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Secondary Testicular Tumors
VoL 118, Se1ptember Printed in
THE JOURNAL OF UROLOGY
Copyright © 1977 by The Williams & Wilkins Co.
SECONDARY TESTICULAR TUMORS ROBERT P. CRICCO
AND
STANLEY J. KANDZARI
From the Division of Urology, West Virginia University Medical Center, Morgantown, West Virginia
ABSTRACT
A case of bilateral testicular metastases from carcinoma of the colon is reported. A review of the literature on secondary testicular tumors reveals their rarity and speculation is made as to the routes of metastases. Metastatic tumors to the testes are extremely rare. In a 24,000 autopsies there were 15 cases Pr,,"';-,,i-w involvement of the testes for an incidence of0.06 cent. 1 The prostate was the most common source of origin. 8 reported colon as the primary site is quite rare with cases to date. Herein we report the first case bilateral testicular metastases from carcinoma of the colon. CASE REPORT
R M , B:33-15-50-4, a 47-year-old white man, was hospitalized on 1976 because of a sudden onset of severe abdominal pain. On examination he was cachectic. There was diffuse au1LJ.u,11u.uu tenderness with peritoneal irritation and absent bowel sounds. The right testicle was in the canal and was hard and enlarged with induration the cord structures. The left testicle also was enlarged, distorted and high in the scrotum. Rectal examination was ·1 norn1.a,. laparotomy revealed diffuse peritoneal carcinomatosis a perforated cecum that also was involved with tmnor. A double-barrel ileostomy was performed. The pathofrom an omental biopsy revealed infiltrating with extensive mucin production. the patient had testicular masses. Because is the most likely cause of bilateral arose whether this was a manifes1111,u,nu"'- or metastases from the colon. Excisional testes revealed mucinous adenocarcinoma of testes (see figure). The tumor was identical in appearance to that seen in the omentum, Convalescence was uneventful and the was started on chemotherapy.
of the colon as the primary site were noted. 1, 3 , 5---s These tumors occur later in Hfe, usually during the sixth and seventh dee-" ades, as opposed to primary testicular tumors, which tend to occur in the third and fourth decades. Bilateral testicular metastases have been reported in casess--12 and all, except 1 that was secondary to retinoblastoma, 6 were secondary to carcinoma of the prostate, We have found no case reports of bilateral testicular metastases from carcinoma of the colon. It is interesting to speculate as to the route of metastasis in secondary testicular tumors. Kay and associates proposed retrograde extension through the vas deferens as a source, 1:i Hanash and associates reported 9 cases of carcinoma of the prostate with metastasis to the spermatic cord, as well as 3 cases of metastases to the testes from the prostate, and gested the possibility of spread through the vas deferens, 6 most likely route of metastasis from carcinoma of the left kidney is via the left spermatic vein. Belsky and
DISCUSSION
In 1936 Willis reviewed metastatic testicular tumors and less than 50 cases. 2 In 1957 Price and Mostofi recases of primary tumors of the testes. 3 They found 38 cases of secondary carcinoma of the testes, with the (14 cases) the most common source. Secondary of the testes by sarcoma was more common. ,py:.roxiinaLtel:v 2.5 cent of generalized lymphomas were in the testes. 1972 Pienkos and Jablokow reported on 90 additional cases from the literature and added 15 of their found the prostate to be the most common source of sources of primary tumor have been reported from small bowel carcinoid, appendix, contralateral testes, pancreas, adrenal, bladder, bile ducts and melanoma. 180 cases of secondary testicular To date Of these only 8 cases of carcinoma tumors have for publication May 6, 1977, annual meeting of Mid-Atlantic Section, American UrolDorado Beach, Puerto Rico, September 26-0cto-
Excisional biopsies from testes show adenocarcinoma and mucin production.
