Metastatic Renal Cell Carcinoma to the Testis: A Clinicopathologic Analysis of Five Cases

Abstract

The testicular spread of renal cell carcinoma is extremely rare. Five cases of renal cell carcinoma metastatic to the testis are described. The patients ranged from 45 to 81 years of age. Four of the five patients had known renal cell carcinoma. The time intervals between the partial and radical nephrectomies for the primary kidney tumors and the occurrence of testicular metastases ranged from 29 to 34 months. In one patient, the testicular mass was the initial presentation leading to a diagnosis of renal cell carcinoma. There were three ipsilateral metastases, one contralateral metastasis, and one bilateral metastasis. The metastatic deposits ranged in size from 2.0 to 5.7 cm. One case had multiple metastatic tumor nodules. All of the metastatic tumors had clear cell histological features, microscopically concordant with the primary renal cell carcinoma subtype. Three patients died of the disease 17 to 42 months after orchiectomy. One patient is alive with additional metastatic lesions 13 months after orchiectomy. One patient had been free of disease at 87 months after orchiectomy but is now on targeted therapy for an additional metastasis at 93 months after orchiectomy. To date, this report is one of the largest single series of patients with renal cell carcinoma metastatic to the testis, and it has the longest follow-up and survival among all the reported cases.

Renal Cell Carcinoma with Testicular Metastases: A Case Report and Review of the Literature

“…In 11,157 patients with metastatic RCC, from 1998 to 2007, the most common sites of spread were to the lung (45.2%), bone (29.5%), distant lymph node (21.8%), and liver (20.3%); metastases to the testes were not noted in this study (13). To our knowledge, there have been less than 50 reported cases of RCC metastasis to the testis (17,(19)(20)(21)(22)(23)(24)(25)(26)(27).…”

“…The testes are considered a "tumor sanctuary," as the low temperature in the scrotum provides an inhospitable environment for metastatic cells (16). Furthermore, the blood-testis barrier, which protects spermatozoa from targeting by the body's immune system, may have an indirect role in preventing metastasis to the testis (17). In an autopsy study of 738 autopsies of adult males with solid neoplasms, five (0.68%) showed metastases to the testis (18).…”

“…A review of the available literature seems to suggest that metastatic spread to the ipsilateral testis is more common than contralateral or bilateral spread (17,(19)(20)(21)(22)(23)(24)(25)(26)(27). It has been hypothesized that metastasis occurs by retrograde venous spread, especially considering the anatomic relationship between the left renal and gonadal veins (28).…”

“…RCC metastasis to the testis is difficult to diagnose, as considerable heterogeneity exists among prior cases. In symptomatic patients, scrotal enlargement and presence of a testicular mass are two common symptoms (17,24,27). However, metastatic carcinomas to the testes are most commonly detected incidentally during autopsy (30).…”

Simultaneous Bilateral Testicular Metastases from Renal Clear Cell Carcinoma: A Rare Presentation in Von Hippel–Lindau disease

“…By the age of 60 years, up to 70% of patients develop RCC (1). Most common sites for RCC metastasis are the lungs, lymph nodes, bones, and liver, although testicular metastasis from RCC is rare and bilateral testicular metastasis is extremely rare (2,3). In this article, we present a VHL patient with synchoronus bilateral testicular metastasis from RCC.…”