Rare pediatric synchronous bilateral testicular germ cell tumors of different pathological types: a case report

The occurrence of synchronous bilateral testicular germ cell tumors (BTGCTs) of different pathologic histologic types in pediatric patients is rare. We reported a case of a left testicular yolk sac tumor (YST) combined with a right testicular mature teratoma. Left orchiectomy and right testis-sparing surgery were performed. Retroperitoneal recurrence was noted 6 months after surgery. The patient underwent reoperation for the resection of a retroperitoneal mass, which was pathologically diagnosed as a recurrent YST. A full cycle of chemotherapy was then administered. No tumor metastasis or recurrence has yet been detected. We present this new case, and we review the previous literature on synchronous BTGCTs to explore the clinicopathologic features and summarize the diagnostic and therapeutic experience. Radical orchiectomy, as the standard treatment for YSTs, should be considered with caution in patients with bilateral testicular tumors. Rapid intraoperative frozen pathology provides support for timely surgical planning. In patients with intraoperative frozen pathologic specimens suggestive of benign lesions, testis-sparing surgery is the preferred treatment option.

Primary Testicular Lymphoma Mimicking Germ-Cell Tumor: A Case Report

There are 1% to 2% of lymphoma cases that include the testis as primary testicular non-Hodgkin lymphoma (NHL). In 35% of cases, it involves both testes and is usually seen as a painless testicular mass. Therefore, in most cases, the management option is radical orchiectomy. The overall prognosis in these cases is poor, as most cases are associated with systemic disease. We report a case of a 42-year-old male who presented with painless right scrotal swelling for three months. The only serologic marker of solid tumors that was elevated was βHCG; others were unremarkable. Ultrasonography was initially ordered as well and showed a heterogeneous intra-testicular lesion of relatively low echogenicity. According to the given age, epidemiology, and clinical presentation, the suspicion of a germ cell tumor was highly likely. Therefore, a right radical inguinal orchiectomy was done, and the specimen was sent for histopathology, which came back as B-cell non-Hodgkin lymphoma. The clinical presentation and the overall picture of the investigations made in this case mimicked a germ cell tumor presentation.

Metastatic signet-ring cell carcinoma of the testis: An unusual case report in Syria

Key Clinical Message

The case of a 44-year-old male with signet-ring cell adenocarcinoma metastasis in the testis emphasizes the significance of immunohistochemistry in identifying the primary site of metastatic tumors. Further research is needed to establish effective treatment strategies for rare malignancies like small intestine signet-ring cell carcinoma. Early diagnosis and appropriate treatment are crucial for improved patient outcomes.

Abstract

Metastasis to the testes is a rare occurrence, and identifying the primary site of origin can pose a significant challenge. Signet-ring cell carcinoma (SRCC) is an uncommon subtype of adenocarcinoma typically found in the stomach but can also occur in other organs. This case report presents a 44-year-old male with signet-ring cell adenocarcinoma metastasis in the right testis. The patient's initial clinical manifestation was testicular painful swelling, and subsequent immunohistochemical analysis using CK7, CK20, and CDX2 markers suggested a gastrointestinal origin. Normal upper and lower endoscopies rise suspicion of a small intestinal origin. The rarity of SRCC of the small intestine and the lack of clinical trials make treatment decisions difficult. This case highlights the importance of immunohistochemistry in determining the primary site of metastatic tumors and underscores the need for further research to establish optimal treatment strategies for rare malignancies like SRCC of the small intestine. As early diagnosis and appropriate treatment are critical for better patient outcomes.

Case Report: Giant paratesticular liposarcoma was resected and refused radical orchiectomy

Paratesticular liposarcoma (PLS) causes scrotal mass changes, rarely in the urinary system. Before surgery, PLS causes scrotal mass changes that are difficult to distinguish from other causes. There has been a report of a giant paratestis liposarcoma resection and refusal to undergo orchiectomy. A 65-year-old man presented with finding the left scrotal mass after 2 years. Physical examination showed that the left scrotal mass was obviously difficult to retract. Pelvic CT showed that the left scrotal mass and flaky fat density shadow accompanied with left inguinal hernia. During surgery, laparoscopic exploration was performed to rule out inguinal hernia, and a scrotal exploration was also performed concurrently. The intraoperative frozen pathology considered lipogenic tumor, and the patient's wife refused to undergo simultaneous left radical orchiectomy. Later the mass was completely removed, and postoperative pathology confirmed paratestis liposarcoma. During a 15-month routine follow-up, the tumor did not recur locally or metastasize distantly. PLS should be focused on early diagnosis and treatment, preoperative examinations and postoperative pathology should be combined, and highly personalized treatment will be implemented.

Management of epididymal leiomyosarcoma: literature narrative, case report and discussion on the use of simple epididymectomy or high radical orchiectomy

Epididymal leiomyosarcomas are rare malignant tumors of smooth muscle origin. We present a case of a low-grade tumor with negative margins managed with a high-radical inguinal orchiectomy. Our review of the literature suggests that low-grade and localized tumors with negative margins can be managed with simple epididymectomy and imaging surveillance.

