Papillary adenocarcinoma of rete testis. Autopsy findings, histochemistry, immunohistochemistry, ultrastructure, and clinical correlations

Adenocarcinoma of the rete testis is a rare neoplasm that usually occurs in men after the age of 60 and carries a variable prognosis. We report an occurrence of this tumor in a 91-year-old man who had been treated for 2 years for an hydrocele. At the time of diagnosis, metastases were not evident; and the patient was treated with local radiotherapy. The diagnosis of papillary adenocarcinoma of the rete testis was made on the basis of: (a) a transition from normal rete testis to atypical and neoplastic rete epithelium; (b) exclusion of primary germinal and nongerminal testicular tumors and spread from distant sources; and (c) electron-microscopic findings, histochemical and immunological studies, and autopsy findings supporting the diagnosis. This is the first reported case of adenocarcinoma of the rete testis that includes documentation of the tumor's metastatic pattern.     

Primary adenocarcinoma of the rete testis

We report a case of adenocarcinoma of the rete testis in a 44-year-old man, presented intially with a hydrocele and later with signs of infection in the affected hemiscrotum. Multiple focal lesions within the testis appeared 6 months later in ultrasounds. After high inguinal orchiectomy, histology revealed a primary adenocarcinoma of the rete testis. Adenocarcinoma of the rete testis is a rare a highly malignant tumour originating in the mediastinum of the testis. Slightly over 40 cases have been reported in the literature. The treatment of choice is radical orchiectomy. Prognosis is poor; as mainly as 40% of patients die within the first year of diagnosis.     

Adenocarcinoma of rete testis

We report a case of adenocarcinoma of rete testis in 64-year-old man. His first diagnosis was hydrocele of left testis, but aspiration cytology showed malignancy. The patient underwent left orchiectomy. The pathological diagnosis was adenocarcinoma of the rete testis. The cancer was suspected to be arising from the duct of rete testis on the histological examination, and no other malignancy was found elsewhere in his body. However, he died at 10 months after the operation for lung metastasis. Adenocarcinoma of rete testis is one of the rarest malignancies. Only 25 cases have been reported since the first case was described by Feek and Hunter in 1945. This is the twenty-sixth case in the literature.     

Adenocarcinoma of the rete testis. A case report

Adenocarcinoma of the rete testis is a rare malignant tumor with a poor prognosis. About 60 cases of this adenocarcinoma have been reported in the literature. The diagnosis is often difficult and made incidentally. Herein, we report a case of adenocarcinoma of the rete testis and review the literature. Our patient was an 80-year-old man who presented with painless scrotal swelling for 2 years. Physical examination revealed an enlarged, hard mass of the left scrotum. The serum markers alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (beta-HCG), and carcinoembryonic antigen (CEA) were negative. Magnetic resonance imaging (MRI) showed a left hydrocele with central necrosis of the testis. After 4 months, the patient presented with appetite loss, general fatigue, and pain in the left scrotum. Positron emission tomography (PET) was performed in another hospital, and the patient was referred for a left testicular tumor, multiple lung metastases, and para-aorta lymph node metastasis. The patient underwent left high inguinal orchiectomy. Pathological examination revealed a hard whitish mass around the testis involving the epididymis and tunica vaginalis and spreading under the subcutaneous tissue. Histological examination revealed adenocarcinoma in the hilum of the testis, which extended to the subcutaneous tissue but not to the surface of the scrotum. The tunica albuginea was intact, and no invasion of carcinoma in the testis was seen. After the histological diagnosis of adenocarcinoma of the rete testis was confirmed, computed tomography (CT) was performed and showed multiple pulmonary nodules and para-aortica lymph node swelling of 3 cm diameter. Because the patient did not wish to receive chemotherapy or other aggressive treatment, he has been followed-up with palliative care since his diagnosis. Although local recurrence has occurred 4 months later, he is still alive for 8 months since his diagnosis.     

