Primary argentaffinoma of the testis: a case report and survey of the literature

Carcinoid disease: review of the literature

Carcinoid syndrome is the product of a rare but fascinating malignant neoplasm. Carcinoid syndrome was described more than 100 years ago, and recent advances in diagnostic localization, elucidation of the mechanisms of oncogenesis, treatment options, and, consequently, patient prognosis have been made. Current modalities of treatment, possible therapeutic implications of new avenues of research, and current literature on the chemotherapeutic combinations used are reviewed.

Reproduction and the APUD system

Substantial evidence for involvement of the APUD system in the normal reproductive tract is limited to the prostate gland and uterine cervix. Most supportive data simply documents the presence of neuro-endocrine cells in these tissues. A biological product(s) or role(s) remains to be discovered, but appears likely in the prostate. Tumors possessing cells with APUD characteristics have been described in many reproductive tissues including the prostate, cervix, endometrium, ovary, and testes. These tumors are generally aggressive in behavior, and optimum therapy needs to be determined.

Primary carcinoid tumor of testis. Immunohistochemical, ultrastructural, and DNA flow cytometric study of three cases with a review of the literature

The cases of three patients with primary carcinoid tumor of the testis were reported. The patients were 41, 44, and 83 years of age. At initial examination, all three had testicular masses with or without associated pain, and none had the carcinoid syndrome. The tumors measured 4.3 cm, 3.0 cm, and 6.5 cm in dimension. All three tumors manifested classic histologic features of carcinoid tumors. The neoplastic cells exhibited argyrophilia, and all were immunoreactive to chromogranin, serotonin, neuron-specific enolase, and cytokeratin. Two tumors had positive test results for gastrin and one had positive test results for substance P and vasoactive intestinal polypeptide. No tumors reacted with somatostatin, insulin, pancreatic polypeptide, or placental alkaline phosphatase. Intracytoplasmic, membrane-bound, round-to-elliptical pleomorphic granules were identified by ultrastructural analysis in all cases. DNA flow cytometric analysis revealed a low degree (near-diploid) DNA aneuploidy in all cases, with a DNA index of 1.15 in two tumors and 1.3 in the third tumor. The three patients are alive and well 11 years, 7 years, and 6 months, respectively, after diagnosis. A total of 57 cases of this entity, including the 3 reported here, have been reported. Of these, 43 were pure carcinoid, and 14 were associated with teratoma; 6 (11.6%) patients developed metastases. Tumor size and the presence of carcinoid syndrome have been found to correlate with metastatic potential. Neither tumor necrosis nor local tumor invasion (into vessels, tunica albuginea, etc.) correlated with adverse prognosis. Carcinoid tumor of the testis is a rare indolent neoplasm with potential for distant metastases.

Argyrophilic and hormone immunoreactive cells in normal and hyperplastic pancreatic ducts and exocrine pancreatic carcinoma

Scattered argyrophil cells were present in normal, large, medium-sized and small pancreatic ducts (ductules). There was marked increase in argyrophil cells in ducts with hyperplastic epithelium. Argyrophil cells were also found in 67.7% of all exocrine pancreatic carcinomas. In a well differentiated group including cystadenocarcinoma, mucinous carcinoma and well differentiated ductal adenocarcinoma argyrophil cells were found in all cases examined. Using four antisera (against insulin, glucagon, somatostatin and gastrin), insulin, glucagon and somatostatin cells were identified in 2.65%, 0.001% and 1.2% of normal ducts, and 7.5%, 2.4% and 4.6% of ducts with hyperplastic epithelium respectively and were also greatly increased in numbers in the latter group. Immunoreactive cells were present in 66.7% of exocrine carcinomas. Cells reactive for insulin were found in 7/15 cases; glucagon in 6/15 cases; somatostatin in 5/15 cases and gastrin in 2/15 cases. Eight cases contained two or more than two types of immunoreactive cells. The presence of argyrophil and hormone immunoreactive cells in pancreatic ducts and carcinomas is indicative of the close developmental relationship between endocrine and exocrine parts of the pancreas. The inter-relationship of response in the different cell types following stimulus suggests that injury to a common precursor may be involved.

