Occult gastric signet ring cell carcinoma presenting as spermatic cord and testicular metastases: "Krukenberg tumor" in a male patient
Department of Pathology, University Medicine, Robert-Koch-Strasse 40, D-37099 Göttingen, Germany.Pathology - Research and Practice (Impact Factor: 1.4). 07/2010; 206(7):519-21. DOI: 10.1016/j.prp.2010.02.006
Krukenberg tumor is a well-known ovarian metastasis, usually of gastric signet ring cell carcinoma in female patients. Although gastric carcinoma is more frequent in men, to our knowledge, only few cases of counterpart testicular metastases have been described as yet. We report a 64-year-old patient who complained of right testicular pain. Right-sided orchiectomy was performed, and metastatic signet ring cell carcinoma of spermatic cord and testis was diagnosed through histological examination and immunohistochemistry. The following stomach biopsy confirmed the primary signet ring cell carcinoma in the stomach. This extremely rare form of metastatic dissemination resembles the Krukenberg tumor of ovaries. Immunohistochemical staining plays an important role in the differential diagnosis of spermatic cord enlargement.
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ABSTRACT: Development of a somatic-type malignancy from a mixed germ cell tumor is a rare but recognized event and typically represented by sarcoma or, less commonly, by carcinoma. This phenomenon is generally believed to result from progression of a teratomatous component. In many cases, because of intermingling of other germ cell tumor components, the diagnosis is apparent; however, in rare cases, metastatic carcinoma to the testis or a novel primary tumor may be a diagnostic consideration. In this study, we report the clinicopathologic, immunohistochemical, and molecular features of a 53-year-old man, whose testicular tumor was composed entirely of signet ring cells, mimicking metastatic carcinoma. Subsequent retroperitoneal lymph node dissection revealed metastatic deposits composed of teratoma and yolk sac tumor, in addition to signet ring cell carcinoma. Fluorescence in situ hybridization for abnormalities of chromosome 12p revealed the presence of i(12p) in both the teratoma and signet ring cell carcinoma in the metastasis and in signet ring cells in the testis, supporting a common germ cell origin. Our report indicates that signet ring carcinoma cells in an orchiectomy specimen, although usually strongly suggestive of metastatic adenocarcinoma from a primary tumor in another organ, may be a primary testicular neoplasm of germ cell tumor origin. This is the first report of testicular signet ring cell carcinoma of germ cell tumor derivation.
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ABSTRACT: Malignant tumors of the spermatic cord are rare. There are a few case reports on spermatic cord metastasis from colonic, gastric, pancreas, and prostatic cancer. Here, we report a 36-year-old man with brucellosis presenting with spermatic cord metastasis as early manifestation of small bowel adenocarcinoma.
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