Utilization of NKX3.1, P501S, Prostate-Specific Antigen, and Steroidogenic Factor 1 to Distinguish Malignant Leydig Cell Tumor From Metastatic Prostatic Adenocarcinoma to the Testis

CONTEXT.—

A recent study demonstrated that NKX3.1-positive staining can uncommonly be seen in testicular Sertoli cell tumors (1 of 4 cases). Also, it was reported that 2 of 3 Leydig cell tumors of the testis showed diffuse cytoplasmic staining for P501S, although it was unclear whether it was specific granular staining that defines true positivity. However, Sertoli cell tumors do not typically pose a diagnostic dilemma with metastatic prostate carcinoma to the testis. In contrast, malignant Leydig cell tumors, which are exceedingly rare, can closely resemble Gleason score 5 + 5 = 10 prostatic adenocarcinoma metastatic to the testis.

OBJECTIVE.—

To evaluate the expression of prostate markers in malignant Leydig cell tumors and steroidogenic factor 1 (SF-1) in high-grade prostate adenocarcinoma, as no data are currently published on these topics.

DESIGN.—

Fifteen cases of malignant Leydig cell tumor were collected from 2 large genitourinary pathology consult services in the United States from 1991 to 2019.

RESULTS.—

All 15 cases were negative immunohistochemically for NKX3.1, and all 9 with available additional material were negative for prostate-specific antigen and P501S and positive for SF-1. SF-1 was negative immunohistochemically in a tissue microarray with cases of high-grade prostatic adenocarcinoma.

CONCLUSIONS.—

The diagnosis of malignant Leydig cell tumor and its distinction from metastatic adenocarcinoma to the testis can be made immunohistochemically on the basis of SF-1 positivity and negativity for NKX3.1.

A rare case of bilateral testicular metastasis from ileocecal NET: multiparametric US detection

Testicular metastasis are rare findings and bilateral metastasis of testes are extremely rare. Here we are describing for the first time a case of bilateral testicular metastasis in a patient with a known ileocecal valve NET using an in-depth ultra-sound studying including microvascular flow imaging (MV-flow), ultra-sound new technique, able to detect small vessel slow-signal.

Adenocarcinoma of the Lung With Initial Presentation as Painful Testicular Metastasis: 18F-FDG PET/CT Findings in an Unusual Case

ABSTRACT

Testicular metastasis is rare, with prostate cancer followed by lung cancer being the commonest primary site. Usually these are incidentally detected and are rarely symptomatic. We present an unusual case of adenocarcinoma lung, presenting initially with right testicular pain. Further workup with 18F-FDG PET/CT demonstrated primary malignancy of the left lung with nodal and right testicular metastasis.

Lymph node density in retroperitoneal lymph node dissection as a novel marker for predicting recurrence in patients with germ cell testicular cancer: A case-control study and long-term clinical experience of a tertiary referral hospital

INTRODUCTION AND OBJECTIVES

In this retrospective study, we aimed to evaluate lymph node (LN) density in retroperitoneal lymph node dissection (RPLND) to analyze whether residual mass after chemotherapy might behave as predicting factor for recurrence in patients with germ cell testicular cancer (GCTC).

MATERIALS AND METHODS

The data of 185 patients that were operated between 12/2004 and 02/2017 because of GCTC were reviewed retrospectively. LN density was calculated. The patients were compared statistically in terms of demographic features, tumor characteristics, serum tumor marker levels, treatment strategies, and pathological results according to GCTC subtypes. Correlation analysis was performed to determine the parameters related to recurrent disease.

RESULTS

The median follow-up was 79 (31-179) months and the median age of the patients was 23 (16-71). The median tumor size was 4 (1-18) cm. Five (2.7%) patients had metastatic disease at initial diagnosis. Seminoma, non-seminomatous-GCT and mix type-GCTC was detected in 62 (33.5%), 60 (32.4%) and 63 (34.1%) patients, respectively. Following inguinal orchiectomy, 48 (25.9%) patients underwent follow-up, 126 (68.1%) patients underwent chemotherapy and 11 (5.9%) patients underwent radiotherapy. A total of 21 (11.4%) patients underwent post-chemotherapy RPLND. Early and late recurrence was seen in 3 (1.6%) and 2 (1.1%) of the patients, respectively. A mild to moderate, negative, but significant correlation was found between the recurrence and the number of LNs containing metastatic deposits and LN density (r= -0.490, P=.024 and r= -0.450, P=.041, respectively).

CONCLUSIONS

There was a negative correlation between the number of LNs containing metastatic deposits and LN density and recurrent disease.

[Symptomatic testicular metastasis of acinar adenocarcinoma of the prostate]

We report about the rare occurrence of symptomatic testicular metastasis of an acinar adenocarcinoma of the prostate. Testicular metastases are usually incidentally detected in patients treated with bilateral orchiectomy or more often during autopsy. In the literature, there are only a few clinical cases describing symptomatic testicular metastases. However, the possibility of such metastases should be considered in patients diagnosed with advanced prostate cancer. Testicular examination should be performed regularly, even in patients with low prostate-specific antigen levels.

