- Email: [email protected]
PRIMARY TESTICULAR SARCOMA
0022-5347/00/1636-1871/0 THE JOURNAL OF UROLOGY® Copyright © 2000 by AMERICAN UROLOGICAL ASSOCIATION, INC.®
Vol. 163, 1871, June 2000 Printed in U.S.A.
PRIMARY TESTICULAR SARCOMA MATTHEW ALLAWAY, UNYIME O. NSEYO
AND
STANLEY J. KANDZARI
From the Department of Urology, West Virginia University, Health Sciences Center, Morgantown, West Virginia, and Division of Urology, Medical College of Virginia, Richmond, Virginia KEY WORDS: sarcoma, testis, germ cells
The majority of primary testicular tumors are of germ cell origin. Other rare testicular primary tumors include lymphoma, stromal cell tumors and sarcomas. We report a case of primary testicular sarcoma. CASE REPORT
A 51-year-old white man presented with a 2-month history of a painless left testicular mass. Medical history was unremarkable. Physical examination revealed a left testicular tumor, which was heterogeneous on ultrasound. ␣-Fetoprotein, -human chorionic gonadotropin and lactate dehydrogenase were normal. The orchiectomy specimen consisted of a 22 gm. testicle with attached spermatic cord. A 1.4 cm. well-defined tan firm nodule was in the middle of the testicle. The remaining spermatic cord and testicle were unremarkable. Microscopically, this tumor was biphasic with spindle cell and epithelioid components. The tumor was examined for germ cell elements. Immunohistochemically, the tumor cells exhibited epithelial and mesenchymal markers. In addition, antibody staining for inhibin was negative. The Armed Forces Institute of Pathology corroborated the diagnosis of malignant spindle cell carcinoma. Postoperative computerized tomography of the body revealed no evidence of malignancy. Quarterly followup computerized tomography of the chest, abdomen and pelvis, and tumor markers remained negative 1 year postoperatively.
all were completely contained within the tunica vaginalis. Mean patient age at presentation was 32 years (range 3 to 86). Sarcomatous elements have been described as nongerm cell components within germ cell tumors, which develop by differentiation of totipotential germ cell to somatic tissue with malignant transformation or by malignant transformation of preexisting teratomatous elements.2 Due to the rarity of primary testicular sarcomas, treatment recommendations are difficult to establish. Of the 16 patients a 71-year-old man who had distant metastasis at the time of diagnosis died of a pure fibrosarcoma. All patients underwent initial orchiectomy and 2 underwent retroperitoneal lymph node dissection, including 1 who had chondrosarcoma that failed to respond to combination chemotherapy and was extirpated surgically.3 CONCLUSIONS
Primary testicular sarcoma is rare and can be mistaken for other stromal tumors. The origin of intratesticular sarcoma is unclear. However, its clinical presentation is similar to that of paratesticular sarcoma. Evaluation of the primary tumor for teratomatous elements is essential because these sarcomas have a poorer prognosis. Overall, treatment recommendation is unclear but it should be individualized.
DISCUSSION
Since 1960, there have been 16 cases of testicular sarcoma reported in the literature.1 Histologically, these cases included 3 leiomyosarcomas, 5 rhabdosarcomas, 2 fibrosarcoma, 2 osteosarcomas, 1 chondrosarcoma and 3 spindle cell sarcomas. Tumor size averaged 6.8 cm. (range 0.2 to 15) and Accepted for publication January 14, 2000.
1871
REFERENCES
1. Washecka, R. M., Mariani, A. J., Zuna, R. E. et al: Primary intratesticular sarcoma. Immunohistochemical ultrastructural and DNA flow cytometric study of three cases with a review of the literature. Cancer, 77: 1524, 1996 2. Ulbright, T. M., Loehrer, P. J., Roth, L. M. et al : The development of non-germ cell malignancies within germ cell tumors. A clinicopathologic study of 11 cases. Cancer, 54: 1824, 1984 3. Mathew, T. and Prabhakaran, K.: Osteosarcoma of the testis. Arch Pathol Lab Med, 105: 38, 1981
Vol. 163, 1871, June 2000 Printed in U.S.A.
