Case Report Urol Int 1992:48:469-470
Divisione Urologia Ospedale Consorziale di Treviglio e Caravaggio, USSL BG 32, Treviglio, Italia
Key Words Testicular tumors Métastasés Secondary tumor
Secondary T umors of T estis: Two Rare Cases and Review of the Literature Abstract Secondary testicular tumor is a rare event. Approximately 200 cases have been documented in the international literature since 1935. The most common pri mary tumor sites have been the prostate, lung and kidney with other sites being reported less frequently. Our literature review discovered only 7 cases originating from primary tumors of the stomach and 14 cases from primary tumors of the colon. We want to add 2 more cases and discuss the possible mechanism of this neoplastic dissemination.
Introduction Metastatic tumors of the testis are extremely rare. In a review of 24,000 autopsies Pienkos and Jablowkow [18] found 15 cases of metastatic involvement of the testis. Reviewing the literature they discovered further 90 cases of secondary testicular tumors: 39 from the prostate, 14 from the lung, 9 from the kidney, 9 from the colon, 6 from the stomach, 2 from the pancreas, 2 from a retinoblasto ma, 1 from a carcinoid of the small bowel, 1 from the skin, 1 from the controlateral testis, 1 from the adrenal gland, 1 from the bladder, 1 from the bile ducts, 1 from the adrenal gland, 1 from the bladder, 1 from the bile ducts, 1 from a sympathicoblastoma, 1 from the appendix and 1 from an unknown carcinoma [ 12, 13, 15,21], In the last 15 years 5 more cases of primitive colonic tumors [1-6,8, 10, 11, 14, 16, 18-20] and only 1 from the stomach [ 17] have been reported.
Case Reports Case J A 73-year-old male with no neoplasm in his family anamnesis and no important illness in remote personal anamnesis was exam ined in July 1988 because of postprandial epigastric pain. Endoscop-
Received: February 26, 1991 Accepted: May 27, 1991
¡cal examination with biopsy revealed gastric carcinoma diffuse type (CID) of the stomach. The surgical treatment has been total gastrec tomy, partial pancreatectomy and splenectomy. Histopathological findings confirmed gastric CID with lymphatic dissemination to the locoregional nodes, splenic ileum nodes and peripancreatic tissues. No dissemination to the liver. Four months later a clinical examina tion revealed a left testicular mass involving the spermatic cord and epididymis. We performed an orchifuniculectomy. Histological find ings showed metastases of gastric CID along the vaginal tunic, albugi nea and spermatic cord. Case 2 The patient was a 65-ycar-old married man with 2 sons. There was no personal or family history of malignant disease. In 1984 he had undergone surgery for coronary' artery disease. He presented himself in 1985 to this institution with a carci noma of the cecum. A right hemicolectomy was performed with excision of two peritoneal metastases. Histology confirmed that the tumor was a mucus-secreting adenocarcinoma of the cecum invad ing the whole thickness of the bowel wall into the pericecal tissue. There was associated lymphadenopathy. Later the patient received irradiation therapy. After 4 months the patient returned with abdominal pain and diarrhea when a barium enema revealed subacute obstruction of the ileum, possibly caused by irradiation. An ileocolic bypass was per formed at a second operation and there was no evidence of meta static disease. The serum carcinoembryonic antigen was 8.1 ng/ml. The patient was well for 1 year until he noticed a mass on the right side of the scrotum. On physical examination several hard nodules, 0.5-1 cm in diameter, some attached to the epididymis, others to the
Dr. Franco Blcfari c/o Divisionc Urologia Ospcdalc Consortiale 1-24047 Treviglio (Italy)
© 1992 S. Karger AG, Basel 0042-1138/92/0484-0469 $2.75/0
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F. Blefari O. Risi P. Pino
spermatic cord, were found. At this time the serum carcinoembryonic antigen was 15 ng/ml, lactate dehydrogenase 358 IU. Liver sonography did not demonstrate any métastasés. Sonography of the scrotum, however, confirmed the clinical impression that there were several nodular masses spread along the spermatic cord in the tunica vaginalis and attached to the tunica albuginea. An orchidectomy was performed. Exploratory laparotomy re vealed multiple malignant deposits in the peritoneum. Histology of the excised testis and cord confirmed the presence of some secondary deposits of the mucus-secreting carcinoma pre viously identified in the cecum involving the spermatic cord, epidid ymis, tunicae albuginea and vaginalis.