Thoracic Metastasectomy in Germ Cell Tumor Patients Treated With First-line Versus Salvage Therapy

BACKGROUND

Outcomes after thoracic metastasectomy in patients with testicular germ cell tumors (GCTs) who received first-line chemotherapy alone versus salvage chemotherapy remain unexplored.

METHODS

We conducted a retrospective review of patients who underwent thoracic metastasectomy for residual GCT between 1997 and 2019 at a single tertiary center. Factors associated with progression-free survival (PFS) and overall survival (OS) were assessed using multivariable Cox regression.

RESULTS

Of 251 patients, 191 received only first-line chemotherapy (76%) and 60 received salvage chemotherapy (24%). Median follow-up was 3.45 years (interquartile range, 1-7.93 years). Among first-line patients without teratoma in the primary tumor, with necrosis in the retroperitoneal nodes and normalized or decreasing serum tumor markers, 17 of 20 had intrathoracic necrosis (85%). Among first-line and salvage patients, respectively, 5-year OS was 93% (95% confidence interval [CI], 89%-98%) versus 63% (95% CI, 51%-78%; P < .001), and 5-year PFS was 69% (95% CI, 62%-77%) versus 40% (95% CI, 29%-56%; P < .001). On multivariable analysis, multiple lung lesions (hazard ratio [HR] = 3.01; 95% CI, 1.50-6.05; P = .002) and brain metastasis (HR = 4.51; 95% CI, 2.34-8.73; P < .001) at diagnosis, salvage chemotherapy (HR = 1.85; 95% CI, 1.10-3.13; P = .021), teratoma (HR = 2.68; 95% CI, 1.50-4.78; P = .001), and viable malignancy (HR = 4.34; 95% CI, 2.44-7.71; P < .001) were associated with worse PFS.

CONCLUSIONS

Although GCT patients treated with salvage chemotherapy followed by thoracic metastasectomy have more aggressive disease and poorer PFS, they can achieve encouraging OS. Our findings highlight the integral role of aggressive thoracic metastasectomy in the treatment of GCT patients with residual thoracic disease after first line-only or salvage chemotherapy.

Paratesticular colon cancer metastasis in an area of remote trauma

A 53-year-old man with a history of colon adenocarcinoma and remote scrotal trauma resulting in a palpable nodule. Gradual increase in the size of this lesion over the year prior to his presentation to our clinic prompted scrotal ultrasound that demonstrated a 1.1 cm solid lesion, which appeared to arise from the right epididymal tail. Subsequent positron emission tomography (PET) scan showed intense focal uptake at the base of the right testicle, suspicious for epididymitis versus underlying neoplasm. Scrotal exploration through an inguinal approach revealed a paratesticular mass. Frozen section from an excisional biopsy was positive for adenocarcinoma. Radical orchiectomy was completed. Final pathology returned as metastatic adenocarcinoma involving soft tissue; testis and spermatic cord were without diagnostic abnormalities and surgical margins were not involved. Subsequent analysis was consistent with colorectal origin. The patient recovered well from surgery and is continuing treatment of metastatic colon cancer per the medical oncology team.

Testicular Metastasis of Pancreatic Carcinoma on FDG-PET/CT

Pancreatic cancer metastasizing to the testis is extremely rare. We present the case of a 65-year-old man who complained of painless swelling of the left scrotum for 9 months. Scrotal ultrasonography revealed a mass in the left testis. Serum CA199 and CA242 were significantly elevated. F-FDG PET/CT was recommended for identifying potential malignancy and showed several hypermetabolic masses in the pancreas, left testis, and right lung. Resection of left testicular and pancreatic masses and fine-needle biopsy of right pulmonary mass were performed, and subsequent pathology confirmed pancreatic adenocarcinoma metastasizing to the testis and lung.

Bilateral Testicular Metastases from Lung Adenocarcinoma Showing an Objective Response to Nivolumab: A Case Report and Review of the Literature

A 69-year-old man who had undergone chemoradiotherapy for advanced pulmonary adenocarcinoma had bilateral testicular and adrenal gland masses on a routine follow-up examination. We performed left orchiectomy, and the histopathological examination confirmed metastatic pulmonary adenocarcinoma involving the extracted testis. He was treated for disease progression with nivolumab after unsuccessful cytotoxic chemotherapy, which resulted in regression of recurrent adrenal and right testicular tumors. We reviewed the existing literature on metastatic testicular tumors and found that testicular metastasis from lung cancer is rare and poses a chemotherapeutic challenge. Based on our experience, immune checkpoint inhibitors seem to have good efficacy for treating testicular metastasis.

Rapid testicular metastasis from bladder transitional urothelial carcinoma after radical cystoprostatectomy: A case report

RATIONALE

Bladder cancer (BC) is commonly diagnosed in the urinary system and the most common subtype is transitional urothelial carcinoma (TCC). Even with the best treatment, tumor recurrence and metastases always occur. While clinicians commonly observe the metastases to pelvic lymph nodes, liver, lung, and bone, it may infrequently spread to some uncommon locations.

