Malignant interstitial cell tumor of the testis

Abstract

A case of malignant interstitial cell tumor of the testis is reported and the literature is reviewed. Malignant interstitial cell tumors occur exclusively in adults. Gynecomastia was noted in 12% of the cases. Elevated plasma levels or increased urinary excretion of estrogen, 17-ketosteroid, or testosterone were demonstrated in 64% of the patients. Vessel invasion, which occurred in 74% of the patients, appears to be the only reliable histologic feature for predicting malignant behavior. There is no proved sensitivity to radiation or chemotherapeutic regimens in patients with disseminated tumor. Once the diagnosis of malignancy is histologically established, inguinal and retroperitoneal lymph node dissections, even in the absence of clinical evidence of metastasis, may be beneficial in providing early staging of the tumor and, perhaps, in preventing subsequent lymphatic spread. Case ReportA 75-year-old man was seen with a two-month history of painless left scrotal enlargement. Physical examination showed enlargement of the left scrotal content to three times normal size. The right testis was of normal size. There was no gynecomastia. There was no history of trauma. Left suprainguinal exploration and orchiectomy were performed. A diagnosis of interstitial cell tumor with histologic features suggesting malignancy was made on pathologic examination. The ultrasound scan of the abdomen, intravenous pyelography, chest radiograph, serum alpha-fetoprotein level, serum beta H C G level, and urinary 17-ketosteroid excretion performed shortly after the surgery showed no abnormalities.Eight months later productive cough and left flank pain developed. The chest radiograph showed mutliple pulmonary Accepted for publication January 20, 1981. nodules. A computed tomography of the abdomen showed periaortic adenopathy. Physical examination revealed no peripheral lymphadenopathy or hepatosplenomegaly. There was no weight loss. The hemogram showed a hematocrit of 55.9%, a hemoglobin of 19.2 g/dl, an erythrocyte count of 6.08 X 103/mm3, a leukocyte count of 9100/mm3 with a normal differential count, and a platelet count of 252 X 103/mm3. Serum chemistry studies were normal except for an elevated alkaline phosphatase level (194 mU/ml). Blood volume studies showed an erythrocyte mass of 47.19 ml/kg (normal 20.0-36.5 ml/kg), and a plasma volume of 41.5 ml/kg (normal 23.4-43.8 ml/kg). The arterial blood gas studies performed at the same time showed no abnormalities. The serum alphafetoprotein, beta HCG, pituitary gonadotropin, and testosterone levels were normal. The patient was treated with Adriamycin (50 mg/m2) and/ Cytoxan (600 mg/m2). No response was observed after three cycles of therapy. The treatment was then changed to Cisplatinum (100 mg/m2). After two courses, the pulmonary nodules decreased slightly in size, but there was no change of the retroperitoneal metastasis. The patient died seven months after the detection of the metastasis. An autopsy was not performed. Pathologic FindingsThe removed left testis measured 5.5 X 4...

A malignant Leydig cell tumor of the testis

“…However, Chen et al have reported that malignant tumors can be identified by the histologic appearance of the primary tumors. They had described malignant interstitial cell tumors with histological features of vessel invasion and capsular invasion [4]. Our case had these histological features, with capsular invasion.…”

“…Microscopic criteria suggestive of malignancy in the tumor included: (1) marked cellular pleomorphism with bizarre cell forms and atypical nuclei; (2) numerous and atypical mitoses; (3) invasion of vascular or lymphatic channels; (4) extension of the tumor into the spermatic cord and invasion of the capsule [4][5][6][7] (see Figure 1). …”

Tiny nodule in the testicle: Case report of a sertoli cell tumor

“…The prognosis of Sertoli cell tumors has been reported as follows. Patients with pathologically benign tumor showed neither recurrence nor metastasis if the tumor was completely removed, whereas approximately half the patients with malignant tumor died of metastasis 1–3 . It is therefore important to diagnose and treat this condition correctly.…”

Atypische Tumoren der Hoden und Hodenhüllen. Ein Bericht über 5 Fälle aus dem Krankengut von 1980 bis 1989

“…30% der Er-wachsenen zeigen endokrinologische Auffälligkeiten mit erhöhtem Östrogen, vermindertem LH und FSH, sowie eine gestörte Spermiogenese (12,13,17,18,19), deren Abklärung auch bei unseren beiden Patienten zur Diagnose des Hodentumors führte. CEA, ß-HCG und Alpha-Fetoprotein sind in der Regel nicht erhöht (4,19 Sowohl die Patienten mit nichtseminomatösen Keimzelltumoren, als auch die Patienten mit malignen nicht germinalen Hodentumoren werden nach der operativen Therapie in ein engmaschiges Nachsorgeprogramm übernommen, in dem eine Sonographie des Abdomens, körperliche Untersuchung, Markerkontrolle und Rö-Thorax in a /jährlichen, ein CT des Abdomens und bei Sertoli-und Leydigzelltumoren Knochenszintigramm in V2Jährlichen Abständen durchgeführt werden (Tab. 1) (12,17,18,19).…”

“…Eine Radiatio führt offenbar zu keiner Tumorverkleinerung (13). Bei isolierter retroperitonealer Metastasierung wird eine radikale retroperitoneale Lymphadenektomie dringend angeraten (4). Es scheint, daß die radikale operative Behandlung derzeit die besten Ergebnisse erzielt.…”