Conclusions Secondary deposits of malignant tumors in the testis arc a rare event. The occurrence in the series of Picnkos and Jablowkow [18] was 0.06%. In 1967, Price and Mostofi [19] reported that in a series of 1,600 testicular tumors, only 38 (2.3 %) were found to be secondary depos its. In accordance with Smallman and Odedra [20] we believe that the most important reason for the rarity of
testicular metastasis is the relatively low temperature of the scrotum. That could be an unacceptable condition for the establishment of metastatic tumor cells. The most frequent primary sites of testicular second ary tumors are the lungs (19%) and prostate (35%). The relatively high occurence rate of prostatic cancer to metas tasize to the testis is, probably, due to the therapeutic orchidectomy performed in these patients. The occurrence of secondary tumors from the gastroin testinal tract is approximately 11 % of primitive gastric tumors, 4% and primitive colonic tumors 9% [9], Metastatic cells can spread to the testis though several routes: (a) retrograde venous extension or embolism; (b) arterial embolism; (c) lymphatic extension; (d) endocanalicular spread. In our case metastases were found in the epididymis spermatic cord, tunicac albuginea and vaginalis of testis but not the testis body. These localizations are considered an extreme rarity in the literature [5, 20], We believe that in this case the tumoral cells spread to the scrotum through the endocanalicular route.
1 Belsky, J.B.; Knowaler. B.E.: Testicular metas tasis from carcinoma of the colon. J. Urol. 72: 712-715(1954). 2 Blefari, F.; Risi, O.: Rare secondary carcinoma from colon to testis. Review of literature and report of a new case. Arch. ital. Urol. LXI: 275— 278(1989). 3 Bodon. G.R.: Dressier. J.A.W.: Metastatic car cinoma of right testicle from primary carci noma of the appendix. J. Urol 97: 885-887 (1967). 4 Bonneau. H.: Spitalier. J.M.; Varette. I.: Pollet, J.F.:Métastasc testiculaire d'un adénocarci nome du rectum. J. Urol.. Paris 73: 947-950 (1967). 5 Burger. R.: Guthrie, T.: Metastatic colonic car cinoma to epididymis. Urology 2: 57(1973). 6 Cricco. R.P.; Kandzari, S.J.: Secondary testicu lar tumors. J. Urol. 118:489-490 (1977). 7 Florentin. P.; Chardot, C.: Métastase testicu laire d'un épithéliome gastrique mucipare. Annls Anat. path.. Paris / /: 3 15-322 ( 1966).
470
8 Hanash, K.A.; Carney, J.A.; Kelalis, P.P.: Met astatic tumors to testicules: routes of metasta sis. J. Urol. 102:465-468 (1969). 9 Haupt. H.M.; Mann, R.B.: Trump, D.L.; Abeloff, M.D.: Metastatic carcinoma involving the testis. Clinical and pathologic distinction from primary testicular neoplasm. Cancer 54: 709714(1984). 10 Hunter, D.T.; Hutcheson, J.B.: Krukenberg tu mor of testicle: report of a second case. J. Urol. 81: 305-308 (1959). 11 Jubelirer, S.J.: Metastatic colonic carcinoma to the testis: case report and review of the litera ture. J. Surg. Oncol. 32:22-24 (1986). 12 Kingler. M.A.: Secondary tumors o f the geni tourinary tract. J. Urol. 65: 144-153 (1951). 13 London, M.Z.; Grossmann, S.N.: Secondary testicular tumors resembling Krukenberg tu mor: case report. J. Urol. 62: 713-716 (1949). 14 Mazzoleni. G.: Metastases to the testis from carcinoma of the colon. Riv. An. Path. One. 23: 304(1973).
15 Meares, E.M.: Ho, T.L.: Metastatic carcinoma involving the testis: a review. J. Urol. 109: 653-655(1973). 16 Moore, J.B.; Law. D.K.; Moore, E.E.; Dean, C.M.: Testicular mass: an initial sign of colon carcinoma. Cancer 49: 4 11-412 (1982). 17 Olesen, J.; Spaun. E.; Wiggers, P.: Metastatic tumor of the epididymis: a case report. Scand. J. Urol. Nephrol. 20:71 (1986). 18 Pier.kos. E.J.; Jablowkow, V.R.: Secondary tes ticular tumors. Cancer 30:481 -485 ( 1972). 19 Price, E.B.: Mostofi, F.K.: Secondary carci noma o f the testis. Cancer 10:592-595 ( 1957). 20 Smallman. L.A.: Odedra. J.K.: Primary carci noma of sigmoid colon metastasizing to epidi dymis and testis. Urology 23: 598-599 (1984). 21 Tiltman AJ: Metastatic tumors in the testis. Histopathology 3: 31-37 (1979).
