1
|
Di Rienzo G, Tafuni A, Maestroni U, Ruffini L, Silini EM, Gasparro D, Pilato FP, Gnetti L. Testicular metastasis of prostate adenocarcinoma: the other side of orchiepididymitis. Pathologica 2024; 116:69-74. [PMID: 38482677 PMCID: PMC10938275 DOI: 10.32074/1591-951x-940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/14/2024] [Indexed: 03/17/2024] Open
Abstract
Background Metastatic prostate adenocarcinoma is a rare event and there are few references to this topic. We report an unusual case of prostate cancer metastasis and review of contemporary literature. Moreover, we discuss the pathogenesis and the clinical aspects of this event. Case presentation A 70-year-old patient was admitted to the hospital for right scrotal pain. The ultrasound examination described an increase in testicular size, suggesting the possibility of orchiepididymitis. Past medical history reported a previous prostate adenocarcinoma. Inflammatory blood tests were normal. Importantly, PSA was 3.3 ng/ml. PET scan positivity in the scrotum raised suspicion of a relapse. Therefore, he underwent right orchiectomy. Conclusion Although metastatic prostate adenocarcinoma is rare, a correct diagnosis is of paramount importance because the therapy changes accordingly. Patients who complain of scrotal pain need to be examined accurately. Although the most common cause behind this symptom is infectious, the patient's past medical history should be reviewed to exclude previous malignancies.
Collapse
Affiliation(s)
| | | | | | - Livia Ruffini
- Nuclear Medicine Division, University Hospital of Parma, Parma, Italy
| | | | | | | | - Letizia Gnetti
- Anatomic Pathology Unit, University Hospital of Parma, Parma, Italy
| |
Collapse
|
2
|
Singh D, Badya R, Drew Z. Prostate-Specific Membrane Antigen (PSMA) Uptake in the Scrotum and Epididymis on PET-CT: When is it Pathological? Indian J Nucl Med 2024; 39:37-42. [PMID: 38817726 PMCID: PMC11135378 DOI: 10.4103/ijnm.ijnm_36_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/29/2023] [Accepted: 08/09/2023] [Indexed: 06/01/2024] Open
Abstract
Prostate cancer is the most common solid organ tumor in men and has been reported to metastasize to unusual sites such as the epididymis. The clinical standard for detecting recurrent disease is through positive emission tomography/computed tomography with the radiotracer 18F-DCFPyL binding prostate-specific membrane antigen (PSMA) expressed by cancerous cells. Although PSMA can also be expressed physiologically, metastases are more likely to be intensely PSMA expressing and in a typical distribution depending on the extent of disease burden in the individual patient. A MEDLINE search revealed only three other case reports of isolated epididymal metastases from prostate cancer diagnosed with prostate-specific membrane antigen positron emission tomography-computed tomography. This case series comprising both metastatic and physiological PSMA expression in the epididymis provides a useful framework for the interpreting physician when the possibility of this rare but important finding is encountered in prostate cancer imaging.
Collapse
Affiliation(s)
- Dalveer Singh
- School of Medicine, The University of Queensland, School of Biomedical Sciences, Brisbane, Australia
- Qscan Radiology Clinics, University of Queensland School of Medicine, Brisbane, Australia
| | - Rohitha Badya
- School of Medicine, The University of Queensland, School of Biomedical Sciences, Brisbane, Australia
- School of Medicine, University of Queensland School of Medicine, Brisbane, Australia
| | - Zachary Drew
- Qscan Radiology Clinics, University of Queensland School of Medicine, Brisbane, Australia
| |
Collapse
|
3
|
Allaume P, Khene ZE, Peyronnet B, Mathieu R, Bensalah K, Rioux-Leclercq N, Kammerer-Jacquet SF. [Secondary tumors localized in testis]. Ann Pathol 2023; 43:361-372. [PMID: 36822906 DOI: 10.1016/j.annpat.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 09/27/2022] [Accepted: 01/12/2023] [Indexed: 02/23/2023]
Abstract
Testis tumors are uncommon in oncology, and testicular metastasis from distant solid tumors are even rarer. We present two cases encountered in our department of pathology in CHU de Rennes, France. Moreover, we collected all reported cases in the Medline/PubMed databases of non-hematopoietic secondary testis tumors in adults, excluding autopsy studies, to propose an integrative study on this topic. In total, we report 98 cases of secondary testis lesions to prostate (n=38, 38.77 %), colorectal (n=19, 19.39%), gastric (n=12, 12.24%), kidney (n=7, 7.14%), lung (n=6, 6.12%) and other primary cancers. The median age at diagnosis was 66.5 years. We identified significantly more prostate adenocarcinoma (P<0.0001) when the primary tumor was known and significantly more colorectal adenocarcinoma (P=0.035) and pancreatic adenocarcinoma (P=0.002) when the primary tumor was unknown. The age at diagnosis was older when the primary tumor was known (P=0.007). We present the challenges for the diagnosis and propose some elements for diagnosis orientation. Finally, we discuss the possible ways of metastatic dissemination from primary site to testis, as illustrated by the two cases we present.