Tumors of the diffuse endocrine system, histochemical and electron-optic aids, and pitfalls in diagnosis

Tumors of the Diffuse Endocrine System are a heterogeneous group of malignant neoplasms which have rather characteristic light microscopic and cytologic features. These are, however, not diagnostic and their identification with separation from non-neuroendocrine carcinomas require important adjunctive evaluations including histochemical analysis, immunocytochemical characterization and electron-optic identification of endocrine secretory products and paracrine effects in the cytoplasm of the neoplastic cells. The importance of proper classification cannot be over-emphasized because of the often considerable biologic and prognostic differences between neuroendocrine carcinomas and other types of carcinoma, notably metastatic carcinomas from the breast and the prostate. Furthermore, the separation of these lesions into two groups; a small cell type and those with large cells (carcinoid type) appears to have clinical significance in both diagnosis and response to therapy.

Mammary carcinoma with argyrophil cells

In a series of 253 cases of carcinoma of the breast, nonargentaffin, argyrophil cells were seen among the tumor cells in 27 cases (10.7%). An electron microscopic examination in one such case revealed dense cored secretory granules surrounded by a limiting membrane within the cytoplasm of the argyrophil tumor cells. Tumors with argyrophil cells, particularly when these cells were abundant, histologically showed a uniform appearance of relatively small constituent cells with oval or round nuclei of a regular size, forming solid alveolar nests or sheets. In one of these tumors, a delicate vascular stroma separated the sheets of tumor cells to form a ribbonlike pattern, simulating the feature of a carcinoid tumor. This tumor, however, is preferably interpreted at present as a mammary carcinoma with features of a carcinoid tumor, because of an incomplete characterization of argyrophil granules in the tumor cells. Other tumors with argyrophil cells were examples basically of ordinarily featured invasive ductal carcinoma. In a search for the origin of these cells, 99 breasts with various noncancerous lesions were examined; however, these argyrophil cells were never detected in any component of these mammary tissues.

Neurosecretory granules in small cell invasive carcinoma of the urinary bladder

A 69-year-old man showed symptoms of urinary bladder irritability and hematuria. Cystoscopy and radiographic studies revealed a tumor within a bladder diverticulum. The tumor shared histologic and ultrastructural features with oat cell carcinoma of the lung, including the presence of small numbers of neurosecretory type granules. In spite of conservative surgical treatment, there has been no evidence of recurrent or metastatic tumor over 14 months of follow-up. Hypophosphatemia was present preoperatively, but resolved spontaneously after tumor resection. In regard to histogenesis, a metaplastic origin is favored. This appears to be the first reported case of a neoplasm of Kultschitzky-type cells arising in the urinary bladder.

Endocrine GEP-cells in primary testicular teratoma

Differentiated teratomas frequently contain the apparent equivalent of gastrointestinal mucosa. 53 testicular teratomas were investigated for the incidence of entero-endocrine cells. Enterochromaffin(EC)-cells were demonstrated by formaldehyde induced fluorescence (FIF), while the other endocrine cells were identified by immunohistochemistry. 11 of 53 teratomas contained endocrine cells associated with the gastrointestinal epithelium. The most frequently found cell type was the EC-cell, followed by somatostatin-, glucagon- and pancreatic polypeptide-immunoreactive cells. The teratoma tissue blocks (20 of 53) also frequently exhibited normal testicular tissue which did not contain any EC-cell or other entero-endocrine cells. The results are of interest in considering the cytogenesis of entero-endocrine cells and the histogenesis of testicular carcinoids, indicating that the entero-endocrine cells derive from the intestinal carcinoids, indicating that the entero-endocrine cells derive from the intestinal epithelium arising from undifferentiated stem cells. Furthermore, it seems probable that primary testicular carcinoids can develop from pre-existent teratomas by proliferation of their entero-endocrine cells.