in a report on testicular metastasis from carcinoma of the colon, found 1 small tumor nodule in the testis with the same histological feature found at the primary site and speculated that retrograde spread from the primary tumor through the left spermatic vein could occur. 5 Several other routes possible for tumor spread, such as direct invasion from uous growths, retrograde venous embolism, retrograde phatic extension from large para-aortic nodes, arterial zation and transperitoneal seeding through a congenital drocele. Therefore, we suggest that when an abnormal testis xs palpated in the older patient one should be suspicious that this may be a manifestation of metastatic disease from an unknown primary tumor. 489
490
CRICCO AND KANDZARI REFERENCES
1. Pienkos, E. J. and Jablokow, V. R.: Secondary testicular tumors. Cancer, 30: 481, 1972. 2. Willis, R. A.: The Spread of Tumours in the Human Body, 2nd ed. London: Butterworth, 1952. 3. Price, E. B., Jr. and Mostofi, F. K.: Secondary carcinoma of the testis. Cancer, 10: 592, 1957. 4. Watson, E. M., Sauer, J. R. and Sadugor, M. G.: Manifestations of the lymphoblastomas in the genito-urinary tract. J. Urol., 61: 626, 1949. 5. Belsky, J.B. and Kornwaler, B. E.: Testicular metastasis from carcinoma of the colon. J. Urol., 72: 712, 1954. 6. Hanash, K. A., Carney, J. A. and Kelalis, P. P.: Metastatic tumors to testicles: routes of metastasis. J. Urol., 102: 465, 1969.
7. Hunter, D. T., Jr. and Hutcheson, J. B.: Krukenberg tumor of the testicle, report of a second case. J. Urol., 81: 305, 1959. 8. Mazzoleni, G.: Metastases to the testis from carcinoma of the colon. Riv. Anat. ·Path. Oncol., 23: 304, 1963. 9. Malek, G. H. and Madsen, P. 0.: Carcinoma of the prostate with unusual metastases. Cancer, 24: 194, 1969. 10. Ney, C., Roth, J. J. and Lopez, C. A.: Carcinoma of the prostate with metastases to the testicle. Arch. Surg., 79: 1028, 1959. 11. Marble, E. J.: Testicular metastases from carcinoma of the prostate: review of the literature and report of a case. J. Urol., 84: 369, 1960. 12. Markland, C.: Testicular tumors. Curr. Prob. Surg., 3: 51, 1968. 13. Kay, S., Hennigar, G. R. and Hoper, J. W.: Carcinoma of the testes metastatic from carcinoma of the prostate. Arch. Path., 57: 121, 1954.
THE JOURNAL OF UROLOGY
Copyright © 1977 by The Williams & Wilkins Co.
SECONDARY TESTICULAR TUMORS ROBERT P. CRICCO
AND
STANLEY J. KANDZARI
From the Division of Urology, West Virginia University Medical Center, Morgantown, West Virginia
ABSTRACT
A case of bilateral testicular metastases from carcinoma of the colon is reported. A review of the literature on secondary testicular tumors reveals their rarity and speculation is made as to the routes of metastases. Metastatic tumors to the testes are extremely rare. In a 24,000 autopsies there were 15 cases Pr,,"';-,,i-w involvement of the testes for an incidence of0.06 cent. 1 The prostate was the most common source of origin. 8 reported colon as the primary site is quite rare with cases to date. Herein we report the first case bilateral testicular metastases from carcinoma of the colon. CASE REPORT
R M , B:33-15-50-4, a 47-year-old white man, was hospitalized on 1976 because of a sudden onset of severe abdominal pain. On examination he was cachectic. There was diffuse au1LJ.u,11u.uu tenderness with peritoneal irritation and absent bowel sounds. The right testicle was in the canal and was hard and enlarged with induration the cord structures. The left testicle also was enlarged, distorted and high in the scrotum. Rectal examination was ·1 norn1.a,. laparotomy revealed diffuse peritoneal carcinomatosis a perforated cecum that also was involved with tmnor. A double-barrel ileostomy was performed. The pathofrom an omental biopsy revealed infiltrating with extensive mucin production. the patient had testicular masses. Because is the most likely cause of bilateral arose whether this was a manifes1111,u,nu"'- or metastases from the colon. Excisional testes revealed mucinous adenocarcinoma of testes (see figure). The tumor was identical in appearance to that seen in the omentum, Convalescence was uneventful and the was started on chemotherapy.