Blefari/Risi/Pino
Secondary Tumors of Testis
Downloaded by: Karolinska Institutet, University Library 130.237.122.245 - 7/11/2017 1:39:27 PM
References
Divisione Urologia Ospedale Consorziale di Treviglio e Caravaggio, USSL BG 32, Treviglio, Italia
Key Words Testicular tumors Métastasés Secondary tumor
Secondary T umors of T estis: Two Rare Cases and Review of the Literature Abstract Secondary testicular tumor is a rare event. Approximately 200 cases have been documented in the international literature since 1935. The most common pri mary tumor sites have been the prostate, lung and kidney with other sites being reported less frequently. Our literature review discovered only 7 cases originating from primary tumors of the stomach and 14 cases from primary tumors of the colon. We want to add 2 more cases and discuss the possible mechanism of this neoplastic dissemination.
Introduction Metastatic tumors of the testis are extremely rare. In a review of 24,000 autopsies Pienkos and Jablowkow [18] found 15 cases of metastatic involvement of the testis. Reviewing the literature they discovered further 90 cases of secondary testicular tumors: 39 from the prostate, 14 from the lung, 9 from the kidney, 9 from the colon, 6 from the stomach, 2 from the pancreas, 2 from a retinoblasto ma, 1 from a carcinoid of the small bowel, 1 from the skin, 1 from the controlateral testis, 1 from the adrenal gland, 1 from the bladder, 1 from the bile ducts, 1 from the adrenal gland, 1 from the bladder, 1 from the bile ducts, 1 from a sympathicoblastoma, 1 from the appendix and 1 from an unknown carcinoma [ 12, 13, 15,21], In the last 15 years 5 more cases of primitive colonic tumors [1-6,8, 10, 11, 14, 16, 18-20] and only 1 from the stomach [ 17] have been reported.
Case Reports Case J A 73-year-old male with no neoplasm in his family anamnesis and no important illness in remote personal anamnesis was exam ined in July 1988 because of postprandial epigastric pain. Endoscop-
Received: February 26, 1991 Accepted: May 27, 1991
¡cal examination with biopsy revealed gastric carcinoma diffuse type (CID) of the stomach. The surgical treatment has been total gastrec tomy, partial pancreatectomy and splenectomy. Histopathological findings confirmed gastric CID with lymphatic dissemination to the locoregional nodes, splenic ileum nodes and peripancreatic tissues. No dissemination to the liver. Four months later a clinical examina tion revealed a left testicular mass involving the spermatic cord and epididymis. We performed an orchifuniculectomy. Histological find ings showed metastases of gastric CID along the vaginal tunic, albugi nea and spermatic cord. Case 2 The patient was a 65-ycar-old married man with 2 sons. There was no personal or family history of malignant disease. In 1984 he had undergone surgery for coronary' artery disease. He presented himself in 1985 to this institution with a carci noma of the cecum. A right hemicolectomy was performed with excision of two peritoneal metastases. Histology confirmed that the tumor was a mucus-secreting adenocarcinoma of the cecum invad ing the whole thickness of the bowel wall into the pericecal tissue. There was associated lymphadenopathy. Later the patient received irradiation therapy. After 4 months the patient returned with abdominal pain and diarrhea when a barium enema revealed subacute obstruction of the ileum, possibly caused by irradiation. An ileocolic bypass was per formed at a second operation and there was no evidence of meta static disease. The serum carcinoembryonic antigen was 8.1 ng/ml. The patient was well for 1 year until he noticed a mass on the right side of the scrotum. On physical examination several hard nodules, 0.5-1 cm in diameter, some attached to the epididymis, others to the
Dr. Franco Blcfari c/o Divisionc Urologia Ospcdalc Consortiale 1-24047 Treviglio (Italy)
© 1992 S. Karger AG, Basel 0042-1138/92/0484-0469 $2.75/0
Downloaded by: Karolinska Institutet, University Library 130.237.122.245 - 7/11/2017 1:39:27 PM
F. Blefari O. Risi P. Pino
spermatic cord, were found. At this time the serum carcinoembryonic antigen was 15 ng/ml, lactate dehydrogenase 358 IU. Liver sonography did not demonstrate any métastasés. Sonography of the scrotum, however, confirmed the clinical impression that there were several nodular masses spread along the spermatic cord in the tunica vaginalis and attached to the tunica albuginea. An orchidectomy was performed. Exploratory laparotomy re vealed multiple malignant deposits in the peritoneum. Histology of the excised testis and cord confirmed the presence of some secondary deposits of the mucus-secreting carcinoma pre viously identified in the cecum involving the spermatic cord, epidid ymis, tunicae albuginea and vaginalis.