Collapse
Affiliation(s)
- Pierre Allaume
- Service anatomie pathologique, CHU de Rennes-université de Rennes 1 Hôpital Pontchaillou, 2, rue Henri Le Guilloux, 35033 Rennes Cedex 9, France.
| | - Zine-Eddine Khene
- Service d'urologie, CHU de Rennes-université de Rennes 1 Hôpital Pontchaillou, 2, rue Henri Le Guilloux, 35033 Rennes Cedex 9, France
| | - Benoît Peyronnet
- Service d'urologie, CHU de Rennes-université de Rennes 1 Hôpital Pontchaillou, 2, rue Henri Le Guilloux, 35033 Rennes Cedex 9, France
| | - Romain Mathieu
- Service d'urologie, CHU de Rennes-université de Rennes 1 Hôpital Pontchaillou, 2, rue Henri Le Guilloux, 35033 Rennes Cedex 9, France
| | - Karim Bensalah
- Service d'urologie, CHU de Rennes-université de Rennes 1 Hôpital Pontchaillou, 2, rue Henri Le Guilloux, 35033 Rennes Cedex 9, France
| | - Nathalie Rioux-Leclercq
- Service anatomie pathologique, CHU de Rennes-université de Rennes 1 Hôpital Pontchaillou, 2, rue Henri Le Guilloux, 35033 Rennes Cedex 9, France
| | - Solène-Florence Kammerer-Jacquet
- Service anatomie pathologique, CHU de Rennes-université de Rennes 1 Hôpital Pontchaillou, 2, rue Henri Le Guilloux, 35033 Rennes Cedex 9, France
| |
Collapse
|
4
|
Balagobi B, Gobishangar S, Sarma S, Brammah R, Jenil A. A young patient with prostatic carcinoma with testicular metastasis. Int J Surg Case Rep 2022; 99:107653. [PMID: 36115121 PMCID: PMC9568776 DOI: 10.1016/j.ijscr.2022.107653] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/07/2022] [Accepted: 09/10/2022] [Indexed: 11/28/2022] Open
Abstract
Prostate cancer is one of the most frequent cancers in males and commonly a disease of the older population, but it is increasingly seen among older adolescents and young adults. The common sites of metastasis of prostatic carcinoma are bones and regional lymph nodes. Testicular metastasis from prostatic carcinoma is an infrequent presentation. We report a case of a young patient with prostatic carcinoma and multiple metastases, including bilateral testis. A 40-year-old male presented with lower urinary tract voiding symptoms and back pain for three months. His prostate-specific antigen level was elevated at 13.98 ng/ml. A magnetic resonance imaging of the prostate revealed two PIRADS V lesions and metastases in multiple bones and regional lymph nodes. On follow up, the patient complained of bilateral testicular swelling and ultrasound scan of the testes revealed bilateral testicular metastasis. Fine needle aspiration cytology of right-side testicular lesion revealed malignant cells compatible with metastasis from prostate cancer. Later involvement of multilevel vertebral and skull metastases was identified by magnetic resonance imaging. A T3bN1M1c staging of prostate cancer was made, androgen deprivation therapy followed by chemo and radiotherapy was instituted, following extensive discussion with the patient. Unfortunately the patient succumbed to the illness during the course of treatment. This case report is of a patient with rare presentation of bilateral testicular metastasis with prostate cancer in young age.
Collapse
|
5
|
Olorunsola IS, Etonyeaku AC, Lekwa BO, Ojo OS. Bilateral secondary testicular, epididymal and spermatic cords carcinoma of prostatic origin: a case report and review of the literature. J Med Case Rep 2021; 15:222. [PMID: 33931116 PMCID: PMC8088057 DOI: 10.1186/s13256-021-02807-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/22/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Prostatic carcinoma is emerging as the most common male malignancy in Nigeria and the second most common male cancer worldwide. Patients often present with locally advances stages, and common sites of metastasis are the spine, pelvis, chest, and long bones. Metastases to the testes and spermatic cords are reputed to be rare and may be indicative of a worse outcome, when they occur. We recently encountered a clinical case of bilateral testicular, epididymal and spermatic cords prostatic cancer metastases. CASE PRESENTATION A 71-year-old Nigerian man, who presented at our hospital with 1-month-old complaints of inability to walk together with low back and bilateral thigh pains. This presentation had been preceded by a 5-month history of lower urinary tract symptoms. On examination, the prostate was hard and nodular as were the left testis and spermatic cord. On histological assessment of a needle biopsy, prostatic adenocarcinoma (Gleason score 5 + 5 = 10) was diagnosed. A subsequent therapeutic bilateral total orchidectomy specimen was found to contain metastatic prostatic carcinoma deposits, in the testes, epididymides, and spermatic cords. Although our patient is currently doing well postoperatively on zoledronic acid, ketoconazole, bicalutamide, and tamsulosin, he is being re-evaluated periodically for any feature of recurrence. CONCLUSION Since it has implications for eventual outcome, every clinically suspicious therapeutic orchidectomy specimen should be subjected to a detailed histopathological examination in order to exclude secondaries from the primary prostatic malignancy.
