Intratesticular mucinous cystadenoma: immunohistochemical comparison with ovarian and colonic tissue

Review of Paratesticular Appendageal Tumors, Morphology, Immunohistochemistry, and Recent Molecular Advances

Paratesticular tumors are a rare and varied group of neoplasms arising from the tissues surrounding the testis, including the epididymis, spermatic cord, and tunica vaginalis, representing less than 10% of intrascrotal tumors. Benign tumors such as adenomatoid tumors are common, often asymptomatic but can cause discomfort. Malignant tumors, like mesothelioma and adenocarcinomas arising from appendageal structures exhibit aggressive behavior and potential for metastasis. Diagnosis involves clinical evaluation, imaging, and histopathological examination. Treatment varies by tumor type, ranging from conservative management to multimodal approaches, with recent molecular advances enhancing personalized treatment strategies.

Case report: Misdiagnosis of primary mucinous cystadenoma of the testicle by ultrasound

Testicular mucinous cystadenoma is a rare benign testicular tumor with the characteristics of being potentially malignant and showing atypical clinical symptoms; this article reports a case of a primary testicular mucinous cystadenoma misdiagnosed as testicular teratoma by ultrasound. A 69-year-old man was admitted to the hospital because of a 1-year history of left-sided testicular enlargement with scrotal swelling and no obvious abnormalities on laboratory tests. Ultrasound examination revealed solid-mass lesions in the left testicle, suggesting a high probability of teratoma, and contrast-enhanced magnetic resonance imaging (MRI) examination suggested an increased possibility of epidermoid cysts. Contrast-enhanced computed tomography (CT) and contrast-enhanced MRI of the preoperative abdomen and pelvis showed no other primary adenocarcinoma. Doctors performed radical resection of the left testicle. The postoperative pathological diagnosis was mucinous cystadenoma, and calcification as well as partially mildly atypical epithelial cells were discovered. Furthermore, there were no neoplastic lesions in the epididymis or spermatic cord. No metastatic lesions were found after 6 months postoperative follow-up, and the patient's prognosis remains good.

Primary Borderline Mucinous Testicular Tumor: A Case Report and Literature Review

Primary mucinous tumors of the testis and paratestis are very rare, with only 29 reported cases detected in a PubMed search. The histopathological characteristics of primary testicular mucinous tumors are similar to their ovarian counterparts, and the diagnosis and naming criteria refer to the criteria for female ovarian mucinous tumors. However, the clinical and imaging features of primary testicular mucinous tumors are poorly understood, and they are thus frequently undiagnosed or misdiagnosed. We present the case of a patient with a primary testicular mucinous tumor. A 52-year-old man presented with a 1-year history of painless enlargement of the left scrotum. Ultrasound examination revealed a cystic mass in the left testis, with viscous fluid areas and calcified spots, irregular solid bulges on the cyst wall, and a small blood supply. Serum alpha-fetoprotein, β-human chorionic gonadotropin, lactate dehydrogenase, renal function, inflammatory markers, and routine urine and blood examinations were all normal. The patient underwent radical resection of the left testis. Postoperative pathology showed a multilocular cystic mass, with the inner wall of the sac lined with mucous columnar epithelial cells, some with mild nuclear atypia, and no interstitial infiltration. The pathological diagnosis was testicular mucinous tumor. Postoperative abdominal and pelvic computed tomography, colonoscopy, and gastroscopy showed no suspicious lesions. The final diagnosis was primary testicular borderline mucinous tumor. The patient underwent postoperative follow-up examinations once a year for 4 years. Serum tumor markers, scrotal ultrasound, abdominal and pelvic computed tomography scans, and colonoscopy and gastroscopy revealed no evidence of metastases or other primary adenocarcinoma. This case highlights the clinical and imaging characteristics of primary testicular mucinous tumors, which might aid their differential diagnosis.

Management of a patient with primary mucinous testicular adenocarcinoma as a rare case with adjuvant and metastatic sequential treatments

INTRODUCTION

Mucinous adenocarcinomas of the testicular surface epithelial tumors are very rare and are similar to malignant ovarian-type surface epithelial tumors. Although only 32 cases have been reported to date, there are only five cases of primary testicular mucinous carcinoma with access to literature in English. So there is still limited information about clinical, etiopathogenesis and treatment options.

