TUMOR-MARKERS IN HYDROCELE FLUIDS OF PATIENTS WITH BENIGN AND MALIGNANT SCROTAL DISEASES

Purpose: We evaluated the presence of human chorionic gonadotropin (hC G), alpha-fetoprotein (AFP) and a panel of other tumor markers in the compartment next to the tumor (that is, the malignant hydrocele fluid) . Materials and Methods: We measured hCG, AFP, neuron-specific enolase , carcinoembryonic antigen and cytokeratin-19 fragments in cubital vei n sera and in hydrocele fluids of patients with testicular cancer. Res ults were compared with those obtained from hydrocele fluids of patien ts with benign disease. Results: All tumor markers remained under the respective cutoff values in benign hydroceles. In patients with pure s eminomas, hCG levels were elevated in 66% of hydroceles but only once in peripheral sera, whereas AFP remained low in both compartments. Fur thermore, of 11 cases of nonseminomatous germ cell tumor hydrocele flu ids, 3 with negative peripheral tumor marker values had to be reclassi fied marker positive, of which 2 showed elevated hCG levels and 1 had increased levels of AFP. Significant changes of neuron-specific enolas e and carcinoembryonic antigen concentrations could not be observed. H owever, a cytokeratin-19 fragment measured by Cyfra 21-1 assay was ele vated in 2 of 3 seminomatous and in 4 of 8 nonseminomatous hydroceles. Conclusions: These data give a new insight into the in vivo secretion pattern of testicular germ cell neoplasms, which demonstrates that th e term ''marker negative'' should be restricted to selected cases of t esticular cancer. Analysis of tumor markers in hydrocele fluids may be a helpful tool in patients with scrotal swelling if clinical and sono graphic results remain uncertain.