over the past two centuries. While the etiology is incompletely understood, cryptorchidism is a known risk factor for the development of testicular tumors—even in the contralateral descended testis. This report presents the history of the relationship between cryptorchidism and testis tumors.
Methods: The literature was reviewed for historical descriptions of cryptorchidism and testis tumors.
Results: While much of our understanding regarding testicular maldescent evolved over the last 200 years, cryptorchidism was described in the Mishnah, the 2nd century CE writing of Jewish oral law. Baron Albrecht von Haller identified the intra-abdominal location of the fetal testis in 1755. Seven years later, through postmortem dissection, John Hunter observed that testes descend during the 8th month of gestation. He also correctly hypothesized that testicles that failed to descend into the scrotum were intrinsically abnormal and that it was best to assist the testis in its passage. Surgical repair was attempted unsuccessfully in early 19th century Germany. James Adams and Thomas Curling are credited with the first orchidopexy on an infant in 1871 in London. Unfortunately, the patient developed a wound infection and died of sepsis. Using antiseptic technique, Thomas Annandale performed the first successful orchidopexy in Edinburgh in 1877. A growing appreciation of histological aberrations in the cryptorchid testis further supported the concept of surgical correction. In the US, Arthur Dean Bevan popularized the orchidopexy, reporting 400 orchidopexies with a 95% success rate in 1918. There were reports of carcinomas affecting undescended testes in the 1850s, and Max Schüller described their malignant potential in 1881. John Cunningham reported a testicular tumor following orchidopexy in 1921. Larger studies emerged by the 1940s documenting the increased incidence of testicular cancer in patients with cryptorchidism. It has since been established that approximately 10% of all germ cell tumors occur in maldescended testes. Early orchidopexy was initially believed to be beneficial by facilitating tumor detection, however more recent data have demonstrated that early repair reduces the risk of subsequent malignancy; histology worsens the longer the testis is undescended. The underlying mechanisms of increased tumorigenesis in this setting remain unclear.
Conclusions: There is a rich history of the management of cryptorchidism and its relation to subsequent tumor formation.
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.jpg "Alexis R. Steinmetz, MD photo")