Papillary cystadenocarcinoma of the epididymis: a case report and review of the literature

Cistadenocarcinoma papilífero de epidídimo: relato de caso e revisão da literatura

Frente a extrema raridade de se encontrar carcinomas no epidídimo, bem como a importância clínico-patológica do seu reconhecimento para o prognóstico e a terapêutica adequados, apresentamos um caso de cistadenocarcinoma papilífero de epidídimo, além de revisão da literatura a respeito. Paciente de 39 anos com aumento de volume da bolsa escrotal à direita há 8 anos indolor, submetido à orquidoepididimectomia total ipsilateral, que revelou achados morfológicos e imunohistoquímicos característicos de a um cistadenocarcinoma papilífero de epidídimo do tipo epitélio ovariano.

Contemporary analysis of epididymal tumors using a national database

Introduction

Epididymal tumors are rare malignancies with sparse research available to guide recommendations. We sought to characterize malignant epididymal tumors in the United States using population level data.

Material and methods

The Surveillance, Epidemiology, and End-Results database was queried for patients diagnosed with malignant epididymal tumors between 1975–2016. International classification of disease for oncology code C63.0 was used to identify population with disease of interest. Primary objective was to characterize patient demographics, disease characteristics, and management. Secondary objectives included overall and cancer-specific survival (CSS) utilizing Kaplan-Meier (KM) analysis.

Results

A total of 66 cases of malignant epididymal tumors were identified during the study period. The cohort was largely white (84.8%), with a mean age of diagnosis of 46.9 years old. The predominant histology consisted of rhabdomyosarcoma 26%, leiomyosarcoma 23%, liposarcoma 17%, adenocarcinoma 9%, and malignant fibrous histiocytoma 5%. During histopathological assessment, 21.1% of tumors were classified as high-grade while 71.2% exhibited sarcomatoid elements. Majority of patients presented with localized disease (68.2%), whereas regional (18.2%) and distant (13.2%) disease was less frequently discovered. All patients were diagnosed by surgical therapy consisting of radical epididymectomy (39.4%), partial epididymectomy (27.3%) or ‘unknown surgery’ (33.3%). Meanwhile, 15.2% and 34.8% received radiation and chemotherapy, respectively. KM analysis revealed an 84.9% CSS at 5-years. Over 60% of documented cases have arisen since 2000, with 3.0% of the cohort diagnosed in 2016, increased from 1.5% of the diagnoses in 1975.

Conclusions

Malignant epididymal tumors are exceedingly rare and typically present with localized disease. Surgical excision is associated with an estimated 85% CSS at 5-years.

Clinicopathological Characteristics, Treatment, and Prognosis of Rarely Primary Epididymal Adenocarcinoma: A Review and Update

Primary epididymal adenocarcinoma (PEA) is exceedingly rare. Only 22 cases had been published worldwide by 2008; nearly 80% of these cases were reported before 2007. In order to investigate the current clinical status of PEA, we search for relevant literatures with “epididymis and adenocarcinoma” and “epididymal and adenocarcinoma” as keywords published between January 1997 and November 2017 in PubMed. As a result, 17 cases are identified. We review these cases and summarize new and important perspectives about the clinicopathological characteristics, diagnosis, treatment, and prognosis of PEA in the present review.

Epididymal papillary cystadenocarcinoma metastasising to the testis in a patient with infertility managed with Onco-microTeSE

Papillary cystadenomas of the epididymis are known to occur in association with Von Hippel-Lindau (VHL) disease. The development of a papillary cystadenocarcinoma, its malignant counterpart, is rare with only a few sporadic cases reported in the literature. Metastatic deposits are exceedingly uncommon; in fact, only a single case report has documented metastases to the paraureteral region, but metastases to the testis have never been reported. A 43-year-old gentleman with VHL disease presented with non-obstructive azoospermia, a right epididymal mass, and an atrophic surgically corrected undescended left testis. The epididymal mass was reported as a papillary cystadenocarcinoma on biopsy. The patient was managed with a radical inguinal orchidectomy and bench microTeSE with successful sperm retrieval. Metastatic papillary cystadenocarcinoma of the epididymis to the testis has never been previously reported. This case was managed by radical orchidectomy and subsequent onco-microTeSE, allowing safe oncological treatment and optimal fertility preservation.

