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DOI: 10.18410/jebmh/2015/706
CASE REPORT
BILATERAL TESTICULAR METASTASIS IN A CASE OF PROSTATE
CARCINOMA: A CASE REPORT
Rekha Patil N1, Satish Helwatkar B2, Sanjay Parate N3, Dinkar Kumbhalkar T4, Waman Raut K5
HOW TO CITE THIS ARTICLE:
Rekha Patil N, Satish Helwatkar B, Sanjay Parate N, Dinkar Kumbhalkar T, Waman Raut K. “Bilateral
Testicular Metastasis in A Case of Prostate Carcinoma; A Case Report”. Journal of Evidence based Medicine
and Healthcare; Volume 2, Issue 33, August 17, 2015; Page: 5069-5072, DOI: 10.18410/jebmh/2015/706
ABSTRACT: Prostate carcinoma is the most common malignancy in men in the world and the
second leading cause of cancer death. The most common sites of metastasis are regional lymph
nodes, bones, lungs, liver, bladder and brain. Testicular metastasis from Prostate carcinoma is
very rare. Unilateral testicular metastasis is more common than bilateral metastasis. We report a
rare case of bilateral testicular metastasis in orchiectomy specimen done for treatment of
prostate carcinoma.
KEYWORDS: Prostate Carcinoma, Testicular Metastasis, Orchiectomy.
INTRODUCTION: Prostate carcinoma (PC) is the most common malignancy in men in the world
and the second leading cause of cancer related deaths. There were an estimated 1100000 new
cases and 307000 cancer related death in 2012. PC is becoming a public health concern.1,2,3,4
PC with localized disease have a favorable prognosis and approximately 10-20% of PC
patients show metastasis at initial diagnosis.1 The most common metastatic sites of PC are the
regional lymph nodes, bones, lungs, liver, adrenal. Saini et al reported a case of omental
metastasis of PC with malignant ascites.1,3,4,5,6
Testicular metastasis from PC are rare despite the proximity.3,4,6,7,8,9,10
We report a rare case of bilateral testicular metastasis in orchiectomy specimen done for
treatment of PC.
CASE REPORT: A 62 years male patient came with the complaints of increase frequency of
micturition, nocturia and weak urinary stream. He was hypertensive and diabetic, on treatment
since 4 years. The positive finding on clinical examination was a significant prostatomegaly on
digital per rectal examination.
On investigation his haemogram was within normal limits. Serum urea was 52 mg/dl,
serum creatinine was 1.6 mg/dl and serum alkaline phosphatase was 289 U/L (Normal range 100250 U/L). Serum Prostate specific antigen was 57.73 ng/ml. Serum total testesteron was 50.70
ng/dl. Serum beta Human chorionic gonadotropin (HCG) was 1.73mIU/ml (Normal range in males
is less than 3 mIU/ml) and serum alpha feto protein was 1.67 ng/ml (Normal range upto
10ng/ml).
Urogenital Ultra Sonography showed enlarged swollen bilateral kidney with bilateral
hydro- uretero -nephrosis and left ureteric calculus and hypertrophy of prostate with median lobe
enlargement.
J of Evidence Based Med & Hlthcare, pISSN- 2349-2562, eISSN- 2349-2570/ Vol. 2/Issue 33/Aug. 17, 2015 Page 5069
DOI: 10.18410/jebmh/2015/706
CASE REPORT
Whole body scan showed multiple skeletal metastasis involving left half of manubrium, D4
and D12 vertebrae, left rib, left iliac crest and left femur, right scapula, cervical vertebrae,
bilateral femur, shoulder, knee and ankle.
Haematoxylin and eosin stained slides of transurethral resection of prostate specimen
showed prostate adenocarcinoma with Gleason score of 3+4=7. (Figure 1)
Figure 1
Bilateral orchiectomy was done for the treatment of prostate carcinoma. Sections showed
atrophic seminiferous tubules along with malignant cells in groups and comado pattern. Cells had
moderate amount of pale cytoplasm vesicular nuclei with prominent nucleolus.
It was reported as metastasis of prostate adenocarcinoma in testis (Figure 2). An
immunohistochemical prostate specific antigen (PSA) examination was performed and it revealed
strong cytoplasmic immunoreaction. (Figure 3). This proved that the testicular metastasis were
from the prostate adenocarcinoma.