Collapse
Affiliation(s)
- Ifeoluwa S. Olorunsola
- Department of Morbid Anatomy and Forensic Medicine, Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Osun Nigeria
| | - Amarachukwu C. Etonyeaku
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun Nigeria
- Mishmael Hospitals and Clinics, Akure, Ondo Nigeria
| | | | - Olusegun S. Ojo
- Department of Morbid Anatomy and Forensic Medicine, Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Osun Nigeria
| |
Collapse
|
6
|
Epididymal Metastasis of Cholangiocarcinoma, an Extremely Rare Event: A Case Report and Review of the Literature. Nephrourol Mon 2019. [DOI: 10.5812/numonthly.91140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
7
|
Lee KA, Mayer E, Khoo V. Painful testicular metastasis from prostate adenocarcinoma. BMJ Case Rep 2017; 2017:bcr-2017-219963. [PMID: 29212868 DOI: 10.1136/bcr-2017-219963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 60-year-old man presented with unilateral testicular pain and urinary frequency. His presenting prostate-specific antigen (PSA) was 100 ng/mL, and a biopsy revealed Gleason 4+4 prostate adenocarcinoma. The significance of his initial PSA was somewhat complicated by possible prostatitis and early initiation of bicalutamide. PSA rose on two occasions prior to radiotherapy but coincided with a flare of testicular pain on one of these. Whole-body staging diffusion-weighted MRI scan was negative. He was treated with 3 years of androgen deprivation therapy (ADT) and radical radiotherapy. PSA fell to undetectable levels on ADT. Twelve months following completion of ADT, PSA rose to 3.6 ng/mL. No disease recurrence was noted on restaging MRI pelvis. The patient was well, except for persistent testicular symptoms, which failed to resolve following multiple antibiotics. Testicular tumour markers were negative. Ultrasound findings were consistent with chronic epididymitis. A right orchidectomy was performed for symptomatic relief, confirming metastatic prostate adenocarcinoma.
Collapse
Affiliation(s)
- Karla A Lee
- Clinical Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | - Erik Mayer
- Department of Urology, Imperial College Healthcare NHS Trust, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Vincent Khoo
- Clinical Oncology, Royal Marsden NHS Foundation Trust, London, UK
| |
Collapse
|
8
|
Testicular Metastasis From Prostatic Adenocarcinoma Presenting as Recurrent Epididymo-orchitis. Urology 2017; 108:e7-e9. [DOI: 10.1016/j.urology.2017.07.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 06/03/2017] [Accepted: 07/20/2017] [Indexed: 11/21/2022]
|
9
|
A Rare Case of Epididymal Metastasis After Radical Prostatectomy Detected by 68Ga-PSMA PET/CT. Clin Genitourin Cancer 2017; 15:e525-e527. [PMID: 28065536 DOI: 10.1016/j.clgc.2016.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 12/07/2016] [Accepted: 12/10/2016] [Indexed: 12/31/2022]
|
10
|
Santos-Lopes S, Lobo J, Henrique R, Oliveira J. Epididymal metastasis from prostate adenocarcinoma: An unusual and challenging diagnosis suspected in gallium-68 prostate-specific membrane antigen-positron emission tomography/computed tomography and histologically confirmed. Urol Ann 2017; 9:89-91. [PMID: 28216940 PMCID: PMC5308049 DOI: 10.4103/0974-7796.198886] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
A few cases of prostate adenocarcinoma (PCa) metastases to the epididymis have been documented in literature. We report a case of a 69-year-old man with a left epididymal metastasis, 6 years after radical prostatectomy and adjuvant radiation therapy for PCa. Although he developed biochemical recurrence, only gallium-68 prostate-specific membrane antigen-positron emission tomography/computed tomography revealed high uptake in the left testis and retrovesical space. An unrecognized painless firm nodule was palpable on the left epididymis. Radical orchiectomy was performed, and histopathological examination confirmed PCa metastasis located in the epididymis. To the best of our knowledge, this is the 27th reported case of epididymal metastasis from PCa.
Collapse
Affiliation(s)
- Sofia Santos-Lopes
- Department of Urology, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - João Lobo
- Department of Pathology, Portuguese Oncology Institute, Porto, Portugal
| | - Rui Henrique
- Department of Pathology, Portuguese Oncology Institute, Porto, Portugal
| | - Jorge Oliveira
- Department of Urology, Portuguese Oncology Institute, Porto, Portugal
| |
Collapse
|
11
|
|