Primary adenocarcinoma of the rete testis

Abstract

Fig. 1. A, Diagnostic MRI and, B, 1 year after treatment shows almost complete involution of an orbital metastasis of a prostatic adenocarcinoma. Case reports Cases 1 and 2A 76-year-old man (patient A) and an 83-year-old man (patient B) were examined in 1993 by the ophthalmologist because of diplopia due to progressive unilateral exophthalmus. CT and MRI in both instances showed locally destructive tumours in the right (patient A) and left (patient B) orbital bony and soft tissues. Biopsies revealed adenocarcinomas, which were positive for PSA and PAP on immunohistochemistry. Both patients had high levels of PSA in the serum, 211 ng/mL in patient A and 131.6 ng/mL in patient B. The serum alkaline phosphatase values were normal, although bone scintigraphy showed multiple 'hot spots'. In both cases, a DRE indicated grossly extra-prostatic disease of TNM-stage T4; moreover, TRUS showed multiple hypoechoic lesions, extracapsular disease and seminal vesicle invasion. The TRUS-guided prostate needle biopsies in both patients revealed poorly differentiated adenocarcinomas. Patient A was treated with bilateral subcapsular orchidectomy. One month later the orbital tumour was clearly regressing and the serum PSA level had decreased to 15.4 ng/mL, with a testosterone level of 0.8 nmol/L. A follow-up MRI scan at one year showed almost complete involution of the orbital metastatic process (Fig. 1) and all the visual variables improved to near normality. However, follow-up bone scintigraphy revealed new 'hot spots' in the lumbar vertebral region, while the patient remained in good condition with no pain and an active daily life. The serum PSA level stabilized, with a final value of 14.0 ng/mL. The total follow-up after diagnosis has been 25 months.Patient B was treated with local radiation of the orbital metastasis and chemical castration using the LHRHanalogue goserelin (Zoladex) in 3.6 mg monthly subcutaneous depots after initial pretreatment with cyproterone acetate (Androcur) 100 mg three times daily for 4 weeks. Several weeks after initiation, the serum PSA level was 62.7 ng/mL and the serum testosterone was 0.6 nmol/L. The impaired visual variables showed no improvement.© 1997 British Journal of Urology 288

Primary adenocarcinoma of the rete testis with elevation of serum carcinoembryonic antigen: a case report

“…Three of these cases had metastases at presentation [2,8], and one had local recurrence, retroperitoneal lymph node swelling, and multiple lung metastases 13 months after orchiectomy [9] (Table 1). Three patients with normal serum CEA levels were alive during the observation period [6,7,10]. In four cases with immunostaining for CEA, the tumor cells were positive for CEA [2,6,8].…”

“…Three patients with normal serum CEA levels were alive during the observation period [6,7,10]. In four cases with immunostaining for CEA, the tumor cells were positive for CEA [2,6,8]. Thus, CEA might be a biomarker that reflects the progression of adenocarcinoma of the rete testis.…”

“…The present case also showed elevation of serum CA19-9 levels, which increased progressively with disease progression. Okada et al reported that the serum CA19-9 level was within normal limits, but the tumors were strongly positive for CA19-9 immunostaining [6]. However, there have been few reports about the association of adenocarcinoma of the rete testis with CA19-9.…”

Adenocarcinoma of rete testis masquerading as epididymal cysts

“…Histological criteria must be adhered to before making a final diagnosis [ 1, 2]. Metastases are reported to appear soon and at various sites [ 2, 3]. Patients seldom survive longer than 1 year although survival up to 5 years without metastases has been reported [ 3].…”

“…Metastases are reported to appear soon and at various sites [ 2, 3]. Patients seldom survive longer than 1 year although survival up to 5 years without metastases has been reported [ 3]. Long‐term follow‐up in a large number of cases is needed to clarify the natural history of progression and plan definitive management.…”