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Xiao T, Luo LH, Guo LF, Wang LQ, Feng L. Primary testicular neuroendocrine tumor with liver lymph node metastasis: A case report and review of the literature. World J Clin Cases 2022; 10:12028-12035. [PMID: 36405286 PMCID: PMC9669844 DOI: 10.12998/wjcc.v10.i32.12028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/28/2022] [Accepted: 10/17/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Primary testicular neuroendocrine tumors (TNETs) are sporadic, accounting for only 0.23% of all testicular tumors. Few cases have been reported in the literature, and no uniform treatment protocol exists. We report a case of a primary TNET with liver lymph node metastasis diagnosed at the age of 24 years and discuss its clinicopathological features, diagnosis, differential diagnosis, treatment, and prognosis.
CASE SUMMARY We report the case of a 24-year-old patient with a primary TNET with liver lymph node metastasis. The patient was found to have a right testicular swelling of about 3 cm × 4 cm in size with unclear borders and no testicular pressure pain seven years ago without any examination or treatment. One month ago, an ultrasound examination was performed for persistent enlargement of the right testis, which showed an occupying lesion of the right testis approximately 110 mm × 102 mm × 82 mm in size. Magnetic resonance imaging scan of the testis (plain scan) showed that the right testis was an occupying lesion with inhomogeneous density and mixed signal, the boundary was still clear, and the possibility of seminoma was considered; chest X-ray and computed tomography did not show any apparent abnormalities. The patient underwent radical orchiectomy, and the pathological examination suggested a right TNET with a typical carcinoid tumor histological type. One month after the surgery, the patient received nine cycles of lanreotide chemotherapy at a dose of 90 mg/mo without adverse effects. No distant lymph node or other organ metastases were detected at follow-up. He is in good physical condition and attends regular follow-up visits.
CONCLUSION Neuroendocrine tumors are rare in clinical practice, and the diagnosis mainly relies on the characteristics of microscopic tumor cells and immunohistochemical features. Treatment involves radical orchiectomy. If it is accompanied by distant lymph node metastasis and the metastatic lesion can be resected, it should be surgically removed; if it cannot be resected, growth inhibitor analog octreotide or lanreotide chemotherapy can be administered to obtain good results, with close postoperative follow-up to prevent recurrence and metastasis.
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Affiliation(s)
- Tong Xiao
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Long-Hua Luo
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Liang-Fei Guo
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Li-Qin Wang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Liang Feng
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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Widmeier E, Füllgraf H, Waller CF. Complete remission of Cdx-2 positive primary testicular carcinoid tumor: 10-years follow-up and literature review. BMC Urol 2020; 20:197. [PMID: 33317491 PMCID: PMC7737363 DOI: 10.1186/s12894-020-00768-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 12/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The neuroendocrine cells can cause a variety of malignancies throughout the human body known as the neuroendocrine tumors (NETs) or carcinoid tumors. The primary testicular carcinoid tumor (PTCT) accounts for less than 1% of the testicular neoplasms and for only 0.2% of all carcinoid tumors representing already a very rare neoplastic entity. Here, we present a patient with a history of an exceptionally rare primary testicular carcinoid tumor, staining positive for Cdx-2 along with a literature review. CASE PRESENTATION A 44-year old patient without significant past medical history was diagnosed in September 2009 with primary testicular carcinoid tumor, which was surprisingly staining positively for Cdx-2, too. At the time of the initial diagnosis the tumor was already showing histopathological infiltration of veins. DOTA-TATE-PET/CT imaging and endoscopy studies did not show any signs of distant metastases and in particular no gastrointestinal manifestation following no further medical indication for systemic chemotherapy. The continuous and close follow-up of the patient has reached a total of over 10 years at the time of publication remaining in complete remission. CONCLUSION The diagnosis of primary testicular carcinoid is based on histopathology. The detailed histopathologic assessment of biomarkers based on immunohistochemistry is very important for the classification and the prognosis of the primary testicular carcinoid tumor. Primary testicular carcinoid tumor with Cdx-2 positive stain outlines an exceptionally rare neoplastic entity without a consensus about general follow-up guidelines, requiring close clinical and imaging aftercare and consideration in Cdx-2 positive metastatic tumor of unknown origin.
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Affiliation(s)
- Eugen Widmeier
- Department of Medicine IV, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hannah Füllgraf
- Institute of Surgical Pathology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Cornelius F Waller
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany.
