Metastatic carcinoma involving the testis. Clinical and pathologic distinction from primary testicular neoplasms

Abstract

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.Cancer 54:709-714, 1984.ERM CELL TUMORS are the most common testicular G neoplasms'** and should be the primary diagnostic consideration in young patients who present with a solitary testicular mass. However, the testes may also be the site of metastatic di~ease.~-~' When an occult malignancy first becomes manifest as a testicular mass, its distinction from a primary testicular tumor may be difficult. We report two patients who presented with testicular metastases from clinically occult primary neoplasms; the clinical features of one patient have been previously reported. 44 We review the literature regarding testicular metastases and emphasize the clinical and pathologic differences between primary and secondary testicular neoplasms.

Melanoma metastases in the abdomen and pelvis: Frequency and patterns of spread

“…Melanoma is a tumor which is known to widely metastasize, involving organs which are not commonly involved by other tumors [12][13][14] . For example, melanoma accounts for more than 50% of metastases to the gallbladder ( Figure 5) and is the second most common metastasis to the spleen and the third most common to the testicle (Figure 6) [15][16][17][18][19] . In our population, 39% of patients with metastatic disease had metastases to atypical locations and 11.6% of patients had metastases only in atypical locations.…”

Primary testicular mucinous cystadenoma: Case report and literature review

“…In isolated reports, a papillary pattern of arrangement of mucinous cells lining the tumour correlated with borderline disease or a tumour with low malignant potential. 6 Testicular tumours are smaller and unilocular. The prominent location and symptomatology often lead to early detection.…”

“…Most patients report painless testicular enlargement and occasional hydrocele. 6 The tumour can lead to testicular atrophy, 2 which may incidentally be detected during infertility workup. 5 Metastatic tumours (mostly from colon, stomach, and rarely pancreas) are an important differential diagnosis with regard to ovarian-type surface epithelial tumours of the testes.…”

Malignant melanoma representing with testicular metastasis: a case report and review of the literature

“…The most common primary site has been reported to be the prostate gland, contributing 35% 1 and 38% 2 of all primaries in 2 separate series. Other common sites include the lung, colon and kidney.…”