Radical and testis-sparing surgery for primary testicular tumors: A single-center experience

The aim of the present study was to assess the oncological and functional outcomes of testis-sparing surgery (TSS) for testicular tumors compared with radical orchiectomy (RO) in a single center. A retrospective comparative cohort study was conducted in Changzheng Hospital. Patients were identified using the hospital information system from January 1999 to December 2016, collecting all of the data regarding clinical, treatment and prognostic profiles. Patient follow-up was also executed to obtain information on patients' survival status, serum markers profiles, disease progression, androgen substitution requirement and paternity status. In total 158 patients were enrolled into the cohort study, including 23 TSS cases. The TSS procedure was primarily conducted in younger patients (average age, 31.9 vs. 47.7 years) or those with smaller tumors (average tumor diameter, 26.0 vs. 51.5 mm). The overall survival and recurrence free survival revealed no differences in the two groups, suggesting similar oncological outcomes. Kaplan-Maier analysis demonstrated a higher cumulative paternity rate in the TSS group than in RO group, indicating a possible advantage of preserving patients' fertility in TSS over RO. TSS with proper adjuvant therapies proved to be a promising alternative in the avoidance of emasculation, infertility, life-long androgen substitution and other psychosexual difficulties, as the oncological outcomes were not inferior to RO in the selected cases. However, further investigation is required in order to assess its oncological and functional values.

Paratesticular rhabdomyosarcoma mimicking complicated epididymal cyst

Paratesticular rhabdomyosarcoma (RMS) is a rare nongerm cell intrascrotal malignant tumor in children and young adult/teens resulting from the mesenchymal tissues of the tunica vaginalis, epididymis, spermatic cord, and testis. RMS accounts for approximately 7% of all genitourinary tract RMSs and 12% of all pediatric scrotal neoplasms. Patients usually present with a painless unilateral scrotal mass. We report a 16-year-old boy with a paratesticular RMS mimicking epididymal cyst. To our knowledge, this is the first case reported in the literature presenting as an epididymal cyst.

Cutaneous and systematic metastasis of testicular choriocarcinoma: Case report and literature review

RATIONALE

Cutaneous metastasis of testicular choriocarcinoma is exceptionally uncommon. To our knowledge, only 14 cases have been reported in the past 10 years in the pubmed. We have an uncommon case of testicular choriocarcinoma who has metastasized to the adjacent skin and organ systems.

PATIENT CONCERNS

An 18-year-old male was diagnosed with initial presentation of cutaneous mass at the left back. Followly,biopsy was performed under local anesthesia.Histopathological examination was consistent with the diagnosis of metastatic choriocarcinoma.

DIAGNOSES

The histopathological assessment of the biopsied tissue, in combination with elevated serum β-HCG levels and presentation of testicular mass, indicated primary testicular choriocarcinoma with cutaneous and systemic metastasis.

INTERVENTIONS

Subsequently radical orchiectomy was performed.

OUTCOMES

Despite the case completed one cycle of cisplatin-based regimen chemotherapy, he died of multiple organ dysfunction syndrome 2 months after surgery.

LESSONS

In this report, cutaneous metastasis with testicular choriocarcinoma is extremely rare. It is important to recognize that this unusual variant of testicular choriocarcinoma has the potential to behave aggressively and to metastasize.

Malignant mesothelioma of the tunica vaginalis testis: A case report and literature review

Malignant mesothelioma of the tunica vaginalis testis is an extremely rare tumor without specific clinical manifestations, mainly including hydrocele formation and a painless mass. We herein present the case of a patient with hydrocele of the left testis, without any other complaints. Tunica vaginalis subinvolution was performed, and postoperative pathological examination revealed a malignant mesothelioma arising from the left tunica vaginalis testis. Whole-body positron emission tomography-computed tomography (PET-CT) and subsequent abdominal and pelvic magnetic resonance imaging (MRI) revealed no evidence of local lymphadenopathy. Radical left orchiectomy was performed after the pathological diagnosis. The pathological examination after the second surgery demonstrated that the tumor had invaded the adjacent periorchium and spermatic cord, but there was no evidence of local lymph node metastasis. Pemetrexed and cisplatin were administered at a dose of 900 and 130 mg, respectively, on the first day of a 28-day cycle. After 6 months of therapy, the disease had not progressed on abdominal and pelvic PET-CT and MRI. The patient was still followed up in our urology outpatient clinic at the time of the present report. Although testicular hydrocele is a common and easily diagnosed condition, detailed medical history and physical examination are required. Thus, when clinicians encounter patients with testicular hydrocele, a variety of possible causes must be considered, including testicular or paratesticular tumors, even rare tumors such as mesothelioma of the tunica vaginalis testis.

Hydrocele with a surprise: Malignant mesothelioma of the tunica vaginalis - Case report and review of literature

Hydrocele is a very common condition that is simple to evaluate and treat. Management of hydrocele is usually delegated to the junior members of the surgical team. Sometimes this simple condition can spring huge surprises. A 20-year-old man presented with acute onset large, painless fluctuant left hemi-scrotal swelling. Scrotal ultrasonography showed thickened tunica vaginalis. A diagnosis of left hydrocele was made and repair by excision of sac was planned. During the procedure, the sac was found studded with red nodular growths; histopathology reported malignant mesothelioma of tunica vaginalis. Metastatic evaluation showed extensive retroperitoneal lymph nodal involvement. Despite receiving adjuvant chemotherapy with radiotherapy patient died due to extensive metastasis within 16 months. This case is presented for rarity of diagnosis, young age of presentation, absence of etiological factor and rapidly progressive clinical course.