PATIENT CONCERNS

The patient was a 67-year-old man with a diagnosis of high-grade TCC with squamous differentiation in the bladder and prostate. Subsequently, radical cystoprostatectomy, adjuvant radiotherapy, and chemotherapy were performed. However, he felt intermittent right scrotal pain about 1 year later.

DIAGNOSIS

Ultrasound strongly suggested a testicular neoplasm of right testis, but the left was normal.

INTERVENTIONS

The patient underwent a right radical orchiectomy and histopathology confirmed testicular metastatic neoplasm from bladder. Moreover, further examination with positron emission tomography revealed no visible distant spread of the urothelial carcinoma.

OUTCOMES

No signs of tumor recurrence or distant metastasis were visible under follow-up 1 year after radical orchiectomy.

LESSONS

Testicular mass may be metastatic tumor during follow-up for patients who were diagnosed as BC, especially for TCC with variant histology. The reason of this could be explained of residual micrometastases after surgery and need more examination to discover local micrometastases to apply more aggressive treatment.

Isolated testicular metastasis from prostatic adenocarcinoma

Metastatic carcinomas to the testes are rare with prostate adenocarcinoma being the most common. Reported cases of metastatic carcinoma to the testes are usually associated with metastasis to other sites. Metastasis to the testis alone without associated secondaries to other sites can occur and so far, few cases have been reported globally. Due to the rarity of such presentation and the need for proper evaluation of orchiectomy specimens for prostatic adenocarcinoma, we report a case of an 84-year-old with isolated metastasis to the left testes. This was discovered incidentally the following orchiectomy as a form of hormonal therapy for prostatic adenocarcinoma.

A case of cervical spinal mass with cord compression and rib bone metastasis from presumably burned-out seminomatous testicular germ cell tumor

Most germ cell tumors are located in the gonads however there are instances where these tumors are located elsewhere in which are termed extragonadal germ cell tumors. When primary lesion of the testicular tumor has regressed, the term "burned-out testicular tumor" has been proposed. We herein report the first case of burned-out seminoma of the testis presenting as a cervical spinal mass causing cord compression with bone metastasis.

Genomic Features for Therapeutic Insights of Chemotherapy-Resistant, Primary Mediastinal Nonseminomatous Germ Cell Tumors and Comparison with Gonadal Counterpart

Primary mediastinal nonseminomatous germ cell tumors (PMNSGCT) frequently become refractory to chemotherapy, and no effective salvage therapy exists. We performed genomic profiling on a series of 44 PMNSGCT and compared the results with those from chemorefractory, metastatic pure seminomatous (Sem, n = 22) and nonseminomatous (NS, n = 86) testicular germ cell tumors. Archival tissues were sequenced by a hybrid capture-based technology (FoundationONE; Foundation Medicine, Inc., Cambridge, MA). Microsatellite instability (MSI) and tumor mutational burden (TMB, mutations [mut]/Mb) were determined.Statistically significant differences in genomic alterations (GA) of PMNSGCT versus NS included higher TP53 pathway GA (p < .0001), PIK3CA pathway GA (p < .0001), and lower cell-cycle pathway GA (p = .0004). There were no MSI-high PMNSGCT cases. Mean TMB was similar between the groups, but there were more ≥10 mut/Mb in the PMNSGCT group versus NS (11.4% vs. 4.6%).The GA identified in PMNSGCT were similar to the findings from NS, with differential opportunities for targeted therapies and immunotherapies. Further study of precision treatments appears warranted.

Ultrasonographic features of testicular metastasis from renal clear cell carcinoma that mimics a seminoma: A case report

RATIONALE

Testicular metastases from renal cell carcinoma (RCC) are extremely rare. To the best of our knowledge, only 35 cases have been described in the literatures.

PATIENT CONCERNS

A 64-year-old male presented to our urology clinic for a palpable painless mass on his right side of the scrotum by self-examination 1 week ago, with a general abdominal ultrasonographic report showing a mass in his right kidney.

DIAGNOSES AND INTERVENTIONS

Scrotal B-mode ultrasound revealed a 15 × 13 × 15 mm well-defined round homogenously hypoechoic nodule with a halo at the upper pole of the right testis. Color Doppler and spectral Doppler ultrasound detected abundant intranodular and perinodular blood flow signals including both arteries and veins. Malignancy was suspected. Abdominal contrast-enhanced computed tomography identified an irregular tumor in the posterior side of the right kidney, highly suspicious for renal carcinoma. The patient received right radical nephrectomy and right partial orchiectomy. Histologically, the right renal mass was diagnosed as RCC, clear cell type, grade 2. As to the right testicular mass, a metastasis from renal clear cell carcinoma was confirmed.

OUTCOMES

The patient has lived with no recurrence for at least 17 months without adjuvant therapy.

LESSONS

In the case, we focus on the ultrasonographic features of the testicular metastasis from RCC. Ultrasound could provide initial and helpful information for diagnosis. When finding a mass in the testicle on the ultrasound, although most of them are primary, it is important to know whether the patient has tumor history from other parts of the body. A halo may be a special feature for metastases. Contrast-enhanced ultrasound (CEUS) and ultrasonic elastography could provide more information for differential diagnoses.