Conclusions Secondary deposits of malignant tumors in the testis arc a rare event. The occurrence in the series of Picnkos and Jablowkow [18] was 0.06%. In 1967, Price and Mostofi [19] reported that in a series of 1,600 testicular tumors, only 38 (2.3 %) were found to be secondary depos its. In accordance with Smallman and Odedra [20] we believe that the most important reason for the rarity of
testicular metastasis is the relatively low temperature of the scrotum. That could be an unacceptable condition for the establishment of metastatic tumor cells. The most frequent primary sites of testicular second ary tumors are the lungs (19%) and prostate (35%). The relatively high occurence rate of prostatic cancer to metas tasize to the testis is, probably, due to the therapeutic orchidectomy performed in these patients. The occurrence of secondary tumors from the gastroin testinal tract is approximately 11 % of primitive gastric tumors, 4% and primitive colonic tumors 9% [9], Metastatic cells can spread to the testis though several routes: (a) retrograde venous extension or embolism; (b) arterial embolism; (c) lymphatic extension; (d) endocanalicular spread. In our case metastases were found in the epididymis spermatic cord, tunicac albuginea and vaginalis of testis but not the testis body. These localizations are considered an extreme rarity in the literature [5, 20], We believe that in this case the tumoral cells spread to the scrotum through the endocanalicular route.
1 Belsky, J.B.; Knowaler. B.E.: Testicular metas tasis from carcinoma of the colon. J. Urol. 72: 712-715(1954). 2 Blefari, F.; Risi, O.: Rare secondary carcinoma from colon to testis. Review of literature and report of a new case. Arch. ital. Urol. LXI: 275— 278(1989). 3 Bodon. G.R.: Dressier. J.A.W.: Metastatic car cinoma of right testicle from primary carci noma of the appendix. J. Urol 97: 885-887 (1967). 4 Bonneau. H.: Spitalier. J.M.; Varette. I.: Pollet, J.F.:Métastasc testiculaire d'un adénocarci nome du rectum. J. Urol.. Paris 73: 947-950 (1967). 5 Burger. R.: Guthrie, T.: Metastatic colonic car cinoma to epididymis. Urology 2: 57(1973). 6 Cricco. R.P.; Kandzari, S.J.: Secondary testicu lar tumors. J. Urol. 118:489-490 (1977). 7 Florentin. P.; Chardot, C.: Métastase testicu laire d'un épithéliome gastrique mucipare. Annls Anat. path.. Paris / /: 3 15-322 ( 1966).
470
8 Hanash, K.A.; Carney, J.A.; Kelalis, P.P.: Met astatic tumors to testicules: routes of metasta sis. J. Urol. 102:465-468 (1969). 9 Haupt. H.M.; Mann, R.B.: Trump, D.L.; Abeloff, M.D.: Metastatic carcinoma involving the testis. Clinical and pathologic distinction from primary testicular neoplasm. Cancer 54: 709714(1984). 10 Hunter, D.T.; Hutcheson, J.B.: Krukenberg tu mor of testicle: report of a second case. J. Urol. 81: 305-308 (1959). 11 Jubelirer, S.J.: Metastatic colonic carcinoma to the testis: case report and review of the litera ture. J. Surg. Oncol. 32:22-24 (1986). 12 Kingler. M.A.: Secondary tumors o f the geni tourinary tract. J. Urol. 65: 144-153 (1951). 13 London, M.Z.; Grossmann, S.N.: Secondary testicular tumors resembling Krukenberg tu mor: case report. J. Urol. 62: 713-716 (1949). 14 Mazzoleni. G.: Metastases to the testis from carcinoma of the colon. Riv. An. Path. One. 23: 304(1973).
15 Meares, E.M.: Ho, T.L.: Metastatic carcinoma involving the testis: a review. J. Urol. 109: 653-655(1973). 16 Moore, J.B.; Law. D.K.; Moore, E.E.; Dean, C.M.: Testicular mass: an initial sign of colon carcinoma. Cancer 49: 4 11-412 (1982). 17 Olesen, J.; Spaun. E.; Wiggers, P.: Metastatic tumor of the epididymis: a case report. Scand. J. Urol. Nephrol. 20:71 (1986). 18 Pier.kos. E.J.; Jablowkow, V.R.: Secondary tes ticular tumors. Cancer 30:481 -485 ( 1972). 19 Price, E.B.: Mostofi, F.K.: Secondary carci noma o f the testis. Cancer 10:592-595 ( 1957). 20 Smallman. L.A.: Odedra. J.K.: Primary carci noma of sigmoid colon metastasizing to epidi dymis and testis. Urology 23: 598-599 (1984). 21 Tiltman AJ: Metastatic tumors in the testis. Histopathology 3: 31-37 (1979).
Blefari/Risi/Pino
Secondary Tumors of Testis
Downloaded by: Karolinska Institutet, University Library 130.237.122.245 - 7/11/2017 1:39:27 PM
References
