Metástasis testicular de cáncer renal de células claras: reporte de un caso y revisión de literatura / Testicular Metastasis of clear cell renal cancer: report of a case and review of literature

INTRODUCCIÓN: El carcinoma renal es la tercera neoplasia dentro de los tumores genitourinarios, correspondiendo a un 3 por ciento del total de tumores malignos primarios del adulto a nivel mundial. En Chile tiene una mortalidad de 2-3/100.000 habitantes, presentando un 30 por ciento metástasis al momento del diagnóstico, siendo las metástasis testiculares infrecuentes. CASO CLÍNICO: Hombre de 73 años, con antecedente de varicocele izquierdo sintomático sometido a nefrectomía radical laparoscópica izquierda en Mayo 2011 por tumor renal. Biopsia informa carcinoma de células claras tipo clásico, que invade cápsula renal y teiido adiposo perirrenal con área de carcinoma sarcomatoide. Etapificación: Pt2B NX. En Diciembre 2011 presenta aumento de volumen nodular, pétreo e indoloro en testículo izquierdo. Ecografía y ecodoppler evidencian lesión focal hipoecogénica, sólida. Marcadores tumorales negativos. Tras orquiectomía radical izquierda, biopsia indica metástasis de carcinoma de células claras renal. Tomografía computarizada de tórax abdomen y pelvis informa múltiples nódulos pulmonares de aspecto metastásico, clasificándosele en etapa IV, actualmente con cuidados paliativos DISCUSIÓN: Los metástasis testiculares son infrecuentes encontrándose como hallazgos en autopsias u orquiectomías, presentes simultáneamente con el tumor primario renal o precediendo a su diagnóstico. La mayoría son ipsilaterales izquierdas, asociadas a varicocele, y su baja incidencia podría deberse a su temperatura y localización anatómica distal. CONCLUSIÓN: El caso expuesto ilustra la infrecuente presentación de una metástasis de cáncer renal como masa testicular la cual debiese ser considerada frente a una masa sin antecedente de otro cáncer primario o con marcadores germinales negativos, aunque no ha sido descrita previamente en nuestro medio.

INTRODUCTION: Renal cell carcinoma is the third neoplasia in genitourinary tumors, corresponding to 3 percent of adult primary malignant tumors worldwide. In Chile it has a 2-3/100.000 mortality, 30 percent showing metastasis at diagnosis, testicular metastases being rare. CASE REPORT: 73 year old man with a history of symptomatic varicocele who underwent a left radical nephrectomy for renal tumor in May 2011. Biopsy reports clear cell carcinoma classic type that invades renal capsule and perirenal adipose teiido with sarcomatoid carcinoma area. Staging: Pt2B NX. In December 2011 he presents a painless nodular tumor in the left testicle. Doppler ultrasonography evidences a hypoechoic solid focal lesion. Tumor Markers are negative. After left radical orchiectomy, biopsy shows metastasis of renal clear cell carcinoma. Computed tomography of the chest, abdomen and pelvis reported multiple pulmonary metastatic nodules. He was classified as stage IV and currently recieves palliative care DISCUSSION: testicular metastases are an uncommon finding usually in autopsies or orchiectomy samples, present simultaneously or preceding the primary renal tumor. Most are ipsilateral left and are associated with varicocele. Its low incidence may be due to its anatomical distal location or temperature. CONCLUSION: This case illustrates an uncommon presentation of a metastatic renal cancer. It ought to be considered against a testicular mass with no history of another primary cancer or negative germ cell tumor markers, This uncommon finding has not been previously described in our media.

During twenty years of Cisplatin-based therapy the face of nonseminomatous testicular germ cell tumors is still changing: an evaluation of presentation, management, predictive factors and survival

Purpose: To assess the changing presentation and treatment of nonseminomatous testicular germ cell tumors (NSGCT) and to investigate predictive factors for the status of metastasis at diagnosis and on relapse and death. Materials and Methods: Retrospective record review of 147 patients that underwent inguinal orchiectomy from 1987-2007. Follow-up data was available for 102 patients (median follow-up: 80 months (0-243); 96 patients alive). Results: Mean patients age increased (p = 0.015) and more patients were diagnosed in clinical stage I (CSI) (p = 0.040). The fraction of yolk sac (YS) elements inclined (p = 0.030) and pT2 tumors increased (p < 0.001). Retroperitoneal lymph node dissection (RPLND) declined whereas more patients were treated with chemotherapy (p < 0.001; p = 0.004). There was an increase in relapse free (RFS) and cancer specific survival (CSS) due to an improvement in patients with disseminated disease (p = 0.014; p < 0.001). The presence of YS and teratoma elements showed a reduction in the odds ratio (OR) for metastasis at diagnosis (p = 0.002, OR: 0.262; p = 0.009, OR: 0.428) whereas higher pT-stage was associated to their presence (p = 0.039). Patients with disseminated disease (CS > I) showed a declined CSS compared to CSI patients (p = 0.055). The presence of YS elements was associated to an improved RFS (p = 0.038). Conclusions: In our single institution study the face of NSGCT markedly changed over 20 years even after the introduction of Cisplatin-based chemotherapy. These changes were accompanied by an improvement in RFS and CSS. When dealing with NSGCT patients such observations now and in the future should be taken into account. .