Mammary gland tumors in a male Cocker Spaniel

BACKGROUND

Mammary gland tumors are the most common tumors in sexually intact female dogs; however, they are rare in male dogs. This study was conducted to investigate the relationship between sexual hormones and mammary gland tumors in a male dog.

CASE PRESENTATION

A 13-year-old, intact male Cocker Spaniel presented to the Veterinary Teaching Hospital of Kangwon National University, Republic of Korea, with an acute right ruptured caudal abdominal mass. Physical examination revealed a 14 × 14 cm ruptured mass in the right caudal abdomen, as well as a 1.5 × 1.5 cm mass in the first right mammary gland. The estrogen and progesterone concentrations in serum were within normal levels. Total mastectomy was done on the right side mammary glands. Following surgery, the site was fully recovered; however, a mass that had grown to 2 × 2 cm was found in the left fifth mammary gland and a testis tumor was also found over the period of 4 months. Mastectomy was performed on the left caudal mammary gland and castration was also performed. After the final surgery, the dog fully recovered. Histopathological examination of all three masses revealed high grade mammary adenocarcinoma in the mammary gland and the testis was diagnosed as Leydig cell adenoma. Immunohistochemical analysis revealed that the estrogen and progesterone receptors were expressed on limited cells in mammary and testis tumors.

CONCLUSION

The results of this study suggest that mammary tumors and testes tumors can occur in male dogs without relationship to female sexual hormone.

A Complete Response with Rituximab in Metastatic Diffuse Large B-Cell Lymphoma of the Testis: Case Report

Primary testicular lymphoma is an uncommon testicular tumour. We present a case of a primary non-Hodgkin lymphoma of the testis, describing its clinical and pathological features and discussing our treatment strategy. A 68-year-old man showed a firm erythematous testicular mass within the right emiscrotum. Subsequent ultrasonography demonstrated a right inferior pole testicular mass with disomogenously hypoecogenic. The patient was submitted to inguinal orchidectomy. Light microscopy demonstrated the classic appearance of a diffuse large B-cell lymphoma. The immunohistochemical study showed tumour cells intensively positive for CD45, Ki67 and CD20. No evidence of extra-testicular involvement by lymphoma was found. At 6 months, a TC-PET showed a clinical relapse in lung and abdominal lymphonodes, while clinical examination demonstrated a single, indolent and erythematous nodule in the left foot. The histologic analysis confirmed diagnosis of CD-20 positive B-cell lymphoma. The patient was treated with an anti-CD 20 monoclonal antibody (rituximab) alone every 3 weeks. After 3 months a complete response was observed in all sites of disease. The patient was free from disease at 12 months follow-up.

[Hematologic neoplasms with testicular involvement]

OBJECTIVE

We report two cases of patients with a previous diagnosis of hematologic tumor who present with testicular recurrence, and we carry out a review of the literature regarding the infrequency of this pathology.

METHODS

We present a retrospective review of the medical records of two patients diagnosed with hematologic malignancies (acute myelogenous leukemia and multiple myeloma) with occurrence of relapse in the testicle. We reviewed the management and outcome after treatment with bilateral orchiectomy.

RESULTS

Case 1: The patient was diagnosed with acute myeloid leukemia and treated with an allogeneic transplant. Two years later, the patient reported an increase in testicular size. The complementary studies lead us to suspect a testicular recurrence that was confirmed after orchiectomy. Currently, the patient awaits the start of a chemotherapy treatment prior to a new allogeneic transplant. Case 2: Patient with the diagnosis of multiple myeloma who started a polychemotherapy treatment without response and underwent allogeneic transplant. After five months with complete remission, there were signs of systemic recurrence, and a study for a new transplant was carried out. During the study, potential testicular recurrence was observed. After a batch of complementary tests, bilateral orchiectomy was performed and the diagnosis was confirmed. Currently, the patient is undergoing an allogeneic transplant protocol after radiotherapy and chemotherapy treatment.

CONCLUSIONS

Currently the mortality rate in cases of relapse of hematologic malignancy in the testicle has declined despite the sharp rise in its incidence. This is because of, as in our case, early diagnosis and the combined use of chemotherapy, radiotherapy and surgery. This has been achieved through an interdisciplinary collaboration of urologists, hematologists, oncologists and radiotherapists.

Genital invasion or perigenital spread may pose a risk of marginal misses for Intensity Modulated Radiotherapy (IMRT) in anal cancer

BACKGROUND

While intensity modulated radiotherapy (IMRT) in anal cancer is feasible and improves high-dose conformality, the current RTOG/AGITG contouring atlas and planning guidelines lack specific instructions on how to proceed with external genitalia. Meanwhile, the RTOG-Protocol 0529 explicitly recommends genital sparing on the basis of specific genital dose constraints. Recent pattern-of-relapse studies based on conventional techniques suggest that marginal miss might be a potential consequence of genital sparing. Our goal is to outline the potential scope and increase the awareness for this clinical issue.

METHODS

We present and discuss four patients with perigenital spread in anal cancer in both early and advanced stages (three at time of first diagnosis and one in form of relapse). Genital/perigenital spread was observed once as direct genital infiltration and thrice in form of perigenital lymphatic spread.

