[Polyorchidism]. / Poliorquidismo.

OBJECTIVE: To report one case of supernumerary testicle, a rare entity with around 100 cases published. METHODS: 44-year-old male patient consulting for incidental discovering of a right scrotal mass. The diagnosis of polyorchidism was suspected after physical examination, ultrasound, and CT scan, and confirmed subsequently on surgical exploration and biopsy. Due to the absence of pathology and complete normal seminal lines decision was taken to not perform orchiectomy of the supernumerary testicle. RESULTS: There are classifications for proper evaluation of polyorchidism, which state the relation between site of the testicle in relation to scrotum, existence or absence of independent epididymis and vasa deferentia for both testicles. CONCLUSIONS: Although remotely, there is a possibility of malignant degeneration of these testicles, so that surgical exploration and excision of the supernumerary testicles when their biopsy is doubtful in terms of dysplasia or if they present carcinoma in situ or they are a source of pain.

Pliorquidismo / Polyorchidism

OBJETIVO: Presentamos un caso de teste supernumerario, rara entidad, de la que hay recogidos y fundamentados unos 100 casos.MÉTODOS: Se trata de un varón de 44 años, que consultó por descubrimiento casual de masa escrotal derecha. A la exploración física, ecográfica y tomográfica ya se sospechó el diagnóstico de poliorquidia, refrendándose posteriormente mediante exploración quirúrgica y biopsia. Dada la ausencia de patología y la completa normalidad de la línea seminal se optó por no actuar, no extirpando el teste supernumerario.RESULTADOS: Existen clasificaciones para una correcta evaluación de la poliorquidia, que relacionan la localización respecto a escroto, y la existencia o no de epidídimo y deferentes independientes para las dos gónadas.CONCLUSIONES: Aunque remota, existe la posibilidad de degeneración maligna en estos testes, por lo que se impone la exploración quirúrgica y la extirpación de los testes supernumerarios cuando la biopsia arroje dudas, en cuanto a displasia o presencia de carcinoma in situ, o cuando sean origen de dolor(AU)

OBJECTIVE: To report one case of supernumerary testicle, a rare entity with around 100 cases published.METHODS: 44-year-old male patient consulting for incidental discovering of a right scrotal mass. The diagnosis of polyorchidism was suspected after physical examination, ultrasound, and CT scan, and confirmed subsequently on surgical exploration and biopsy.Due to the absence of pathology and complete normal seminal lines decision was taken to not perform orchiectomy of the supernumerary testicle.RESULTS: There are classifications for proper evaluation of polyorchidism, which state the relation between site of the testicle in relation to scrotum, existence or absence of independent epididymis and vasa deferentia for both testicles.CONCLUSIONS: Although remotely, there is a possibility of malignant degeneration of these testicles, so that surgical exploration and excision of the supernumerary testicles when their biopsy is doubtful in terms of dysplasia or if they present carcinoma in situ or they are a source of pain(AU)

[Neurological metastases secondary to germ cell testicular tumor]. / Metástasis neurológicas secundarias a tumor testicular germinal.

OBJECTIVE: Neurological metastases secondary to urological tumors account for 12% overall. The ones derived from germ cells testicular tumors are exceptional in the age of cisplatin. METHODS: We report one case of mixed germ cell tumor in a 49-year-old male patient treated with systemic chemotherapy during 18 months before presenting with severe central and peripheral neurological symptoms leading to death due to massive cerebral hemorrhage. RESULTS: We describe three types of presentation of cerebral metastases in patients with testicular cancer. Type I present synchronically with the primary tumor. Type 2 are diagnosed after a period of remission after conventional cytostatic treatment. Type 3 metastases are diagnosed during the course of the disease and its treatment. CONCLUSIONS: Except unique metastases classified in groups 1 and 2, which are susceptible of surgery or radiosurgery, in which in response may be expected; the rest of lesions secondary to germ cell tumors have an ominous prognosis and outcomes, with short survivals.

[Adenomatoid tumor of the epididymis. Report of five cases]. / Tumor adenomatoide epididimario. Aportación de 5 casos.