Figure 2
Figure 3
DISCUSSION: Testis is a rare organ for metastatic neoplasm.4 Metastatic tumors in testis
excluding lymphoma and leukaemia are extremely rare.6,11,12 The main reason for relatively low
incidence of metastasis to the testis can be explained by the unfavorable condition for the
establishment of metastatic tumors with relatively low temperature of the scrotum.4
J of Evidence Based Med & Hlthcare, pISSN- 2349-2562, eISSN- 2349-2570/ Vol. 2/Issue 33/Aug. 17, 2015 Page 5070
DOI: 10.18410/jebmh/2015/706
CASE REPORT
Metastasis to testis is most commonly from the prostate, lung, colon, stomach, melanoma,
and kidney. Increased detection of testicular metastasis from prostate carcinoma can be
explained by orchiectomy done for prostate carcinoma.3,4,11,12,13
Semans in 1938 reported the first case of prostatic carcinoma metastasizing to testis.3
In autopsy reviews the incidence of testicular metastasis from prostatic carcinoma was
found to be 0.02-2.5%. Approximately 4% of the patients with prostate cancer were incidentally
diagnosed after orchiectomy done for treatment.3,4,6,12,13,14
Testicular metastasis from prostate carcinoma are rare despite the proximity.3,4,6,7,8,9 There
are numerous possible routes by which the prostatic carcinoma metastasize. The tumor may
spread from the prostatic urethra by retrograde venous extension or embolism, arterial embolism
or by direct invasion into the lymphatics, adjacent tissue, transperitoneal seeding through
communicating hydrocele sac and lumen of vas deferens.3,5,15 In the present case the
angiolymphatic extension can be suspected.
Unilateral testicular involvement is more common than bilateral involvement.4,13,15 This
patient had bilateral testicular metastasis.
The presence or absence of metastasis in a patient of prostate carcinoma determines the
prognosis of the patient.5,10 Testicular metastasis from prostate carcinoma is commonly excepted
as a sign of advanced disease. The clinical picture of metastasis to the testis is inconstant and
usually there is no palpable mass in the testis. Most of these are diagnosed on routine
histopathological examination of testicular tissue removed for the treatment of prostate
carcinoma.3,6,8,9, 12,14,15
Manikandan 2006 et al reported a case of bilateral testicular metastasis 7 years after the
initial diagnosis of prostate carcinoma where the patient presented with testicular lump.9
We report this rare case of bilateral testicular metastasis from prostate carcinoma in
orchiectomy specimen done for the treatment of prostate carcinoma.
This shows the importance of careful histopathological examination of the testicular tissue
removed for the treatment of prostate carcinoma. Immunohistochemical study helps in
confirming the diagnosis.
REFERENCES:
1. Saini R, Dodagoudar C, Talwar V, Singh S. Malignant ascites with omental metastasis: a
rare event in prostate cancer. J Cancer Metastasis Treat 2015; 1:34-35.
2. Oluwole OP, Atim T. Prostate cancer in a retroviral positive patient: A case report and
review of the literature. Case Study Case Rep 2015; 5(2):57-62.
3. Se Yun Kwon, Hyun Su Jung, Jung Guk Lee, Seock Hwan Choi, Tae Gyun Kwon and Tae
Hwan Kim. Solitary testicular metastasis of prostate cancer mimicking primary testicular
cancer. Korean J Urol.2011; 52(10):718-720.
4. Bisong Haupt, Jae Y. Ro, Alberto G. Ayala, Jim Zhai. Metastatic prostatic carcinoma to
Testis: Histological features mimicking lymphoma. Int J Clin Exp Pathol 2009; 2(1):104-107.
5. Bubendorf L, Schopfer A, Wagner U, Sauter G, Moch H, Willi N, Gasser TC, Mihatsch MJ.
Metastatic patterns of prostate cancer: an autopsy study of 1589 patients. Hum Pathol2000;
31(5):578-583.
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CASE REPORT
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Kusaka A, Koie T, Yamamoto H, Hamano I, Yoneyama T, et al. Testicular metastasis of
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AUTHORS:
1. Rekha Patil N.
2. Satish Helwatkar B.
3. Sanjay Parate N.
4. Dinkar Kumbhalkar T.
5. Waman Raut K.
PARTICULARS OF CONTRIBUTORS:
1. Assistant Professor, Department of
Pathology, Government Medical College,
Nagpur.
2. Associate Professor, Department of
Pathology, Government Medical College,
Nagpur.
3. Associate Professor, Department of
Pathology, Government Medical College,
Nagpur.
4. Professor, Department of Pathology,
Government Medical College,
Nagpur.
5.
5. Professor and HOD, Department of
Pathology, Government Medical College,
Nagpur.
NAME ADDRESS EMAIL ID OF THE
CORRESPONDING AUTHOR:
Dr. Rekha Patil N,
Poonam Apartment,
Near RFC Guest House,
Behind Shankar Nagar Post Office,
Dandige Layout, Shankar Nagar,
Nagpur-440010.
E-mail: [email protected]
Date
Date
Date
Date
of
of
of
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Submission: 10/08/2015.
Peer Review: 11/08/2015.
Acceptance: 13/08/2015.
Publishing: 17/08/2015.
J of Evidence Based Med & Hlthcare, pISSN- 2349-2562, eISSN- 2349-2570/ Vol. 2/Issue 33/Aug. 17, 2015 Page 5072