A CASE OF ADENOCARCINOMA OF THE EPIDIDYMIS WITH HYDROCELE

A 72-year-old man presented with left scrotal swelling. The patient was diagnosed with left testicular hydrocele and underwent the hydrocele aspiration. However, it recurred within a short period. Magnetic resonance imaging (MRI) revealed a tumor in the epididymis and the patient then underwent left high orchiectomy. The histopathological examination revealed an adenocarcinoma of the epididymis. Ten months after the surgery, the patient has been free of disease.

Primary adenocarcinoma of the epididymis: case report and review of the literature

Primary epididymal malignancies are uncommon, and epididymal adenocarcinomas are exceedingly rare. We report a case of primary adenocarcinoma of the epididymis in a 62-year-old man and review the world literature on epididymal adenocarcinoma.

Adenocarcinoma of the epididymis: a report of four cases and review of the literature

Primary epididymal carcinoma is extremely rare and has been the subject of only sporadic case reports; the validity of some of the reported tumors is questionable. We report our experience with four examples, which arose in men 27, 66, 77, and 81 years of age. All of them presented with scrotal masses; three of them had small hydroceles. None had a history of von Hippel-Lindau disease. Grossly, all of the tumors were centered in the epididymis and two were confined to it. One tumor invaded the periepididymal soft tissue and spermatic cord and the fourth invaded the adjacent testis. They were 2.0-7.0 cm in greatest diameter; three had foci of hemorrhage and necrosis. Microscopically, all of the tumors were adenocarcinomas. Two of them were composed of approximately equal numbers of simple tubules and more complex tubulopapillary formations lined by cuboidal or columnar predominantly clear cells that infiltrated the epididymal smooth muscle wall, periepididymal soft tissue, or both. The other two had large cysts into which grew complex papillary or confluent, back-to-back glands lined by columnar cells with clear, lightly amphophilic or eosinophilic cytoplasm. Necrosis was present in three cases. An undifferentiated, sheetlike growth of anaplastic tumor cells was present focally in one case. Cilia were absent. Small amounts of cytoplasmic glycogen were present in the two cases in which periodic acid-Schiff staining was performed. Immunohistochemical staining, performed in one case, demonstrated strong positivity for cytokeratins (AE1/3, Cam 5.2) and epithelial membrane antigen (luminal only). Results of staining for carcinoembryonic antigen, Leu M1, B72.3, and Ber-EP4 were negative. Ultrastructural analysis, performed in one case, showed well-developed desmosomal junctions, cytoplasmic multivesicular bodies, glycogen particles, and well-developed cilia. Two of three patients with follow-up data died of disease 8 months and 2.5 years after diagnosis; the third was disease free 30 years after the diagnosis despite having paraaortic lymph node metastases at the time of presentation. After reviewing the literature and analyzing our cases, we conclude that bona fide examples of epididymal adenocarcinoma are usually tubular, tubulocystic, or tubulopapillary adenocarcinomas, often with an appreciable content of clear cells, which can usually be readily separated from other paratesticular malignant tumors, such as malignant mesothelioma and carcinomas of the müllerian type. Distinction from metastasis may be difficult and may depend largely on careful clinical evaluation.

Papillary adenocarcinoma of the epididymis

An 82 year old man with a unilateral epididymal mass was found, on histopathologic examination of a surgically removed specimen, to have a primary papillary adenocarcinoma of a clear cell variant which mimicked renal cell carcinoma. Repeated imaging studies confirmed the absence of renal cell carcinoma. Because the present case had great similarities in histologic appearance and anatomical location to papillary cystadenoma of the epididymis, it may be a malignant counterpart of the latter type of tumor.