OBJECTIVE: Adenomatoid tumor of the epididymis is unfrequent, benign, with no malignant outcomes described. METHODS: We report five cases, with patient's ages varying from 31 to 76 years, and tumor sizes from 6 to 30 mm. All patients underwent surgery with excision of the mass, some of them after several months of growing. In one of the cases the evolution reached six years. RESULTS: None of the cases presented recurrence or bad outcome after surgery. Pathology confirmed the benign adenomatoid character in all cases. CONCLUSIONS: Despite the clinical, ultrasound and physical examination findings suggest the localization in the epididymis and its benign character, surgical exploration is mandatory with surgical excision of the paratesticular mass.

[Sertoli cell malignant tumor]. / Tumor de células de Sertoli maligno.

OBJECTIVE: We report a new case of Sertoli cell testicular tumor with malignant characteristics. METHODS: 77 year-old male patient, suffering a general wasting syndrome presenting with a left solid testicular mass with the diagnosis of malignant Sertoli cell tumor after orchyectomy, without local, regional or distant dissemination, and a benign outcome after 18 months of follow-up. RESULTS: Sertoli cell tumor or androblastoma is classified as non-germ cell tumor derived from the stroma of the sexual cords. There are three types depending on its cellular composition: calcified big cell, sclerotic cell, and the most frequent of all, the classic type. CONCLUSIONS: Being the Sertoli cell testicular tumor rare, its malignant type is even rarer, accounting for not more than 10% of all. Despite the pathological characteristics related to malignancy, its posterior behaviour is unpredictable and not much known, the some than follow-up and treatment, because it is not sensible to cytostatic drugs. The existence of metastases continues to be the only valid parameter with prognostic value.

Metástasis neurológicas secundarias a tumor testicular germinal / Neurological metastases secondary to germ cell testicular tumor

Objetivo: Las metástasis neurológicas secundarias a tumores urológicos suponen un 12% del total. Las derivadas de los tumores germinales testiculares en la época del cisplatino son excepcionales. Métodos: Presentamos un caso de tumor germinal mixto en un varón de 49 años tratado mediante quimioterapia sistémica desde 18 meses antes que presentó severa clínica neurológica central y periférica, que le condujo a la muerte por hemorragia cerebral masiva. Resultados: Se describen 3 tipos de presentación de las metástasis cerebrales en pacientes con cáncer testicular. El tipo 1 en el que se presentan sincrónicamente al tumor primario. El tipo 2 en el que se diagnostican tras un período de remisión luego del tratamiento citostático convencional. En el tipo 3 las metástasis se diagnostican durante el curso de la enfermedad y durante su tratamiento. Conclusiones: Salvo en caso de metástasis únicas encuadradas en el grupo 1 y 2 susceptibles de cirugía o radiocirugía, en el que cabe esperar respuesta, en el resto de lesiones secundarias a tumores germinales la evolución y el pronóstico son ominosos, con supervivencias escasas (AU)

Objective: Neurological metastases secondary to urological tumors account for 12% overall. The ones derived from germ cells testicular tumors are exceptional in the age of cisplatin. Methods: We report one case of mixed germ cell tumor in a 49-year-old male patient treated with systemic chemotherapy during 18 months before presenting with severe central and peripheral neurological symptoms leading to death due to massive cerebral hemorrhage. Results: We describe three types of presentation of cerebral metastases in patients with testicular cancer. Type 1 present synchronically with the primary tumor. Type 2 are diagnosed after a period of remission after conventional cytostatic treatment. Type 3 metastases are diagnosed during the course of the disease and its treatment. Conclusions: Except unique metastases classified in groups I and 2, which are susceptible of surgery or radiosurgery, in which in response may be expected; the rest of lesions secondary to germ cell tumors have an ominous prognosis and outcomes, with short survivals (AU)

Tumor adenomatoide epididimario. Aportación de 5 casos / Adenomatoid tumor of the epididimys. Report of five cases

Objetivo: El tumor adenomatoide de epidídimo es infrecuente, de carácter benigno, no habiéndose descrito evoluciones malignas. Método: Presentamos 5 casos, con edades variopintas entre los 31 y los 76 años, y también con tamaños diversos entre los 6 y los 30 mm. Todos fueron intervenidos realizándose exéresis de la masa, tras varios meses de crecimiento. En un caso la evolución era de 6 años. Resultado: Ninguno presentó ni recidiva ni evolución tórpida tras la cirugía. La histología confirmó el carácter adenomatoide benigno en todos ellos. Conclusiones: A pesar de que los hallazgos clínicos, ecográficos y exploratorios sugieren la localización epididimaria y la benignidad, es mandatoria la exploración y extirpación quirúrgica de toda masa sólida paratesticular (AU)