CASE REPORT

In this article, we discuss a 56-year-old male patient diagnosed with testicular mucinous adenocarcinoma due to its rarity in the light of literature review.Management and outcome: We preferred cisplatin-paclitaxel regimen for adjuvant treatment. We then used sequential treatments including oxaliplatin, 5-fluorourasil, etoposide, gemcitabine, and docetaxel to treat metastatic disease. The patient underwent lung metastasectomy for the first relapse. The patient was diagnosed in November 2013 and the response to treatment was evaluated in December 2019 and stable disease was detected. The patient, who has a total survival of 73 months, is still under treatment.

DISCUSSION

Excluding malign transformation and borderline mucinous testicular tumors from mucinous cystadenomas of the testis, the knowledge on carcinogenesis, clinical course, and treatment of primary testicular mucinous adenocarcinomas is very limited.

Borderline Mucinous Testicular Tumour: Diagnostic and Management difficulties

A 45-year-old man presented with right-sided testicular swelling and pain. An examination found a tender, firm right testis, a clinically normal left testis and no palpable lymphadenopathy. Tumour and inflammatory markers were within normal limits. A scrotal ultrasound scan showed an intratesticular, avascular lesion measuring 4.4×2.6×1.8 cm. A CT scan of his chest/abdomen/pelvis (CT C/A/P) showed no metastatic or primary lesions. An elective right-inguinal orchidectomy was subsequently performed. Histopathology showed a cystic mucinous tumour lined with intestinal-type epithelium. Differentials of metastatic adenocarcinoma, possibly of a gastrointestinal origin, a monodermal teratoma, or a borderline mucinous tumour of the testicle (BMTT) were considered. Following 12 p genetic studies and a colonoscopy, both of which found no abnormalities, a presumptive diagnosis of a BMTT was made. The patient is to have an annual urological review with a CT C/A/P and 5 yearly colonoscopies.

Mucinous Cystadenoma of the Testis: A Case Report with Immunohistochemical Findings

Mucinous cystadenoma of the testis is a very rare tumor. Herein, we report a case of mucinous cystadenoma arising in the testis of a 61-year-old man, along with a literature review. Computed tomography showed a 2.5-cm-sized poorly enhancing cystic mass. Grossly, the tumor was a unilocular cystic mass filled with mucinous material and confined to the testicular parenchyma. Histologically, the cyst had a fibrotic wall lined by mucinous columnar epithelium without atypia. Immunohistochemical staining was positive for cytokeratin 20 and CDX2, as well as focally positive for cytokeratin 7. The pathologic diagnosis was mucinous cystadenoma.

Non-pancreatic retroperitoneal mucinous neoplasms and a discussion of the differential diagnosis

Retroperitoneal mucinous neoplasms are common and have a wide range of differential diagnoses to consider. It is of utmost importance to maintain a multidisciplinary approach when evaluating these lesions. Clinical history, surgical impression and radiographic studies should be obtained and used in conjunction with morphology and immunohistochemistry to help guide the pathologist to the correct diagnosis. We recently encountered a case of a 51-year-old man who presented with an 11.5 cm left-sided retroperitoneal mucinous neoplasm. This lesion was initially diagnosed as a low-grade mucinous carcinoma of probable pancreatic origin at an outside facility, and he was subsequently treated with chemotherapy. One year later he presented to our institution and underwent retroperitoneal en bloc resection of the 7-cm residual multiloculated mucinous neoplasm. When discussed at tumor board additional medical history was obtained, and review of the patient's chart revealed a remote history of left orchiectomy for a mixed malignant germ cell tumor and metastatic embryonal carcinoma in 2 of 34 retroperitoneal/para-aortic lymph nodes. With no clinical evidence of tumor in the pancreas or extension from it, the predominately para-aortic location of the tumor favors a mucinous carcinoma arising from a rest of mature metastatic/proliferating teratoma that persisted after chemotherapy. This case illustrates the importance of a thorough history, however remote, and correlation with imaging in the development of differential diagnoses, as well as, the need to consider non-pancreaticobiliary sources of retroperitoneal mucinous tumors.