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Darré T, Doukouré B, Kouyaté M, Djiwa T, Kwamé D, Napo-Koura G. A rare testicular tumor: primary carcinoid tumor. TUMORI JOURNAL 2019; 105:NP20-NP23. [PMID: 30799770 DOI: 10.1177/0300891619832263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Primary carcinoid tumors are rare and constitute 0.23% of all testicular tumors. We report a case of primary carcinoid tumor of testicular localization, with a review of the literature. CASE PRESENTATION A 29-year-old man, without specific ascendants, consulted the urology department for progressive scrotal swelling of 6 months, associated with pain. After surgery, histology showed diffuse tumor proliferation composed of small round monotone cells with hyperchromatic nuclei evoking undifferentiated carcinoma. Immunohistochemistry showed that tumor cells were positive for chromogranin A and negative for placental alkaline phosphatase and α-fetoprotein. CONCLUSION Primary neuroendocrine carcinoma of the testis is a very rare malignant tumor. Immunohistochemistry contributes to its diagnosis in relation to other metastatic neuroendocrine carcinomas, carcinoid tumor teratomas, seminoma, and Sertoli cells.
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Affiliation(s)
- Tchin Darré
- Department of Pathology, University Teaching Hospital of Lomé, Togo
| | - Brahima Doukouré
- Department of Pathology, University Teaching Hospital of Cocody, Abidjan, Ivory Coast
| | - Mohamed Kouyaté
- Department of Pathology, University Teaching Hospital of Cocody, Abidjan, Ivory Coast
| | - Toukilnan Djiwa
- Department of Pathology, University Teaching Hospital of Lomé, Togo
| | - Doh Kwamé
- Department of Pathology, University Teaching Hospital of Lomé, Togo
| | - Gado Napo-Koura
- Department of Pathology, University Teaching Hospital of Lomé, Togo
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Büberal G, Sarsik B, Şimşir A, Tamsel S, Şen S. Testisin karsinoid tümörü: Nadir bir olgu. EGE TIP DERGISI 2019. [DOI: 10.19161/etd.416034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Primary Carcinoid Tumor of the Testis: A Case Report and Review of the Literature. Case Rep Urol 2018; 2018:3614387. [PMID: 30631634 PMCID: PMC6304607 DOI: 10.1155/2018/3614387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 11/12/2018] [Accepted: 11/22/2018] [Indexed: 12/03/2022] Open
Abstract
Carcinoid tumors usually arise in the gastrointestinal tract. Immunocytohistochemical and radiologic studies are important in detecting the primary tumor site. Primary carcinoid tumors of the testis are particularly rare with a high malignant potential warranting long-term follow-up. We present the case of a primary carcinoid tumor of the testis with long-term surveillance.
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Bangash HK, Hayne D, Thyer IA. Metastatic primary testicular carcinoid tumor managed with radical orchiectomy, retroperitoneal lymph node dissection and inferior vena cava excision: Case report. Urol Case Rep 2017; 15:56-58. [PMID: 28971023 PMCID: PMC5612786 DOI: 10.1016/j.eucr.2017.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 09/11/2017] [Indexed: 11/27/2022] Open
Abstract
Metastatic primary testicular carcinoid tumor remains a very rare condition. We report the first case of metastatic primary testicular carcinoid tumor where along retroperitoneal lymph node dissection excision of the Inferior Vena Cava was also performed. The rarity is further emphasised by the presence of a contralateral testicular dermoid cyst. Given the features of the tumor were not in keeping with the traditional predictors of metastases (primary tumor >7.3 cm, poor differentiation and the presence of carcinoid syndrome) this case adds valuable addition to the relatively limited literature available on this rare condition.
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Affiliation(s)
- H K Bangash
- Fiona Stanley Hospital, Murdoch, WA, Australia
| | - D Hayne
- Fiona Stanley Hospital, Murdoch, WA, Australia.,School of Surgery, University of Western Australia, Perth, WA, Australia
| | - I A Thyer
- Fiona Stanley Hospital, Murdoch, WA, Australia
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Frozen section analysis of unusual small testicular tumor masses: report of 3 cases. TUMORI JOURNAL 2016; 102:F10283EB-15F1-4A24-8933-934ADD86A8DD. [PMID: 26893271 DOI: 10.5301/tj.5000477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE Nonpalpable tumors of the testis are generally incidental findings on ultrasound examination. Most of these tumors are benign but some turn out to be germinal tumors at histology. Therefore, intraoperative histopathologic analysis of nonpalpable testicular lesions is pivotal for guiding a testis-sparing surgical approach. METHODS We report clinical and pathologic characteristics of 3 small nodules of the testis with challenging histologic features at intraoperative frozen section examination and peculiar histology. One was a known testicular mass, undertreated for 5 years, whose enlargement worried the patient, while the other 2 were incidental findings during clinical testicular examination for non-neoplastic diseases. CONCLUSIONS The 3 cases reported are characterized by small size, which limited the accuracy of preoperative ultrasound diagnosis. Intraoperative frozen section examination was able to rule out a diagnosis of germ cell malignancy in all cases, but diagnosis was conclusive only at histology. Knowledge of unexpected rare testicular lesions is of great relevance at the time of frozen section examination in view of conservative surgical strategy.