Carcinoid of the uterine cervix: a case report with light and electron microscopic studies

The case of a 33-year-old woman with primary carcinoid of the uterine cervix is reported. Primary carcinoid tumor is well known to occur in organs such as the gastrointestinal tract, lung and gonads. However, its occurrence in the uterine cervix is rare. To our knowledge, primary carcinoid of the uterine cervix has not been reported from the United States, although it has been well documented by non-American authors. Light microscopically, the tumor was characterized by formation of solid nests, trabeculae and glands. The cells therein showed argyrophil granules but were negative for argentaffin reaction. Electron microscopy revealed the presence of numerous neurosecretory granules and microfilaments. On the basis of light microscopic ultrastructural and cytochemical properties, the tumor is believed to arise from the normal argyrophil cell of the cervix and is regarded as an endocrine tumor, a member of the group of neoplasms called apudomas.

Primary carcinoid tumor of the testis: case report, ultrastructure and review of the literature

A case of primary pure carcinoid tumor of the testis which occurred in a 71-year-old male is reported. The patient was treated by radical orchiectomy and remains well and symptom free 10 months after operation. Histologically as well as ultrastructurally the tumor showed typical appearances of carcinoid tumor of midgut derivation. 23 cases of carcinoid tumors of the testis were discovered in the literature. Of these 17 were primary testicular carcinoids, and 6 were metastatic to the testis. Of the 17 cases of primary carcinoid tumors, 14 were pure carcinoids and only 3 were associated with teratoma. None of the primary testicular carcinoids were associated with metastases and the prognosis after orchiectomy was excellent, thus indicating that no further therapy is necessary. The prognosis of patients with carcinoid metastatic to the testis is poor. In view of this it is very important to determine whether the tumor is primary or metastatic.

Primary carcinoid tumor of testis

A case of pure, primary testicular carcinoid tumor in a forty-four-year-old male is reported. The patient presented with painless testicular enlargement, and testicular tumor was diagnosed. Orchiectomy was performed, and histology revealed a primary argentaffinoma. The patient is well and symptom free two years after diagnosis.

Carcinoid tumors of the testis

The clinical and pathologic findings in 16 cases of carcinoid tumor of the testis are presented: 10 tumors were primary in the testis, 2 were teratomas, 2 were in the spermatic cord and 2 were metastatic. Most of these tumors occurred in middle-aged patients and the symptoms were those of testicular tumor in general, that is swelling, pain and tenderness. In none of the primary case was there evidence of carcinoid syndrome and no determination of serotonin was made before orchiectomy. Followup in 12 cases was from 4 months to 16 years postoperatively. Three patients died 2 to 4 years after orchiectomy: 1 with generalized metastasis and 2 with intercurrent diseases. Two patients were lost to followup and the remaining patients are well. Although ovarian carcinoids usually occur in teratoma and do not metastasize 1 of the primary cases produced generalized metastasis.

Primary carcinoid of testis

A patient with primary solid carcinoid of the testis is described and 8 previous cases are reviewed. Ultrastructural study of our case disclosed pleomorphic granules, typical of the insular type carcinoid of the intestine of midgut derivation. Primary solid testicular carcinoid appears to behave as a benign neoplasms. None of these patients had evidence of metastases or the carcinoid syndrome for periods ranging from 20 months to 25 years.

Carcinoid of the uterine cervix: additional observations on a new tumor entity

Twelve carcinoid tumors of the uterine cervix were studied. Based on the microscopic structure, they were divided into well-differentiated and poorly differentiated types. Both tumor varieties affected adult women. The clinical and gross features of these tumors were indistinguishable from those of invasive squamous cell carcinoma. Of the 12 patients, six died, four with poorly differentiated carcinoid and two with the well-differentiated type. Three patients are alive and symptom-free 9 months to 2 years after treatment; the remaining three were lost to follow-up. Microscopically, four well-differentiated carcinoids showed argyrophil cells, and ultrastructurally two had neurosecretory granules. One of the well-differentiated carcinoids resembled islet cell carcinoma and two had areas resembling medullary carcinoma of the thyroid. The poorly differentiated type of carcinoid had a histologic structure and a cell population very similar to that of the oat cell carcinoma of the lung. Of this group, four were argyrophilic, and by electron microscopy four contained pleomorphic secretory granules. It is considered that these tumors arise from the normal argyrophil cell of the cervix and are part of the group of neoplasms of the diffuse endocrine cell system (APUD).