PRIMARY TESTICULAR SARCOMA MATTHEW ALLAWAY, UNYIME O. NSEYO
AND
STANLEY J. KANDZARI
From the Department of Urology, West Virginia University, Health Sciences Center, Morgantown, West Virginia, and Division of Urology, Medical College of Virginia, Richmond, Virginia KEY WORDS: sarcoma, testis, germ cells
The majority of primary testicular tumors are of germ cell origin. Other rare testicular primary tumors include lymphoma, stromal cell tumors and sarcomas. We report a case of primary testicular sarcoma. CASE REPORT
A 51-year-old white man presented with a 2-month history of a painless left testicular mass. Medical history was unremarkable. Physical examination revealed a left testicular tumor, which was heterogeneous on ultrasound. ␣-Fetoprotein, -human chorionic gonadotropin and lactate dehydrogenase were normal. The orchiectomy specimen consisted of a 22 gm. testicle with attached spermatic cord. A 1.4 cm. well-defined tan firm nodule was in the middle of the testicle. The remaining spermatic cord and testicle were unremarkable. Microscopically, this tumor was biphasic with spindle cell and epithelioid components. The tumor was examined for germ cell elements. Immunohistochemically, the tumor cells exhibited epithelial and mesenchymal markers. In addition, antibody staining for inhibin was negative. The Armed Forces Institute of Pathology corroborated the diagnosis of malignant spindle cell carcinoma. Postoperative computerized tomography of the body revealed no evidence of malignancy. Quarterly followup computerized tomography of the chest, abdomen and pelvis, and tumor markers remained negative 1 year postoperatively.
all were completely contained within the tunica vaginalis. Mean patient age at presentation was 32 years (range 3 to 86). Sarcomatous elements have been described as nongerm cell components within germ cell tumors, which develop by differentiation of totipotential germ cell to somatic tissue with malignant transformation or by malignant transformation of preexisting teratomatous elements.2 Due to the rarity of primary testicular sarcomas, treatment recommendations are difficult to establish. Of the 16 patients a 71-year-old man who had distant metastasis at the time of diagnosis died of a pure fibrosarcoma. All patients underwent initial orchiectomy and 2 underwent retroperitoneal lymph node dissection, including 1 who had chondrosarcoma that failed to respond to combination chemotherapy and was extirpated surgically.3 CONCLUSIONS
Primary testicular sarcoma is rare and can be mistaken for other stromal tumors. The origin of intratesticular sarcoma is unclear. However, its clinical presentation is similar to that of paratesticular sarcoma. Evaluation of the primary tumor for teratomatous elements is essential because these sarcomas have a poorer prognosis. Overall, treatment recommendation is unclear but it should be individualized.
DISCUSSION
Since 1960, there have been 16 cases of testicular sarcoma reported in the literature.1 Histologically, these cases included 3 leiomyosarcomas, 5 rhabdosarcomas, 2 fibrosarcoma, 2 osteosarcomas, 1 chondrosarcoma and 3 spindle cell sarcomas. Tumor size averaged 6.8 cm. (range 0.2 to 15) and Accepted for publication January 14, 2000.
1871
REFERENCES
1. Washecka, R. M., Mariani, A. J., Zuna, R. E. et al: Primary intratesticular sarcoma. Immunohistochemical ultrastructural and DNA flow cytometric study of three cases with a review of the literature. Cancer, 77: 1524, 1996 2. Ulbright, T. M., Loehrer, P. J., Roth, L. M. et al : The development of non-germ cell malignancies within germ cell tumors. A clinicopathologic study of 11 cases. Cancer, 54: 1824, 1984 3. Mathew, T. and Prabhakaran, K.: Osteosarcoma of the testis. Arch Pathol Lab Med, 105: 38, 1981