of the colon as the primary site were noted. 1, 3 , 5---s These tumors occur later in Hfe, usually during the sixth and seventh dee-" ades, as opposed to primary testicular tumors, which tend to occur in the third and fourth decades. Bilateral testicular metastases have been reported in casess--12 and all, except 1 that was secondary to retinoblastoma, 6 were secondary to carcinoma of the prostate, We have found no case reports of bilateral testicular metastases from carcinoma of the colon. It is interesting to speculate as to the route of metastasis in secondary testicular tumors. Kay and associates proposed retrograde extension through the vas deferens as a source, 1:i Hanash and associates reported 9 cases of carcinoma of the prostate with metastasis to the spermatic cord, as well as 3 cases of metastases to the testes from the prostate, and gested the possibility of spread through the vas deferens, 6 most likely route of metastasis from carcinoma of the left kidney is via the left spermatic vein. Belsky and
DISCUSSION
In 1936 Willis reviewed metastatic testicular tumors and less than 50 cases. 2 In 1957 Price and Mostofi recases of primary tumors of the testes. 3 They found 38 cases of secondary carcinoma of the testes, with the (14 cases) the most common source. Secondary of the testes by sarcoma was more common. ,py:.roxiinaLtel:v 2.5 cent of generalized lymphomas were in the testes. 1972 Pienkos and Jablokow reported on 90 additional cases from the literature and added 15 of their found the prostate to be the most common source of sources of primary tumor have been reported from small bowel carcinoid, appendix, contralateral testes, pancreas, adrenal, bladder, bile ducts and melanoma. 180 cases of secondary testicular To date Of these only 8 cases of carcinoma tumors have for publication May 6, 1977, annual meeting of Mid-Atlantic Section, American UrolDorado Beach, Puerto Rico, September 26-0cto-
Excisional biopsies from testes show adenocarcinoma and mucin production.
in a report on testicular metastasis from carcinoma of the colon, found 1 small tumor nodule in the testis with the same histological feature found at the primary site and speculated that retrograde spread from the primary tumor through the left spermatic vein could occur. 5 Several other routes possible for tumor spread, such as direct invasion from uous growths, retrograde venous embolism, retrograde phatic extension from large para-aortic nodes, arterial zation and transperitoneal seeding through a congenital drocele. Therefore, we suggest that when an abnormal testis xs palpated in the older patient one should be suspicious that this may be a manifestation of metastatic disease from an unknown primary tumor. 489
490
CRICCO AND KANDZARI REFERENCES
1. Pienkos, E. J. and Jablokow, V. R.: Secondary testicular tumors. Cancer, 30: 481, 1972. 2. Willis, R. A.: The Spread of Tumours in the Human Body, 2nd ed. London: Butterworth, 1952. 3. Price, E. B., Jr. and Mostofi, F. K.: Secondary carcinoma of the testis. Cancer, 10: 592, 1957. 4. Watson, E. M., Sauer, J. R. and Sadugor, M. G.: Manifestations of the lymphoblastomas in the genito-urinary tract. J. Urol., 61: 626, 1949. 5. Belsky, J.B. and Kornwaler, B. E.: Testicular metastasis from carcinoma of the colon. J. Urol., 72: 712, 1954. 6. Hanash, K. A., Carney, J. A. and Kelalis, P. P.: Metastatic tumors to testicles: routes of metastasis. J. Urol., 102: 465, 1969.
7. Hunter, D. T., Jr. and Hutcheson, J. B.: Krukenberg tumor of the testicle, report of a second case. J. Urol., 81: 305, 1959. 8. Mazzoleni, G.: Metastases to the testis from carcinoma of the colon. Riv. Anat. ·Path. Oncol., 23: 304, 1963. 9. Malek, G. H. and Madsen, P. 0.: Carcinoma of the prostate with unusual metastases. Cancer, 24: 194, 1969. 10. Ney, C., Roth, J. J. and Lopez, C. A.: Carcinoma of the prostate with metastases to the testicle. Arch. Surg., 79: 1028, 1959. 11. Marble, E. J.: Testicular metastases from carcinoma of the prostate: review of the literature and report of a case. J. Urol., 84: 369, 1960. 12. Markland, C.: Testicular tumors. Curr. Prob. Surg., 3: 51, 1968. 13. Kay, S., Hennigar, G. R. and Hoper, J. W.: Carcinoma of the testes metastatic from carcinoma of the prostate. Arch. Path., 57: 121, 1954.