Primary Carcinoid Tumors of the Testis: A Clinicopathologic Study of 29 Cases

Abstract

Testicular carcinoid tumors are rare with only limited studies. We identified 29 primary testicular carcinoid cases from 7 academic institutions. Patients ranged in age from 12 to 65 years old (mean 36). The most common presenting symptom was the sole finding of either a testicular mass or swelling seen in 15/24 cases with available information. The next most common mode of presentation was as an incidental finding seen in 6 cases. Two patients had carcinoid syndrome including diarrhea, hot flashes, and palpitations. Nineteen were pure carcinoid tumors, 3 were associated with cystic teratoma, 2 with cysts lacking epithelial lining, 4 with epidermoid cyst, and 1 with dermoid cyst. The mean size was 2.5 cm. All 29 primary carcinoids lacked associated intratubular germ cell neoplasia, unclassified type. Mitotic figures were rare in primary carcinoid tumors with only 3 cases showing more than 2 per 10 HPF; necrosis was found in only 1 case. Random scattered mild to moderate nuclear atypia was seen in 12/29 cases. Of the 28 cases found premortem, treatment included focal excision in 3 patients and radical orchiectomy in 25 patients. Follow-up, available in 24 cases, ranged from 1 to 228 months (mean 52.7 mo); of the 20 patients with testicular typical carcinoid tumors found premortem, all were alive at last follow-up without recurrences or metastases. Of the 4 patients with a primary atypical carcinoid tumor, 1 at the time of diagnosis had retroperitoneal and lung metastases who after chemotherapy underwent resection of the retroperitoneal tumor showing metastatic yolk sac tumor and embryonal carcinoma. After resection, serum AFP levels remained elevated and the patient is scheduled for salvage chemotherapy and bone marrow transplant. The other 2 patients with atypical carcinoid and follow-up had no evidence of disease at 68 and 114 months. Most primary carcinoid tumors of the testis have a benign clinical course even if associated with epidermoid/dermoid cysts, or histologically mature teratoma. However, lesions with the morphology of atypical carcinoid can occasionally exhibit metastatic spread.

Primary carcinoid tumor of the testis: A rare case

“…Atypical carcinoid tumors have either coagulative necrosis or increased mitotic activity, with 2-10 mitoses per 10 HPFs. In a series of 29 cases, 1 of the 3 atypical carcinoid tumors had agressive behavior, with a lymph node metastasis and a lung metastasis (9).…”

Primary pure carcinoid tumors of the testis: Clinicopathological and immunophenotypical characteristics of 11 cases

“…The incidences of primary testicular carcinoids in North America and Japan are lower than 1 and 0.2%, respectively (6,8). At the West China Hospital, 688 male patients with testicular neoplasms underwent surgical resections between 1978 and 2013.…”

“…In general, primary testicular carcinoids have an excellent prognosis, with certain cases only incidentally observed at autopsy (8). Approximately 11% of primary testicular carcinoid tumors exhibit malignant behavior (3,15).…”

“…Since then, around 150 cases of carcinoid tumors in the testis have been reported (5)(6)(7)(8)(9)(10)(11). Data on ethnicity and geographical distribution have revealed that the majority of carcinoid tumors occurred in Europe or the United States.…”

Well Differentiated Neuroendocrine Carcinoma of the Testis in a Nigerian Male

“…They most commonly have their origin within the testis either in pure form or in association with a germ cell tumor, but could also be metastases from the gastrointestinal tract or lungs [2]. Testicular carcinoids most often present as a painless testicular mass or enlargement; only a few cases present with carcinoid syndrome [1,3]. Like carcinoid tumors in other sites, they could have typical or atypical histopathology, which can predict their clinical behaviour [3].…”