RESULTS

We review the available data regarding the potential consequences of genital sparing in anal cancer. Pattern-of-relapse studies in anal cancer after conventional radiotherapy and the current use of IMRT in anal cancer are equivocal but suggest that genital sparing may occasionally result in marginal miss. An obvious hypothesis suggested by our report is that perigenital lymphovascular invasion might be associated with manifest inguinal N+ disease.

CONCLUSIONS

Local failure has low salvage rates in recent anal cancer treatment series. Perigenital spread may pose a risk of marginal misses in IMRT in anal cancer. To prevent marginal misses, meticulous pattern-of-relapse analyses of controlled IMRT-series are warranted. Until their publication, genital sparing should be applied with caution, PET/CT should be used when possible and meeting genital dose constraints should not be prioritized over CTV coverage, especially (but not only) in stage T3/4 and N+ disease.

[Metastatic testicular melanoma. Case report]

A 33 year-old male, who five years earlier was operated for a nodular melanoma in vertical growth phase of 1.5mm thick (Breslow), Clark II-III, presented to the Emergency department with a progressive increase of the left testicle. Ultrasound scan examination revealed a 2 x 2 cm solid mass in the left testis, with normal right testis.With the diagnosis of testicular neoplasm, we requested Alpha-fetoprotein and beta HCG levels, and patient underwent radical orchiectomy.

[RARE CASE OF STOMACH CANCER METASTASIS]

The article presents the description of the case of metastasis of stomach cancer in the right testicle and epididymis, cellular tissue along the spermatic cord, prepuce and scrotum in the absence of metastases in the peritoneum and abdominal organs.

Minimally invasive post-chemotherapy retroperitoneal lymph node dissection for nonseminoma

INTRODUCTION

We present our experience with minimally-invasive retroperitoneal lymph node dissection (MI-RPLND) in the post-chemotherapy (PC) setting for residual masses in patients with nonseminoma.

MATERIALS AND METHODS

Nineteen men who underwent PC MI-RPLND (14--laparoscopic, 5--robotic) for low-volume residual disease (no more than 5 clinically enlarged retroperitoneal masses, size < 5 cm, no adjacent organ or vascular invasion) between 2006 and 2011 were identified. Clinicodemographic information and pathological outcomes were reported.

RESULTS

Median age of our study population was 32 (interquartile range [IQR]: 28-39). Most patients presented with clinical stage II disease (63%) and were categorized as good risk (90%) by the International Germ Cell Consensus Classification. Median size of residual masses on PC imaging was 2.1 cm (IQR: 1.7-3). Full-template bilateral RPLND was completed in 53% of cases, and modified left-sided RPLND in 47%. Median operative time was 370 minutes (IQR: 320-420), and median estimated blood loss was 300 cc (IQR: 150-450). Median length of stay was 3 days (IQR: 2-3). Five patients (26%) experienced a postoperative 30 day complication, but none were higher than Clavien grade II. On final pathology, median number of lymph nodes removed was 12 (IQR: 8-23), and 8 patients (42%) had residual teratoma. No patient experienced a recurrence at median follow up of 24 months (IQR: 5-76).

CONCLUSIONS

PC MI-RPLND is a feasible option in a select group of patients with acceptable patient morbidity and short-term outcomes. Longer follow up is required to determine the oncologic efficacy of this approach.

Testicular metastasis from gastric carcinoma: A case report

Gastric cancer (GC) is the most prevalent malignancy in the world, especially in China. GC has been postulated to spread via several different routes, including through hematogenous channels, lymphatic vessels, the seeding of peritoneal surfaces, direct extension through the gastric wall, and retrograde extension through the vas deferens or lymphatics. Testicular metastasis is rare. We show here a 53-year-old patient with GC who underwent a radical total gastrectomy approximately 22 mo ago after he presented with a sensation of heaviness and swelling of the right hemiscrotum. The diagnosis of metastatic adenocarcinoma was made after a right-side orchiectomy. We report the first case of testicular metastasis from gastric adenocarcinoma in mainland China and summarize the clinicopathologic features of the disease based on previously published papers.

Testicular and inguinal lymph node metastases of medullary thyroid cancer: a case report and review of the literature

BACKGROUND

The involvement of the testis by metastatic medullary thyroid carcinoma has never been described before. We describe the first case of metastatic medullary thyroid carcinoma affecting testis and inguinal lymph nodes.

CASE PRESENTATION

A 73-year-old Caucasian man was referred to undergo urologic surgery due to a painless nodule in the right testis and an homolateral inguinal lymphoadenomegaly. The patient had a history of medullary thyroid carcinoma with relapsing disease to the spine and lung nodules. Serum calcitonin and CEA levels were 175 pg/ml and 22 ng/ml, respectively. With suspected testicular cancer, the patient underwent radical right orchiectomy with the excision biopsy of the right inguinal lymph node. Histopathology and immunohistochemistry revealed that both the lesions were due to metastases from medullary thyroid carcinoma.

CONCLUSION

Metastases to the testis and inguinal lymph nodes may be due to various solid and hematological tumors. This case, despite its rarity, suggests that testis and inguinal lymph nodes should be considered as potential secondary sites of medullary thyroid carcinoma as well.