Objective: Adenomatoid tumor of the epididymis is unfrequent, benign, with no malignant outcomes described. Methods: We report five cases, with patient's ages varying from 31 to 76 years, and tumor sizes from 6 to 30 mm. All patients underwent surgery with excision of the mass, some of them after several months of growing. In one of the cases the evolution reached six years. Results: None of the cases presented recurrence or bad outcome after surgery. Pathology confirmed the benign adenomatoid character in all cases. Conclusions: Despite the clinical, ultrasound and physical examination findings suggest the localization in the epididymis and its benign character, surgical exploration is mandatory with surgical excision of the paratesticular mass (AU)

Tumor de células de Sertoli maligno / Sertoli cell malignant tumor

Objetivo: Aportamos a la literatura un nuevo caso de tumor testicular compuesto por células de Sertoli de características histológicas malignas. Métodos: Se trata de un varón de 77 años, afecto de un síndrome general constitucional y una masa sólida testicular izquierda en la que tras la orquiectomía se diagnostica de tumor de células de Sertoli maligno, sin diseminación locorregional ni a distancia, con una benigna evolución tras 18 meses de seguimiento. Resultados: El tumor de células de Sertoli o androblastoma se encuadra en la clasificación de tumores no germinales derivados del estroma de los cordones sexuales. Se reconocen 3 tipos dependiendo de su composición celular: de célula grande calcificada, de célula esclerosada, y la más frecuente de todas, la variante clásica. Conclusiones: Siendo el tumor de células de Sertoli un tumor testicular poco común, la forma maligna lo es menos aún, no más del 10% del total. A pesar de las características patológicas que se relacionan con la malignidad, su comportamiento posterior es imprevisible y poco conocido, al igual que la forma de seguimiento y tratamiento, pues no es sensible a citostáticos. La presencia de metástasis sigue siendo hoy en día el único parámetro válido como valor pronóstico (AU)

Objective: We report a new case of Sertoli cell testicular tumor with malignant characteristics. Methods: 77-year-old male patient, suffering a general wasting syndrome presenting with a left solid testicular mass with the diagnosis of malignant Sertoli cell tumor after orchyectomy, without local, regional or distant dissemination, and a benign outcome after 18 months of follow-up. Results: Sertoli cell tumor or androblastoma is classified as non-germ cell tumor derived from the stroma of the sexual cords. There are three types depending on its cellular composition: calcified big cell, sclerotic cell, and the most frequent of all, the classic type. Conclusions: Being the Sertoli cell testicular tumor rare, its malignant type is even rarer, accounting for not more than 10% of all. Despite the pathological characteristics related to malignancy, its posterior behaviour is unpredictable and not much known, the same than follow-up and treatment, because it is not sensible to cytostatic drugs. The existence of metastases continues to be the only valid parameter with prognostic value (AU)

[Epithelioid renal angiomyolipoma]. / Angiomiolipoma epitelioide renal.

OBJECTIVE: To issue the existence of a variety of angiomyolipoma, named epithelioid, with different histological and clinic properties. METHODS: We report the case of a 17 year old female, with Bourneville's disease, who was discovered to have a solid renal mass suggestive of carcinoma in a control CT scan, adjacent to other smaller masses identified as angiomyolipomas. RESULTS: After several tumorectomies, the suspicious mass, 4 cm in size, was diagnosed as epithelioid angiomyolipoma, with immunohistochemical confirmation of capacity for HMB45, and negative vimentin and keratin. CONCLUSIONS: Despite the possibility of coexistence of adenocarcinoma and angiomyolipoma, the existence of an epithelioid variety cannot be discarded, mainly in patients with phakomatosis. The indications for surgery are the same than for the rest of renal masses. Nevertheless, follow-up criteria must be stricter due to the possibility of torpid outcome in terms of dissemination of this infrequent variety of angiomyolipoma.