Simultaneous Bilateral Testicular Metastases from Renal Clear Cell Carcinoma: A Rare Presentation in Von Hippel–Lindau disease

Abstract

In this article, we present a Von Hippel–Lindau (VHL) patient with synchoronus bilateral testicular metastasis from renal cell carcinoma (RCC). A 50 year-old man, a known case of VHL syndrome was referred with palpable masses in both the testes. His medical history demonstrated that he had undergone the brain surgery for cerebellar hemangioblastoma. He had undergone simultaneous Whipple’s pancreatectomy and left radical nephrectomy becuase of well-differentiated neuroendocrine tumors in head and body of the pancreas and a 6-cm clear cell-type grade-3 RCC in the left kidney. Scrotal sonography demonstrated vascular and heteroechogen masses measuring 19×14 mm in lower pole of the right testicle, 19×16 mm in upper pole of the right testicle, and 23×16.5 mm in upper pole of the left testicle. After having patient’s consent, bilateral orchiectomy was performed by inguinal incision. Histopathologic examination and immunohistochemistry staining revealed metastasis from RCC. The most common neoplasm of reproductive system in VHL patients is epididymal papillary cystadenoma. Owing to it’s benign nature, the management is conservative with routine physical examination and ultrasonography. Our patient indicated that every scrotal mass in patients with VHL is not to be considered as epididymal papillary cystadenoma.

A Case of Bilateral Synchronous Paratesticular Leiomyoma

“…Nevi are the most common benign tumor in the scrotum, and squamous cell carcinomas are the most common malignancy, of which leiomyoma was reported in 10 of the 127 cases of primary scrotal neoplasm [9]. The report of a tumor occurring simultaneously in both testes is very rare, with one report of nonseminomatous germ cell tumors [10], another with liposarcoma [11], and another of metastatic renal clear cell carcinomas occurring in a patient with von Hippel–Lindau [12]. The most common benign tumors in the paratesticular regions contain adenomatoid tumors, leiomyomas, and lipomas, and adenomatoid tumors are the most frequent and leiomyomas are the second most common tumors [2].…”