睾丸网腺癌(1例报告并文献复习)

目的了解睾丸网腺癌的发病和临床特点，提高其早期诊断和治疗水平。方法分析1例睾丸网腺癌患者的临床资料，并结合文献对睾丸网腺癌的临床病理特点、早期诊断和治疗进行讨论。结果术前诊断为左睾丸鞘膜积液、左睾丸肿瘤待排，遂行左高位睾丸切除术，术后病理检查诊断为睾丸网腺癌。免疫组化：AFP（-），PLAP（-），CK（＋），CD30（-），CK20（＋）。术后CT示肝内多发转移瘤、左肾和左肾上腺转移改变。结论睾丸网腺癌是原发于睾丸网纵膈的恶性肿瘤，极为罕见，其临床表现独特，基本治疗是根治性睾丸切除术辅以根治性腹膜后淋巴结清扫术，放疗和化疗效果欠佳。该病预后差，文献报道5年生存率仅为13％。     

Adenocarcinoma of the rete testis

Summary Adenocarcinoma of the rete testis is a rare tumor. Histologic diagnosis is difficult, and in the past the tumor may have been incorrectly identified in a number of cases, leading to misleading information on the nature and behavior of this neoplasm. We present the case of a 39-year-old man with a long history of a small left hydrocele, who was lost to follow-up and presented again 2 years later with testicular discomfort. Sonographic findings were consistent with a testicular tumor. Histology confirmed low-grade adenocarcinoma of the rete testis, the first reported tumor of this grade. Previously reported cases of rete testis carcinoma are reviewed.     

Cystadenocarcinoma of the rete testis

We report a rare case of primary adenocarcinoma of the rete testis. The stage A lesion was managed successfully with orchiectomy and retroperitoneal lymph node dissection. The histopathological features, treatment and prognosis of this unusual malignancy are reviewed.     

Adenocarcinoma of rete testis.

Adenocarcinoma of the rete testis is a rare tumor of the genital tract. An advanced case of adenocarcinoma thought to arise from the rete testis is presented. We believe this is the eighteenth reported case.     

Adenocarcinoma of rete testis

Adenocarcinoma of the rete testis is a very rare malignant neoplasm originating in the epithelium of the rete testis. Histologically, it appears as a papillary adenocarcinoma. The first case was reported in the literature in 1853 and since that time only 16 additional cases have been reported. This report represents the eighteenth case.     

睾丸网腺癌1例报告并文献复习

目的：认识睾丸网腺癌的发病和临床特点，提高早期诊断和治疗水平。方法：分析1例睾丸网腺癌患者的临床资料，并结合文献复习就睾丸网腺癌的早期诊断和治疗进行讨论。结果：术前诊断为左侧附睾丸睾丸炎，并继发性睾丸鞘膜积液，拟行左附睾切除加鞘膜翻转术，术中发现左睾丸质硬并有肿物，遂行睾丸、附睾切除术，术后病理检查诊断为睾丸网腺癌侵及睾丸和附睾。结论：睾丸网腺癌临床表现独特，其基本治疗是根治性睾丸切除术辅以根治性腹膜后淋巴结清扫术，放疗和化疗效果欠佳。     

Rete testis adenocarcinoma recurring in the inguinal lymph nodes. A case report

Adenocarcinoma of the rete testis is a rare neoplasm with 41 reported cases in the literature till 1994. In most of the reported cases, the neoplasm presents as a scrotal mass with diffuse enlargement. The aetiology is unknown and the clinical course of the tumour is not very well defined. In six of the reported cases metastatic spread of the tumour to inguinal lymph nodes was demonstrated in the follow-up. We report herein a distinctive case of rete testis adenocarcinoma presenting as an isolated inguinal recurrence one year after radical orchiectomy.     

Adenocarcinoma of the rete testis. Case report, ultrastructural observations, and clinicopathologic correlates

Adenocarcinoma of the rete testis is a rare tumor that tends to occur in men over the age of 60 and is usually associated with a poor prognosis. We report such a tumor occurring in a 63-year-old male 2 years after he underwent a scrotal exploration in the management of a hydrocele, varicocele, and inguinal hernia. The postorchidectomy course was characterized by slowly advancing, painful scrotal and perineal skin recurrences, lymph node metastases, and the absence of response to Adriamycin and electron-beam therapy. We are confident that the lesion is a carcinoma of the rete testis because: 1) the tumor is situated mainly in the testicular mediastinum, 2) primary germinal and nongerminal testicular tumors and spread from distant sources have been excluded, 3) a transition from normal rete testis to atypical and neoplastic rete epithelium is demonstrable, and 4) the transmission electron-microscopic findings support our conclusion. The distinction between carcinoma of the rete testis and malignant mesothelioma may be difficult and requires consideration of the gross, light-microscopic, and ultrastructural tumor characteristics in optimally fixed tissue.     