[Metastasis in testis from prostate cancer]

We present a case of an 89-year-old male diagnosed with a prostatic adenocarcinoma. He developed a metastasis to his left testis and was treated with bilateral orchiectomy. Histology showed a ductal adenocarcinoma with positive immunohistochemical markers for PSA and p501. Testicular metastases from prostate cancer are rare and are assumed to be associated with progressed disease and poor prognosis. Ductal adenocarcinomas may be associated with a higher risk of dissemination to the testis.

Multiple myeloma with testicular involvement: a case report and review of the literature

We report a case of a very unusual metastasis of multiple myeloma to the testis in a 53-year-old-patient, documented with images and anatomic-pathological exam. Our case report is of interest because it is one of the rarest forms ever reported of advanced multiple myeloma.

Recurrent peritoneal carcinomatosis in the scrotum in a patient with a history of mucocele of the appendix

Paratesticular metastases are rare entities and a paratesticular metastasis of a mucinous appendiceal adenocarcinoma with peritoneal carcinomatosis has not been reported in the literature in the last 15 years. We present a case of mucinous appendiceal adenocarcinoma that progressed to peritoneal carcinomatosis. Twenty months following surgery and intraperitoneal therapy, the patient presented with testicular pain and swelling. Ultrasound examination raised suspicion for a neoplastic process and pathology confirmed a metastatic mucinous adenocarcinoma of appendiceal origin. Radiologists should be cognizant of potential paratesticular metastases in patients with a known history of malignancy with new testicular pain and swelling.

Long-term outcome of primary endocrine non-Hodgkin lymphomas: does the site make the difference?

AIM

Primary lymphomas of endocrine glands are extremely rare. Our study adds more data to the few published series regarding the incidence, clinical characteristics, management and overall survival (OS) by comparing the various diffuse large B-cell endocrine lymphomas. Moreover, it contributes to a better understanding of these neoplasms and provides concepts for future research.

METHODS

We retrospectively evaluated the clinical profile and the patterns of outcome among patients who were treated in our center with the diagnosis of aggressive, B-cell, primary endocrine lymphoma.

RESULTS

Between May 1980 and December 2011, 450 patients were diagnosed as primary extranodal non-Hodgkin lymphomas. Among them, 18 cases (4%) were primary testicular lymphoma (PTL), 8 cases (2%) were primary thyroid lymphoma (PTHL) and 4 cases (1%) were primary adrenal lymphoma (PAL). The therapeutic approaches employed were variable, including mainly chemotherapy in combination with radiotherapy and surgery. The median OS for the patients with PTL and PAL was 27 and 6 months, respectively. Better outcome was observed in patients with PTHL for whom the median OS has not been reached yet, whereas the PAL group had the worst prognosis.

CONCLUSIONS

The discrepancies in the outcome among endocrine lymphomas could be partly attributed to their biologic variability, which might be determined by the initial site involved. We conclude that treatment decisions should be made according to a multi-disciplinary approach to avoid unnecessary surgery. Existing treatment strategies for PTL and PAL fail to provide long-term survival, rendering the application of novel therapeutic approaches essential.

Symptomatic bilateral testicular metastasis from carcinoma of the prostate

A man in his late 70s, on hormonal treatment for prostatic adenocarcinoma, presented with bilateral enlarged and painful testes. Bilateral orchidectomy was undertaken and subsequent histological examination revealed both testes completely infiltrated with metastatic prostatic carcinoma.

Acute promyelocytic leukemia with Flt3-TKD and WT1 mutations relapsing in a testicle and followed by systemic relapse

Extramedullary relapse is a rare phenomenon in patients with acute promyelocytic leukemia (APL), especially that derived from urogenital systems like the testicles. In this report, we describe an APL patient who had received standard induction/maintenance therapy resulting in durable remission for 4.5 years, when he presented with a unilateral testicular mass confirmed as myeloid sarcoma; this was followed by systemic relapse of APL. Retrospective analysis of the involved blood and bone marrow samples at the time of the initial diagnosis revealed a rare point mutation of FLT3-TKD and a novel mutation of WT1. These mutations were detected recurrently throughout the course of the disease. After reinduction therapy with arsenic trioxide and all-trans retinoic acid combined with daunorubicin, complete hematological remission was achieved for the ensuing salvage allogeneic hematopoietic stem cell transplant.

Is modified retroperitoneal lymph node dissection alive for clinical stage I non-seminomatous germ cell testicular tumor?

PURPOSE

To evaluate efficacy of modified retroperitoneal lymph node dissection (RPLND) in the management of patients with pathological stage (PS) I non-seminomatous germ cell testicular tumor (NSGCT) in a retrospective study.

MATERIALS AND METHODS

Between April 2002 and April 2012, 55 patients with clinical stage (CS) I NSGCT had undergone modified RPLND according to Sloan-Kettering modified RPLND template. Clinicopathological parameters, retroperitoneal relapse, and antegrade ejaculation rate were evaluated in patients with PS I.

