ADENOCARCINOMA
DONALD MICHEAL
J. MEHAN,
OF RETE TESTIS
M.D.
J. CHEHVAL,
M.D.
From the Departments of Urology, St. Mary’s Health Center and St. Louis University, St. Louis, Missouri
ABSTRACT - Adenocarcinoma of the rete testis is a very rare malignant neoplasm originating in the epithelium of the rete testis. Histologically, it appears as a papillary adenocarcinoma. The first case was reported in the literature in 1853 and since that time only 16 additional cases have been reported. This report represents the eighteenth case.
Comment
Case Report The patient is a thirty-five-year-old male Caucasian who was admitted to the hospital for evaluation of a right scrotal mass. He had undergone a hydrocelectomy in Yugoslavia five years previously, and since that time had had an enlarged indurated right testicle. During the two to three months prior to admission the testis had increased in size slightly. Physical examination revealed an enlarged right testis measuring 6 by 5 by 3 cm. There was definite induration along the epididymis and lower pole of the testicle without tenderness nor fluctuance. Laboratory evaluation, including complete blood cell count, urine analysis, SMA, chest x-ray film, and intravenous pyelogram were all normal. Inguinal exploration of the testis was performed after clamping of the pedicle of the testicle. The tunica albuginea testis was involved in a multicystic chronic inflammatory process with a granular reaction of the lower pole. An inguinal orchiectomy was performed. Examination of the lower pole area of the testicle revealed characteristic histopathologic changes of adenocarcinoma of the rete testis. The cord was not invaded by tumor (Figs. 1 to 3). After having established the diagnosis, a pedal lymphangiogram was done and was normal. The patient was given 4,860 rads of megavoltage therapy to the right hemipelvis and para-aortic node areas. He is alive and doing well without evidence of tumor six months after diagnosis.
UROLOGY
/ APRIL 1977 / VOLUME
IX, NUMBER
4
Feek and Hunter in 1945l first outlined the criteria for histology and diagnosis of adenocarcinoma of the rete testis: (1) maximal involvement of the mediastinum testis but minimal involvement of the corpus; (2) evidence of outward extension from the mediastinum testis with compression of the normal tubules; and (3) growth outside of the testis into the sac of tunica vaginalis but not outside the parietal layer of the tunica. Teilum2 described the characteristic histologic features of the tumor as multicystic papillary adenocarcinoma, the papillary processes involving a vascular core with tendency toward acinar formation.
FIGURE 1. Papillary adenocarcinonza of rete testes. Many rete passages are partially filled with papillary tumor growth.
FIGURE 2. Papillary adenocarcinomu of rete testes. There is partial occlusion of rete passages with papillary tumor; in addition there is tumor invasion of connective tissue stroma.
orchiectomy unless a previous testicular biopsy or orchidopexy had been performed.’ In 2 cases tumor had developed in undescended testis. The tumors have often responded well to radiation.3-5 Radiation has therefore been recommended to the inguinal, iliac, and paraaortic lymph nodes in tumors confined to the testicle with no evidence of metastasis (Stage A). In tumors of the testicle with only intraabdominal metastasis (Stage B) radiation to the mediastinum and supraclavicular nodes has been added, and in lesions with widespread metastasis (Stage C) chemotherapy should also be considered, although the prognosis has been poor in these cases.5 1035 Bellevue Avenue St. Louis, Missouri 63117 (DR. MEHAN) ACKNOWLEDGMENT. To Dr. E. B. Price, pathologist, who has had occasion to review all cases on file at the Armed Institute of Pathology, and who reviewed our case
and confirmed the diagnosis.
References
1. FEEK, J. D., and HUNTER, W. C. :
Papillary carcinoma arising from rete testis, Arch. Pathol. 40: 399
(1945). 2. TEILUM, G.:
FIGURE 3. carcinoma
Reveals
papillary
nature
of adeno-
Review of reported cases revealed that the tumors are highly malignant, and the degree of malignancy is shown by the fact that metastasis developed in 11 of the cases in less than a year. ‘-’ Local recurrence has been rare after
460
Special Tumors of Ovary and Testis and Related Extragonadal Lesions: Comparative Pathology and Histological Identification, Philadelphia, J. B. Lippincott Co., 1971, p. 407. 3. SCHOEN, S. S., and RUSH, B. F.: Adenocarcinoma of the rete testis, J. Urol. 82: 356 (1959). 4. DESBURG, D., and TANNO,V. : Adenocarcinoma of the rete testis, ibid. 91: 87 (1964). 5. WHITEHEAD, D. E., VELENSI, Q. J., and BROWN, J. S.: Adenocarcinoma of the rete testis, ibid. 107:
992 (1972). 6. TURNER, R. W., and WILLIAMSON, J.: Adenocarcinoma of the rete testis, ibid. 109: 850 (1973). 7. SCHAPIRA, H. E., and ENGEL, M.: Adenocarcinoma of the rete testis, N.Y. State J. Med. 72: 1283 (1972).