Primary borderline mucinous tumors of the testis: a case report and literature review

Ovarian-type epithelial tumors of the testes and paratestes are very rare. Mucinous subtypes of such tumors are extremely rare; only 25 cases have been reported to date. Ovarian-type epithelial tumors are histologically classified into cystadenomas, borderline tumors, and carcinomas. We herein report a case involving a 60-year-old man with a primary borderline mucinous tumor of the testis. He underwent orchiectomy and has developed no recurrence for 4 years. This is the 26th report of a mucinous tumor of the testis in the literature. We also herein review the literature and discuss the etiology, prognosis, and treatment of mucinous tumors of the testes.

Novel Hormone Receptors Present in Apocrine Cystadenoma of the Eyelid

A 53-year-old woman presented with an apocrine cystadenoma of the right upper eyelid. Histologic examination revealed proliferating epithelial cells with apocrine snouts and occasional mitotic figures. Immunohistochemical analysis revealed a Ki-67 index of 15% and positive staining for synaptophysin, chromogranin, estrogen receptor, progesterone receptor, gross cystic disease fluid protein (GCDFP)-15, and mammoglobin. The complement of positive immunomarkers in this case reinforces the importance of total excision and careful histologic assessment.

Primary borderline mucinous neoplasm of the testis: A case report and literature review

Testicular/paratesticular neoplasms morphologically resembling surface epithelial tumors of ovarian type are rare neoplasms. The criteria for the diagnosis and nomenclature of these tumors parallels those used for ovarian homologues. Pathologists and urologists need to be wary of this uncommon entity, excluding metastatic mucinous adenocarcinoma and herniation of mucinous tumors into paratestis/scrotal sac by careful clinicopathological correlation. Herein, we present the first case of borderline mucinous tumor of testis to be reported from India.

Primary testicular mucinous neoplasms: case report and literature review

Testicular epithelial mucinous tumours are an extremely rare, but interesting form of testicular neoplasm. We reviewed the medical literature using PubMed search terms: testis, mucinous cystadenoma, mucinous cystadenocarcinoma, neoplasms and testicular neoplasms. We describe a case from our institution and provide a review of the literature. Only 11 previously reported cases of mucinous testicular tumours have been reported in the English literature. The natural history of these tumours is poorly understood, due to their rarity, but it appears that, like their ovarian counterparts, they have an excellent prognosis. Exclusion of metastasis is an important point for the urologist when encountering a mucinous testicular tumour, as metastatic cystic lesions may mimic a primary mucinous tumour. We describe a case of ossified testicular mucinous tumour of low malignant potential. Such tumours are common in the ovary, but arise very rarely in the testicle. The clinical and histological features of this tumour are presented, and previously reported cases are reviewed to highlight important clinical features.

Mucinous cystadenocarcinoma of the testis: a case report

We present a rare case of unilateral intratesticular cystadenocarcinoma with mucinous differentiation in a 71-year-old male patient. The orchiectomy specimen revealed a 3.5-cm well to moderately differentiated cystic neoplasm with elongated fine papillary structures lined by columnar epithelium with alternating goblet and ciliated cells completely replacing the testicular parenchyma. Immunohistochemical studies showed positivity for cytokeratin 20, carcinoembryonic antigen, and mucin 2, and negativity for cytokeratin 7, mucin 5AC, vimentin, thyroid transcription factor 1, Wilms' tumor 1, and cancer antigen 125. The current case shows a focal cyst-lining component with benign appearance. Imaging studies and colonoscopy showed no evidence of other suspicious lesions. This tumor resembles morphologically to an intestinal-type ovarian surface epithelial tumor.

Paratesticular mucinous cystadenoma arising from an oviduct-like müllerian remnant: a case report and review of the literature

A mucinous cystadenoma of the paratestis arising from an unequivocal oviduct-like structure in an 18-year-old man is reported. Mucinous cystadenomas of the testis and paratestis are extremely rare benign tumors of controversial origin. The diagnosis may be challenging and is of clinical importance because these lesions may mimic a teratoma, and teratomas in postpubertal males carry a malignant potential regardless of the degree of maturation. A few case reports and reviews of testicular and paratesticular mucinous neoplasms resembling ovarian tumors have suggested the possibility of a müllerian origin of these tumors. However, no histologic evidence has been found to support such a histogenesis. The current case demonstrates a clear transition from müllerian-type tubal epithelium to intestinal-type mucinous epithelium. This finding, in conjunction with immunophenotypic studies, strongly supports a derivation from a paratesticular müllerian remnant. To our knowledge this represents the first substantial evidence that, in at least some cases, mucinous cystadenomas of the testis and paratestis are of müllerian derivation.