RESULTS

Of 55 patients, 41 (74.5%) and 14 (25.5%) subjects were in PS I and II, respectively. In PS I group, the mean patients' age was 32.8 years (range, 19 to 51 years) at the end of the follow-up period. Three patients missed the follow-up; hence, were excluded from the study. Mean follow-up duration was 56 months (range, 6 to 120 months). Tumor recurrence was identified in no subjects at the end of the follow-up period. Overall peri and postoperative complication rate was 18% (7 patients). Out of 38 patients, 23 (61%) had post RPLND antegrade ejaculation at the end of the study.

CONCLUSION

Modified template RPLND is a safe, effective, and sufficient treatment for patients with no retroperitoneal micrometastasis after the procedure. Furthermore, this strategy may obviate the need for close, expensive, and potentially harmful follow-up protocol in patients with PS I NSGCT.

[Spinal cord compression by testicular germ cell tumor: case report]

Malignant spinal cord compression occurs in 2.5% - 5% cancer patients. Early diagnosis and therapeutic intervention are critical for pain control and improvement of any neurological deficit. Treatment should be directed to the underlying disease together with appropriate symptom management. The case of a man with tetraparesis of 24 hours duration is presented. He had surgery five days earlier because of a testicular tumor and spinal magnetic resonance imaging (MRI) showed spinal cord compression by a soft tissue mass between C7 and D2. After confirming the diagnosis of mixed germ cell tumor, stage IIIC, the patient began chemotherapy with progressive neurological improvement. Two years after diagnosis the patient presents a slight reduction of strength in the right hand and remains without any evidence of disease. This case illustrates the importance of early diagnosis of spinal cord compression and one of the main indications for the use of chemotherapy as the treatment for an oncologic emergency.

An unusual variant of prostatic adenocarcinoma with metastasis to testis. A case report

Ductal adenocarcinoma of the prostate is considered to be a rare variant of prostatic adenocarcinoma when compared to the more common acinar adenocarcinoma. We report here a case of ductal adenocarcinoma of the prostate in a 68-year old man who presented with complaints of abdominal pain, retention of urine and hematuria of one month duration. Clinical examination showed prostatomegaly. The serum Prostate Specific Antigen (PSA) value was raised to 79ng/mL. Histopathological and immunohistochemical evaluation of resected specimen of prostate revealed ductal adenocarcinoma of the prostate. The patient was lost to follow up and presented four years after the initial diagnosis with metastasis to the bone and testis. Though prostatic cancers have the ability for wide spread dissemination, metastasis to testis is rare. Immunohistochemical staining with PSA and Prostatic Acid Phosphatase (PAP) can help in establishing prostatic nature of the neoplasm. We are reporting this case because of the rarity of metastasis of prostatic carcinoma to testis and for stressing the need for keeping in mind the possibility of metastatic carcinoma also while dealing with testicular tumors.

[Retroperitoneal lymphadenectomy - pro robotic]

The indications to perform primary retroperitoneal lymph node dissection (RPLND) in patients with clinical stage I non-seminomatous germ cell tumors have changed. An initial surgical staging can be justified only for exceptional situations, such as a pure teratoma. Other indications can be the surgical staging and treatment of high risk patients in elective surgery. In this situation, however, only sparse data are available regarding the oncological and therapeutic effect of a minimally invasive approach compared to open surgery. Data are available on the feasibility of laparoscopically performed post-chemotherapy RPLND; however, patients for this approach must be highly selected. In general, robotic-assisted RPLND potentially offers major advantages in terms of safety and oncological efficiency compared to a classical laparoscopic approach. Especially in post-chemotherapy RPLND, the division of lumbar vessels and the control of great vessel lesions may be facilitated. However, only surgeons who are capable of handling a major vessel lesion endoscopically should consider using a robotic-assisted technique. Only patients with relatively small residual tumors without a major involvement of great vessels can be considered as candidates for robotic-assisted post-chemotherapy RPLND.

Prostate cancer with solitary metastases to the bilateral testis

We present the case of an 81-year-old patient with testicular metastasis from prostate carcinoma. After the initial diagnosis of prostate cancer, he had an 8-year course of hormonal therapy and showed no clinical evidence of metastasis to other organs. Asymptomatic metastasis of prostate carcinoma to the testis is a rare clinical condition. We diagnosed his condition, based on histopathology following a subcapsular orchiectomy and transurethral resection of the prostate.

Testicular fusocellular rhabdomyosarcoma as a metastasis of elbow sclerosing rhabdomyosarcoma: A clinicopathologic, immunohistochemical and molecular study of one case

Sclerosing rhabdomyosarcoma (SRMS) is an infrequent variant of rhabdomyosarcoma characterized by extensive intercellular hyaline fibrosis. We report the case of a 37 year-old male with a 9 x 6 cm SRMS on the right elbow. Histologically, the tumor showed an abundant extracellular hyaline matrix with extratumoral vascular emboli and microscopic foci of fusocellular embryonal rhabdomyosarcoma (FRMS) separated by a fibrotic band from the sclerosing areas. One year later the patient presented with a right intratesticular tumor of 1.2 x 0.8 cm, which was reported as pure FRMS. Immunohistochemically, SRMS was positive only for MyoD1 and Vimentin and negative for Myogenin and Desmin. Both the elbow emboli with the extratumoral foci of FRMS and the intratesticular tumor were positive for Myogenin, MyoD1, Vimentin and Desmin. Using fluorescent in situ hybridization (FISH), the SRMS and the FRMS tumor cells of the elbow and the FRMS tumor cells of the testis were found to be negative for FOXO1A translocation in chromosome 13. PCR chimeric transcriptional products PAX3-FKHR and PAX7-FKHR were not found. Six months following testicular resection, the patient died of multiple metastases in the mediastinum, lung and right thigh.