retrospective study of testicular relapse in acute lymphoblastic leukemia

Testicular relapse in ALL usually appear as painless testicular enlargement mostly unilateral. Diagnosed by wedge biopsy. The testis is a frequent site of relapse. To find out the incidence of testicular relapse in ALL, time of diagnosis of testicular relapse, age group more commonly associated with testicular relapse, the association of testicular relapse with other relapses [medullary or extra-medullary], and prognosis of patients with testicular relapse. Aretrospective study in the central teaching hospital of children in Baghdad- unit of hematology and oncology, during January 2000 - December 2006. Two hundred-four males were studied retrospectively. Informations were obtained from patients' files. The incidence of testicular relapse was in 18 patients represented [8.8%] of total cases of boys with ALL below 15 years. Relapse is mainly unilateral in 15 patients [83.3%] and mostly in the right side in 11 patients [61.1%] of total cases with testicular relapse. There is no significant statistical incidence of relapse with the age of patient represented by 2 cases [6.2%] from [0-2 years], 11 cases [8.2%] from [2-10 years], and 5 cases [13%] more than [10 years]. Time of diagnosis of relapse was mainly during the oral maintenance therapy [13] patients [72.5%]. Testicular relapse was isolated in 8 patients [44%] and combined with other relapses in 10 patients [56%] of them 7 patients [39%] with bone marrow relapse and 3 patients [17%] with CNS relapse. The outcome of patients with testicular relapse was better after discontinuation of chemotherapy "after three years of treatment" [2 cases diagnosed with relapse both of them still alive] represented [100%], while during the maintenance therapy of 13 patients, 6 [46.2%] of them still alive, 6 patients [46.2%] of them died, and 1 patient [7.6%] with no report, while induction chemotherapy 2 cases 1 [50%] alive and 1 [50%] died]. Patients with isolated testicular relapse had better outcome represented by 6 patients [75%] still alive and 2 patients [25%] died, patients with combined relapse had worse outcome, represented by 3 patients [30%] alive, 5 patients [50%] died, and 2 patients [20%] with no report. Incidence of testicular relapse significantly decreased after the introduction of more intensive chemotherapy in Jan 2004 from 9.8% to 3.1%. Incidence of testicular relapse decrease with introduction of intensive chemotherapy and had higher incidence during the maintenance therapy, associated with increased incidence with other medullary and extra-medullary relapses, and has better prognosis when it is late and isolated than for early and combined relapse

Urothelial carcinoma of the bladder with asynchronous metastases to both testes

Urothelial carcinoma [UC] or transitional cell carcinoma [TCC] of the bladder has a high likelihood of metastasis, and the more common sites of distant metastasis are bone, liver and lung. Metastasis to the testis is extremely rare. We identified five cases of bladder UC metastasing to the testis in the literature, none of which occurred bilaterally. We present this case of asynchronous UC metastases to both testes as the first report in the literature. Metastatic disease should be considered as a potential differential diagnosis for testicular tumors arising in patients with a history of UC.

Cutaneous metastasis of testicular choriocarcinoma, diagnosed by fine-needle aspiration cytology: A rare case report and review of the literature.

Skin metastasis of testicular choriocarcinoma is very rare. Until now about nine cases have been reported in the English literature; however, only one of them has been diagnosed by fine-needle aspiration (FNA) cytology. Herein, we report our experience with FNA cytology diagnosis of a metastatic testicular choriocarcinoma to the skin of chin. The combination of highly atypical mononuclear cells (cytotrophoblasts) and multinucleated malignant cells (syncytiotrophoblasts) are characteristic of metastatic tumor in a known case of choriocarcinoma of testis.

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.

Single testicular metastasis mimicking primary testicular neoplasm: a rare manifestation of prostate cancer

The incidence of secondary testicular tumors ranges from 0.02 to 2.5 percent among autopsies in general. With the exception of leukemias and lymphomas, prostate cancer is the most common primary site. It is diagnosed in autopsies or incidentally, following therapeutic orchiectomies in more advanced stages of the disease. In the present report, we show a case of testicular metastasis derived from prostate neoplasm whose clinical presentation as a single metastasis was similar to a primary testicular neoplasm. The diagnosis was evidenced after orchiectomy by histological examination and immunohistochemical tests.

Bilateral epididymal metastases from primary adenocarcinoma of the prostate

A 65-year-old man diagnosed with adenocarcinoma of the prostate gland opted for hormonal manipulation and had bilateral orchiectomy. Histological evaluation showed tumour deposits in both epididymides. Despite the relatively common occurrence of adenocarcinoma of the prostate, epididymal metastasis is a rare occurrence. This case highlights the need for proper evaluation of the testes and para-testicular structures so that accurate staging of these tumours can be made

Metástasis secundarias en testículos / Secondary metastasis in testis

La presente publicación tiene la finalidad de presentar dos (2) nuevos casos de Metástasis Testicular del Carcinoma de la Próstata, dado su baja frecuencia, repasar bibliografía y recordar sus posibles vías de Metástasis. Según PUIGUERT la pulpa testicular extirpada se remite al laboratorio para su examen histológico, de acuerdo al estado de las células germinales y las células intersticiales de LEYDIG se podría decidir el tratamiento estrogénico complementario. Pero la Anatomía Patológica de los Testículos, también sirve como en estos dos casos para la detección de Metástasis de un Carcinoma Prostático y cambiar el M como ocurrió con nuestro primer paciente

Metástasis poco frecuente en el carcinoma de la próstata / Infrequent metastasis in carcinoma of the prostatic

La presente publicación tiene la finalidad de presentar dos (2) nuevos casos de metástasis testicular del carcinoma de la próstata, dada su baja frecuencia, repasar a bibliografía y recordar sus posibles vías de metástasis. Según Puigvert la pulpa testicular extirpada se remite al laboratorio para su examen histológico; de acuerdo con el estado de las células germinales y las células intersticiales de Leydig, se podría decidir el tratamiento estrogénico complementario. Pero la anatomía patológica de los testículos también sirve, como en estos dos casos, para la detección de metástasis de un carcinoma prostático y cambiar el M. como ocurrió con nuestro primer paciente