Concomitant testicular seminoma and ectopic adrenal tissue of the cord in a 45-year-old male

Abstract

Aberrant adrenal tissue near the adrenal gland is common, but the finding of ectopic adrenal tissue in structures around the spermatic cord and testis is rare. We describe a case of concomitant seminoma and ectopic adrenal tissue of the spermatic cord occurring in an adult patient who had undergone orchidopexy as a child. IntroductionAberrant adrenal tissue near the adrenal gland is common, but the finding of ectopic adrenal tissue in structures around the spermatic cord and testis remains rare. 1 In 1740, Morgagni first described ectopic adrenal tissue in the vicinity of the adrenal gland, 2 and in 1885 Dagonest noted the presence of adrenocortical tissue in the spermatic cord of an infant.3 Other non-adrenal sites include the coeliac axis, renal parenchyma, broad ligament and ovary; the placenta, hepatic, pulmonary and intracranial lesions, including eleventh cranial deposits, have also been described. 4,5 Case reportA 45-year-old male was referred to the outpatient department with a 3-month history of a painless right testicular mass. There was no history of trauma, recent infection, systemic upset or weight loss. His history was remarkable for essential hypertension and an inguinal orchidopexy at age 13 for an undescended right testicle. He had fathered 6 children.Physical examination revealed a soft non-tender abdomen with a right inguinal scar. There was a discreet mass in the upper pole of his right testicle, a right scrotal scar consistent with his orchidopexy and a normal left hemiscrotum. Tumour markers (alpha fetoprotein, beta human chorionic gonadotrophin and lactate dehydrogenase) were normal. Scrotal ultrasound demonstrated a 9-mm mass in the upper pole of the right testicle and a nodule in the right spermatic cord (Fig. 1). He underwent a right radical orchidectomy via his old inguinal scar. Final histopathological analysis revealed a classic seminoma, which stained positive for placental alkaline phosphatase (PLAP), but negative for Ber-H21, inhibin and Alphafeto protein (Fig. 2). No lymphovascular invasion was noted and it was staged as a pT1 lesion. The nodule in the spermatic cord contained morphological features consistent with an adrenal rest (Fig. 3). DiscussionIn the pediatric population, ectopic adrenal tissue found during inguinoscrotal procedures has been extensively documented 1,5 with a right-sided preponderance. There is an increased incidence of ectopic adrenal tissue within the spermatic cord of males with undescended testes, 5 ranging from 1.6% to 5.1%. 3,6 Autopsy series have shown an incidence of ectopic adrenal tissue adjacent to the native adrenal of up to 32% in adults.7 However, the incidence of ectopic adrenal tissue in the spermatic cord of adults is significantly lower at 1%. 8 Macroscopically, the appearance of ectopic adrenal tissue is characteristic (a round, yellow nodule, firm in consistency, embedded in the cremasteric fibres, resembling a fat lobule).1 Adrenal rests situated far from the original gland are composed entirely of cortical adrenal tissue with n...

Adrenal Cortical Rests in the Fallopian Tube: Report of a Case and Review of the Literature

“…The clinical significance of adrenal remnants is usually not critical and is commonly not related with endocrine irregularities [ 5 ]. Nevertheless, it is important to realize that ectopic tissue may develop the same pathologies as the normal adrenal gland [ 25 ]. Theoretical implications include secondary hyperplasia occurring after adrenalectomy, adrenal insufficiency in certain patients, and the possibility of neoplastic transformation [ 2 , 3 ].…”

Clinicopathological Evaluation of 15 Ectopic Adrenal Tissues

“…In three of them (43, 45 and 38 years of age), the accompanying neoplasm was seminoma and ectopic adrenal was incidentally detected in the spermatic cord after orchiectomy. 2,8,9 In our series, one of the four male patients had seminoma, one had mixed germ cell tumor and one had adenocarcinoma metastasis to the liver. With our cases, the number of ectopic adrenals accompanying a malignant testicular tumor in the literature has increased to five.…”

Adrenal Rests in the Uro-genital Tract of an Adult Population

“…The remaining seven male patients were affected by testicular (six cases) or prostatic (one case) malignancies. To the best of our knowledge, only three cases associated with testicular tumors in adults are on record in the English literature [ 21 , 25 , 37 ].…”