Solitary testicular metastasis from prostate cancer: a rare case of isolated recurrence after radical prostatectomy

BACKGROUND

The prognosis of prostate cancer (PC) is mainly determined by the presence or absence of metastases. An isolated testicular metastasis of PC is rare.

CASE REPORT

A 71-year-old patient with PC presented with an increased serum prostate-specific antigen (PSA) level of 2.07 ng/ml two and a half years after radical prostatectomy. Assuming a local recurrence in the prostatic fossa, local radiotherapy with 64.8 Gy was performed. Unfortunately, the PSA level rose again, accompanied by a swelling of the left testis approximately one month after radiotherapy. A unilateral orchiectomy was then performed, presenting a testicular metastasis of the PC. After orchiectomy, the PSA decreased to <0.07 ng/ml. Two years later, the patient is still tumour-free.

CONCLUSION

Careful clinical follow-up of patients with rising serum PSA level is important to recognize isolated, locally treatable metastastic disease. In particular, rare metastatic sites such as the testis or the epididymis should be taken into account before treatment of biochemical recurrence is initiated.

Metastasis to the tunica vaginalis testis from a primary mucinous tumor of the cecum

OBJECTIVES

We review the literature about secondary testicular tumors.

METHODS

We present the case of a patient with a metastatic mucus-secreting testicular tumor who presented in the emergency room with symptoms of acute scrotum 10 months after surgery for a mixed tumor of the cecum. This type of tumor is rare, and the treatment of choice is orchiectomy; nevertheless, the prognosis of such metastasis remains poor.

RESULTS

Because mucinous tumors can present late dissemination, long-term follow-up with assessment of the most common sites of metastasis is necessary. Our patient died 21 months after the initial diagnosis

CONCLUSIONS

Testicular metastases and mucus-secreting intestinal tumor metastases are rare. These tumors occur in patients older than 60 years of age and young men. As in the case of primary tumors, the treatment is orchiectomy.

The unusual presentation of gastric adenocarcinoma as a testicular mass: a favorable response to docetaxel and Cisplatin plus oral tegafur/uracil and leucovorin

Gastric cancer is one of the most common malignancies in the world. The routes of metastasis include direct extension, lymphatics, and peritoneal or hematogenous spread. Testicular metastasis is rare. We present here a 23-year-old gastric cancer patient who first presented with right-side testis swelling and pain. Diagnosis of metastatic adenocarcinoma was made after right-side orchiectomy. Gastric adenocarcinoma with ascites and peritoneal seeding was found after esophagogastroscopy and abdominal computed tomography. The patient received chemotherapy consisting of docetaxel 36 mg/m(2) and cisplatin 30 mg/m(2) on day 1 and day 8, plus oral tegafur/uracil 300 mg/m(2)/day and leucovorin 90 mg/day on day 1 to day 14 in a 21-day cycle, and he had a partial response to the chemotherapy. Metastatic tumors, especially gastric adenocarcinoma, should be considered in the differential diagnosis of patients presenting with testicular mass and they may respond well to chemotherapy.

Laparoscopic bilateral retroperitoneal lymph node dissection in stage II testis cancer

PURPOSE

We report our experience with laparoscopic bilateral retroperitoneal lymph node dissection (RPLND) in 4 patients with stage II testis cancer.

MATERIALS AND METHODS

Between January 2002 and January 2009, 4 patients with stage II testis cancer underwent laparoscopic bilateral RPLND. In 2 patients, laparoscopic bilateral RPLND was performed for residual mass post-chemotherapy. We performed classic bilateral RPLND without patient repositioning.

RESULTS

The procedure was done uneventfully without any major perioperative complication. The demanding part was contralateral, depending side dissection, which was accomplished with the help of a bowel retractor. Patient repositioning was not necessary.

CONCLUSION

Laparoscopic bilateral RPLND can be performed efficiently and safely in stage II testis cancer, without need to repositioning and placement of trocar in contralateral side.

Clear cell papillary cystadenoma of epididymis, a mimic of metastatic renal cell carcinoma

We discuss a case of 25 year old male who was evaluated for primary infertility following marriage. He had no previous history of urogenital complaints or abnormalities. In fact, his past medical history was unremarkable. On examination epididymal masses were found. Semen analysis showed azoospermia. Right epididymal mass was surgically excised. Histopathology showed an epididymal neoplasm composed of simple and complex papillary processes lining and filling the ducts. The tumor cells were clear and positive for cytoplasmic glycogen. Immunohistochemistry was also supportive. Diagnosis of clear cell papillary cystedenoma was made based on histopathological and immunohistochemical features.