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      Simultaneous bilateral testicular metastases from renal clear cell carcinoma: A case report and review of the literature

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          Abstract

          Metastasis from renal cell carcinoma (RCC) to the testis is rare. This case report presented an extremely rare case of simultaneous bilateral testicular metastases from RCC in a 65-year-old man who had experienced indolent scrotal enlargement over a period of several months. Scrotal ultrasonography showed 4.0- and 2.0-cm-sized masses in the left and right testes, respectively. Contrast-enhanced computed tomography identified multiple tumors in the kidneys, the pancreas and the left adrenal gland. Left orchiectomy and pathological examination were performed and indicated testicular metastasis from clear cell RCC. The patient underwent complete surgical resection of all residual lesions. Postoperative follow-up examination without adjuvant therapy identified no recurrence over 11 months. This study also reviewed existing literature and determined that retrograde venous spread from the primary kidney tumor to the testis may be an important pathway for testicular metastasis from RCC. In conclusion, RCC can result in testicular metastases not only unilaterally, but also bilaterally, as was observed in the present case.

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          Secondary neoplasms of the male genital tract with different patterns of involvement in adults and children.

          S Baithun, N Dutt, Paul A Bates (2000)
          The incidence, presentation and macroscopic and histological features of secondary neoplasms of the male genital tract are described with reference to their differential diagnosis. A retrospective study of cases from the Royal London Hospital yielded a total of 31 secondary neoplasms involving the testis: 14 at postmortem examination and 17 surgical specimens. Nine cases were leukaemias: six acute lymphoblastic and two acute myeloid leukaemias in children, and one chronic lymphocytic leukaemia in an adult. The commonest primary sites of metastases to the testis were prostate (six cases), stomach (five cases) and lung (three cases). There were two malignant melanomas and isolated examples of metastases from the adrenal gland (neuroblastoma), cerebellum (medulloblastoma), soft tissue (alveolar rhabdomyosarcoma), pancreas and rectum. Of the metastases from solid tumours, 12 involved the right testis only, three involved the left and four were bilateral. In seven of these cases there were multiple testicular nodules, in seven there was a single mass, and in the rest there was diffuse involvement. Secondary neoplasms represented 4.6% of all testicular neoplasms at autopsy, and 1.6% in surgical specimens. There were five secondary penile neoplasms: two each from the pancreas and prostate and one from the bladder. Two neoplasms metastatic to the spermatic cord, both from a gastric primary, were included in the series. Secondary neoplasms of the testis occur with a frequency comparable to other sites in the genitourinary tract, and metastases to the spermatic cord, epididymis, and penis, are rare in comparison. Disseminated neoplasms rarely present initially at this site and are histologically distinctive in adults, but in children they must be distinguished from primary small round blue cell tumours.
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            Metastatic carcinoma involving the testis. Clinical and pathologic distinction from primary testicular neoplasms.

            H A Haupt, M Abeloff, Jeffrey Mann … (1984)
            Metastatic carcinoma to the testis is unusual. There are only seven previously reported cases in which a testicular mass was the first clinical manifestation of an underlying malignancy. The authors review 127 cases in which the testis was involved by metastatic carcinoma, and describe an additional two patients in whom a malignant testicular mass was the presenting sign of an underlying nontesticular carcinoma. The tumors most commonly reported to metastasize to the testis are: prostate (45 cases), lung (25 cases), melanoma (12 cases), colon (11 cases), kidney (10 cases), stomach (6 cases), and pancreas (5 cases). Neuroblastoma, retinoblastoma, carcinoid tumor, and cancers of the bile duct, ureter, bladder, salivary gland, and thyroid have also involved the testis secondarily. Nineteen patients (15%) had bilateral testicular metastases. Patients with secondary testicular neoplasms were older in general than those with germ cell tumors (mean, 55 years; median, 57 years). Histologically, the presence of extensive lymphatic and vascular invasion and an interstitial pattern, in which the seminiferous tubules are spared, is suggestive of a metastasis. In four of the nine cases (44%) in which testicular enlargement was the first manifestation of an underlying carcinoma the correct pathologic diagnosis was initially missed. Serum alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG) are occasionally elevated in patients with nontesticular primary tumors, but markedly elevated levels in young patients suggest a nonseminomatous germ cell tumor, as does positive immunoperoxidase staining for AFP and HCG.
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              Secondary testicular tumors.

              E Pienkos, V Jablokow (1972)
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                Author and article information

                Journal
                Journal ID (nlm-ta): Oncol Lett
                Journal ID (iso-abbrev): Oncol Lett
                Journal ID (publisher-id): OL
                Title: Oncology Letters
                Publisher: D.A. Spandidos
                ISSN (Print): 1792-1074
                ISSN (Electronic): 1792-1082
                Publication date (Print): April 2014
                Publication date (Electronic): 27 January 2014
                Publication date PMC-release: 27 January 2014
                Volume: 7
                Issue: 4
                Pages: 1273-1275
                Affiliations
                [1 ]Department of Urology, Saitama Red Cross Hospital, Saitama, Saitama 338-8553, Japan
                [2 ]Department of Pathology, Saitama Red Cross Hospital, Saitama, Saitama 338-8553, Japan
                [3 ]Department of Urology, Nishi-Ohmiya Hospital, Saitama City, Saitama 330-0856, Japan
                [4 ]Department of Surgery, Saitama Red Cross Hospital, Saitama City, Saitama 338-8553, Japan
                Author notes
                Correspondence to: Dr Shingo Moriyama, Department of Urology, Saitama Red Cross Hospital, 8-3-33 Kamiochiai, Chuo Ward, Saitama City, Saitama 338-8553, Japan, E-mail: zodiac_507@ 123456hotmail.com
                Article
                Publisher ID: ol-07-04-1273
                DOI: 10.3892/ol.2014.1830
                PMC ID: 3961255
                PubMed ID: 24944706
                SO-VID: 2e95412e-7b44-4783-a2db-eb4ea188ca37
                Copyright © Copyright © 2014, Spandidos Publications
                License:

                This is an open-access article licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License. The article may be redistributed, reproduced, and reused for non-commercial purposes, provided the original source is properly cited.

                History
                Date received : 18 June 2013
                Date accepted : 17 December 2013
                Categories
                Subject: Articles

                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: renal cell carcinoma,metastasis,testicular neoplasm
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: renal cell carcinoma, metastasis, testicular neoplasm

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