UROLOGY /
APRIL 1977 / VOLUME IX, NUMBER4
DONALD MICHEAL
J. MEHAN,
OF RETE TESTIS
M.D.
J. CHEHVAL,
M.D.
From the Departments of Urology, St. Mary’s Health Center and St. Louis University, St. Louis, Missouri
ABSTRACT - Adenocarcinoma of the rete testis is a very rare malignant neoplasm originating in the epithelium of the rete testis. Histologically, it appears as a papillary adenocarcinoma. The first case was reported in the literature in 1853 and since that time only 16 additional cases have been reported. This report represents the eighteenth case.
Comment
Case Report The patient is a thirty-five-year-old male Caucasian who was admitted to the hospital for evaluation of a right scrotal mass. He had undergone a hydrocelectomy in Yugoslavia five years previously, and since that time had had an enlarged indurated right testicle. During the two to three months prior to admission the testis had increased in size slightly. Physical examination revealed an enlarged right testis measuring 6 by 5 by 3 cm. There was definite induration along the epididymis and lower pole of the testicle without tenderness nor fluctuance. Laboratory evaluation, including complete blood cell count, urine analysis, SMA, chest x-ray film, and intravenous pyelogram were all normal. Inguinal exploration of the testis was performed after clamping of the pedicle of the testicle. The tunica albuginea testis was involved in a multicystic chronic inflammatory process with a granular reaction of the lower pole. An inguinal orchiectomy was performed. Examination of the lower pole area of the testicle revealed characteristic histopathologic changes of adenocarcinoma of the rete testis. The cord was not invaded by tumor (Figs. 1 to 3). After having established the diagnosis, a pedal lymphangiogram was done and was normal. The patient was given 4,860 rads of megavoltage therapy to the right hemipelvis and para-aortic node areas. He is alive and doing well without evidence of tumor six months after diagnosis.
UROLOGY
/ APRIL 1977 / VOLUME
IX, NUMBER
4
Feek and Hunter in 1945l first outlined the criteria for histology and diagnosis of adenocarcinoma of the rete testis: (1) maximal involvement of the mediastinum testis but minimal involvement of the corpus; (2) evidence of outward extension from the mediastinum testis with compression of the normal tubules; and (3) growth outside of the testis into the sac of tunica vaginalis but not outside the parietal layer of the tunica. Teilum2 described the characteristic histologic features of the tumor as multicystic papillary adenocarcinoma, the papillary processes involving a vascular core with tendency toward acinar formation.
FIGURE 1. Papillary adenocarcinonza of rete testes. Many rete passages are partially filled with papillary tumor growth.
FIGURE 2. Papillary adenocarcinomu of rete testes. There is partial occlusion of rete passages with papillary tumor; in addition there is tumor invasion of connective tissue stroma.
orchiectomy unless a previous testicular biopsy or orchidopexy had been performed.’ In 2 cases tumor had developed in undescended testis. The tumors have often responded well to radiation.3-5 Radiation has therefore been recommended to the inguinal, iliac, and paraaortic lymph nodes in tumors confined to the testicle with no evidence of metastasis (Stage A). In tumors of the testicle with only intraabdominal metastasis (Stage B) radiation to the mediastinum and supraclavicular nodes has been added, and in lesions with widespread metastasis (Stage C) chemotherapy should also be considered, although the prognosis has been poor in these cases.5 1035 Bellevue Avenue St. Louis, Missouri 63117 (DR. MEHAN) ACKNOWLEDGMENT. To Dr. E. B. Price, pathologist, who has had occasion to review all cases on file at the Armed Institute of Pathology, and who reviewed our case
and confirmed the diagnosis.
References
1. FEEK, J. D., and HUNTER, W. C. :
Papillary carcinoma arising from rete testis, Arch. Pathol. 40: 399
(1945). 2. TEILUM, G.:
FIGURE 3. carcinoma
Reveals
papillary
nature
of adeno-
Review of reported cases revealed that the tumors are highly malignant, and the degree of malignancy is shown by the fact that metastasis developed in 11 of the cases in less than a year. ‘-’ Local recurrence has been rare after
460
Special Tumors of Ovary and Testis and Related Extragonadal Lesions: Comparative Pathology and Histological Identification, Philadelphia, J. B. Lippincott Co., 1971, p. 407. 3. SCHOEN, S. S., and RUSH, B. F.: Adenocarcinoma of the rete testis, J. Urol. 82: 356 (1959). 4. DESBURG, D., and TANNO,V. : Adenocarcinoma of the rete testis, ibid. 91: 87 (1964). 5. WHITEHEAD, D. E., VELENSI, Q. J., and BROWN, J. S.: Adenocarcinoma of the rete testis, ibid. 107:
992 (1972). 6. TURNER, R. W., and WILLIAMSON, J.: Adenocarcinoma of the rete testis, ibid. 109: 850 (1973). 7. SCHAPIRA, H. E., and ENGEL, M.: Adenocarcinoma of the rete testis, N.Y. State J. Med. 72: 1283 (1972).
UROLOGY /
APRIL 1977 / VOLUME IX, NUMBER4