Cystic testicular lesions in infancy

The present article reports a case 11 month-old infant with a right intratesticular cyst. We analyze the etiology, differential diagnosis and management off all cystic lesions of the pediatric testis. Patient age at presentation, examination features, tumor markers and sonographic appearance may assist in making a presumptive and occasionally definitive diagnosis preoperatively. The differential diagnosis include intratesticular simple cyst, epidermoid cyst, tunica albuginea cyst, testicular teratoma, juvenil granulosa cell tumor-gonadal stromal tumor, cystic dysplasia of the rete testis, cystic lymphangioma, and testicular torsion. Usually enucleation is the best treatment. A thorough understanding of potentially cystic testis lesions in children leads to the best management choices and often to preservation of a substantial portion of the affected testis.     

Adenomatous hyperplasia of the rete testis: Report of two cases

We present two adenomatous hyperplasia of the rete testis (AHRT) cases. One of them was a 67-year old patient with prostatic adenocarcinoma and the other was a 38-year old patient with undescended testis. AHRT is a rarely seen lesion and usually detected as incidental microscopic finding. It may be confused with malignancy and related to testicular atrophy and hormonal imbalance.The treatment of choice is complete excision.     

Papillary carcinoma of rete testis

A case of a rare papillary adenocarcinoma of the rete testis (or epididymis) with a solitary metastasis to a periaortic lymph node is reported. The favorable outcome over a three and one-third-year period after radical orchiectomy and retroperitoneal lymphadenectomy has been observed. We believe this is the first report of such a tumor being treated with lymphadenectomy.     

睾丸网管状扩张的彩色多普勒超声诊断

目的 :应用彩色多普勒超声诊断睾丸网管状扩张。　方法 :应用彩色多普勒超声 ,对睾丸网管状扩张的二维图像、彩色多普勒血流图 (CDFI)和脉冲多普勒 (PW)进行了描述。　结果 :睾丸网管状扩张有特征性的彩色多普勒超声图像 (二维图像、CDFI和DW)即无相关的睾丸和邻近组织的病变以及在睾丸内扩张的网管内无血流显示。　结论 :彩色多普勒超声是诊断睾丸网管状扩张的首选影像检查方法。     

Rete-testis-Karzinom mit lymphogener Metastasierung

Cancers of the rete testis are uncommon and usually occur in the 6th or 7th decade of life. The prognosis is dreadful. Approx. 40% of the affected patients die within 1 year after diagnosis due to progression of the disease. The primary therapy is surgical. Until now there is no effective chemotherapy. In our case following primary inguinal orchiectomy and confirmation of the diagnosis, a radical retroperitoneal lymphadenectomy and wide local resection were performed. One positive lymph node was found and adjuvant radiotherapy was performed. In this case preoperative PET/CT was not helpful. For the last 3 years now the patient has been disease free. Since cancers of the rete testis are very rare and the literature is scarce, we would like to recommend the introduction of a national registry.     

The role of ultrasonographically guided puncture of the human rete testis in the therapeutic management of nonobstructive azoospermia

We attempted to characterize the cells collected from the rete testis via ultrasonographically guided puncture. Unilateral puncture of the rete testis was performed in nine men with obstructive azoospermia and 51 men with nonobstructive azoospermia. All the aspirated samples from the rete testis were observed via confocal scanning laser microscope and some of them after fluorescent in situ hybridization techniques. Then therapeutic testicular biopsy was performed in the punctured testis of each man. Spermatozoa were found in all rete testis samples and all biopsy samples from obstructed men. Twenty-two nonobstructed men demonstrated absence of spermatozoa in biopsy samples. Twenty-nine nonobstructed men showed spermatozoa in biopsy material and 24 of these men (82%) had demonstrated spermatozoa in rete testis samples. There were no significant differences in fertilization and cleavage rate between intracytoplasmic sperm injection trials using biopsy spermatozoa and rete testis spermatozoa both in obstructed and nonobstructed men. Considering that puncture of the rete testis does not reduce the volume of testicular parenchyma, is less invasive and apparently causes less detrimental effect on testicular vasculature than biopsy, puncture of rete testis is recommended as first line approach for the treatment of azoospermic men. If puncture is negative for spermatozoa in nonobstructed men, biopsy is indicated.     

Adenocarcinoma of the rete testis. Review of the literature apropos of a new case

The authors report the case of a 66 year old man with a Boden stage I adenocarcinoma of the rete testis treated by orchiectomy and adjuvant chemotherapy. Lung metastases developed 46 months later and were responsible for death despite further chemotherapy. Adenocarcinoma of the rete testis is an exceptional tumour, as only 23 cases satisfying the criteria defined by Feek and Hunter have been reported in the literature. The prognosis is poor even in the apparently localized forms (5 year survival less than 25%) and local recurrences and lung and/or hepatic metastases are frequent. Radiotherapy and chemotherapy appear to have little value.