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Lubana SS, Singh N, Chan HC, Heimann D. Primary neuroendocrine tumor (carcinoid tumor) of the testis: a case report with review of literature. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:328-32. [PMID: 26027014 PMCID: PMC4463997 DOI: 10.12659/ajcr.894463] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The term carcinoid (Karzinoide) was coined by German pathologist Oberndorfer in 1907. Primary testicular carcinoid tumors (TCT) are rare, constituting 0.23% of all testicular tumors. In this report we describe a case of primary TCT of the testis and present the results of an extensive literature review to cover all the aspects of carcinoid tumor, including the definition, classification, origin, presentation, diagnostic evaluation, management, prognosis, and follow-up. CASE REPORT A 34-year-old male presented with chronic right scrotal swelling with recent onset of pain. Radical orchiectomy revealed a solid intratesticular tumor confined to the testis and epididymis, without lymphovascular invasion. Histology was consistent with neuroendocrine carcinoma. The tumor was staged as pT1 N0 M0 S2. Immunohistochemistry was positive for neuroendocrine markers. An extratesticular carcinoid tumor was ruled out. Urinary excretion of 5-hydroxyindoleacetic acid and Chromogranin A were within normal range. CONCLUSIONS It is important to follow serotonin levels since the elevated levels of serotonin can cause carcinoid heart disease. If metastatic lesions are not accessible for resection, a trial of octreotide therapy can be given. This case also adds to the rare reports in the literature of primary carcinoid tumors of the testis having low malignant potential. The literature review highlights new diagnostic and therapeutic interventions and stresses the importance of long-term follow-up due to evidence of delayed metastasis or recurrences and also due to emergence of new complications as a result of improved prognosis and prolonged survival.
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Affiliation(s)
- Sandeep Singh Lubana
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Queens, NY, USA
| | - Navdeep Singh
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Queens, NY, USA
| | - Hon Cheung Chan
- Department of Medical Hematology-Oncology, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Queens, NY, USA
| | - David Heimann
- Department of Surgical Oncology, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Queens, NY, USA
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Anwar S, Inselsbacher E, Grundler FM, Hofmann J. Arginine metabolism of Arabidopsis thaliana is modulated by Heterodera schachtii infection. NEMATOLOGY 2015. [DOI: 10.1163/15685411-00002921] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The plant-parasitic cyst nematode Heterodera schachtii induces syncytial feeding structures in the roots of host plants. These syncytia provide all required nutrients, water and solutes to the parasites. Previous studies on the composition of primary metabolites in syncytia revealed significantly increased amino acid levels. However, mainly due to technical limitations, little is known about the role of arginine in plant-nematode interactions. This free amino acid plays a central role in the plant primary metabolism and serves as substrate for metabolites involved in plant stress responses. Thus, in the present work, expression of genes coding for the enzymes of arginine metabolism were studied in nematode-induced syncytia compared to non-infected control roots of Arabidopsis thaliana. Further, amiRNA lines were constructed and T-DNA lines were isolated to test their effects on nematode development. While the silencing of genes involved in arginine synthesis increased nematode development, most T-DNA lines did not show any significant difference from the wild type. Amino acid analyses of syncytia showed that they accumulate high arginine levels. In addition, manipulating arginine cycling had a global effect on the local amino acid composition in syncytia as well as on the systemic amino acid levels in roots and shoots.
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Affiliation(s)
- Shahbaz Anwar
- Department of Crop Sciences, University of Natural Resources and Life Sciences, Konrad Lorenzstrasse 24, 3430 Tulln, Austria
| | - Erich Inselsbacher
- Department of Geography and Regional Research, University of Vienna, 1010 Vienna, Austria
| | - Florian M.W. Grundler
- INRES Molecular Phytomedicine, University Bonn, Karlrobert-Kreiten-Strasse 13, 53115 Bonn, Germany
| | - Julia Hofmann
- Department of Crop Sciences, University of Natural Resources and Life Sciences, Konrad Lorenzstrasse 24, 3430 Tulln, Austria
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Abstract
We report a case of a carcinoid tumor originated in testicle associated with mature teratoma in a 31 years old male. Primary gonadal location of this tumor is unusual, moreover when associated with teratoma. Early diagnosis and treatment determine the prognostic of the patients affected of this neoplasm since the only curative potential treatment is surgery. Follow up must be extent for years due to the possibility of late relapse.
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Abbosh PH, Zhang S, MacLennan GT, Montironi R, Lopez-Beltran A, Rank JP, Baldridge LA, Cheng L. Germ Cell Origin of Testicular Carcinoid Tumors. Clin Cancer Res 2008; 14:1393-6. [DOI: 10.1158/1078-0432.ccr-07-4146] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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