Testicular and inguinal lymph node metastases of medullary thyroid cancer: a case report and review of the literature

BMC Endocrine Disorders

Francesco Torino¹  Salvatore Maria Corsello⁵  Roberto Baldelli²  Steno Sentinelli³  Vincenzo Pompeo⁴  Agnese Barnabei²  Marialuisa Appetecchia² 

[1] Department of Systems Medicine, Chair of Medical Oncology, Tor Vergata University of Rome, Via Montpellier, 1 00133 Rome, Italy;Regina Elena National Cancer Institute, Endocrinology Unit, Via Elio Chianesi 53, I- 00144 Rome, Italy;Department of Pathology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, Rome, Italy;Department of Urology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, Rome, Italy;Endocrinology Unit, Università Cattolica, Largo F. Vito, 8 00168 Rome, Italy

关键词: Inguinal lymph node metastasis;    Testicular metastasis;    Medullary thyroid cancer;   

Others  :  1084874
DOI  :  10.1186/1472-6823-14-84

 received in 2014-06-21, accepted in 2014-09-29,  发布年份 2014

【 摘 要 】

Background

The involvement of the testis by metastatic medullary thyroid carcinoma has never been described before. We describe the first case of metastatic medullary thyroid carcinoma affecting testis and inguinal lymph nodes.

Case presentation

A 73-year-old Caucasian man was referred to undergo urologic surgery due to a painless nodule in the right testis and an homolateral inguinal lymphoadenomegaly. The patient had a history of medullary thyroid carcinoma with relapsing disease to the spine and lung nodules. Serum calcitonin and CEA levels were 175 pg/ml and 22 ng/ml, respectively. With suspected testicular cancer, the patient underwent radical right orchiectomy with the excision biopsy of the right inguinal lymph node. Histopathology and immunohistochemistry revealed that both the lesions were due to metastases from medullary thyroid carcinoma.

Conclusion

Metastases to the testis and inguinal lymph nodes may be due to various solid and hematological tumors. This case, despite its rarity, suggests that testis and inguinal lymph nodes should be considered as potential secondary sites of medullary thyroid carcinoma as well.

【 授权许可】

   
2014 Appetecchia et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Kloos RT, Eng C, Evans DB, Francis GL, Gagel RF, Gharib H, Moley JF, Pacini F, Ringel MD, Schlumberger M, Wells SA Jr: Medullary thyroid cancer: management guidelines of the American Thyroid Association. Thyroid 2009, 19:565-612.
• [2]NCCN Clinical Practice Guidelines in Oncology: Thyroid Carcinoma, Version 2.2013. http://www.nccn.org webcite, Accessed on June 2014
• [3]Wohllk N, Cote GJ, Bugalho MM, Ordonez N, Evans DB, Goepfert H, Khorana S, Schultz P, Richards CS, Gagel RF: Relevance of RET protooncogene mutations in sporadic medullary thyroid carcinoma. J Clin Endocrinol Metab 1996, 81:3740-3745.
• [4]Elisei R, Romei C, Cosci B, Agate L, Bottici V, Molinaro E, Sculli M, Miccoli P, Basolo F, Grasso L, Pacini F, Pinchera A: RET genetic screening in patients with medullary thyroid cancer and their relatives: experience with 807 individuals at one center. J Clin Endocrinol Metab 2007, 92:4725-4729.
• [5]Saad MF, Ordonez NG, Rashid RK, Guido JJ, Hill CS Jr, Hickey RC, Samaan NA: Medullary carcinoma of the thyroid. A study of the clinical features and prognostic factors in 161 patients. Medicine (Baltimore) 1984, 63:319-342.
• [6]Pacini F, Castagna MG, Cipri C, Schlumberger M: Medullary thyroid carcinoma. Clin Oncol 2010, 22:475-485.
• [7]Börcek P, Asa SL, Gentili F, Ezzat S, Kiehl TR: Brain metastasis from medullary thyroid carcinoma. BMJ Case Rep 2010., 29doi:10.1136/bcr.09.2010.3301
• [8]Bhatoe HS, Badwal S, Dutta V, Kannan N: Pituitary metastasis from medullary carcinoma of thyroid: case report and review of literature. J Neurooncol 2008, 89:63-67.
• [9]Ricciato MP, Lombardi CP, Raffaelli M, De Rosa A, Corsello SM: Metastatic breast involvement from medullary thyroid carcinoma: a clue to consider the need of early diagnosis and adequate surgical strategy. Thyroid 2010, 20:831-832.
• [10]Kebebew E, Ituarte PH, Siperstein AE, Duh QY, Clark OH: Medullary thyroid carcinoma: clinical characteristics, treatment, prognostic factors, and a comparison of staging systems. Cancer 2000, 88:1139-1148.
• [11]Esfandiari NH, Hughes DT, Yin H, Banerjee M, Haymart MR: The Effect of Extent of Surgery and Number of Lymph Node Metastases on Overall Survival in Patients with Medullary Thyroid Cancer. J Clin Endocrinol Metab 2014, 99:448-454.
• [12]Dottorini ME, Assi A, Sironi M, Sangalli G, Spreafico G, Colombo L: Multivariate analysis of patients with medullary thyroid carcinoma. Prognostic significance and impact on treatment of clinical and pathologic variables. Cancer 1996, 77:1556-1565.
• [13]Modigliani E, Cohen R, Campos JM, Conte-Devolx B, Maes B, Boneu A, Schlumberger M, Bigorgne JC, Dumontier P, Leclerc L, Corcuff B, Guilhem I: Prognostic factors for survival and for biochemical cure in medullary thyroid carcinoma: results in 899 patients. The GETC Study Group. Groupe d’étude des tumeurs à calcitonine. Clin Endocrinol (Oxford) 1998, 48:265-273.
• [14]Wells SA Jr, Gosnell JE, Gagel RF, Moley J, Pfister D, Sosa JA, Skinner M, Krebs A, Vasselli J, Schlumberger M: Vandetanib for the treatment of patients with locally advanced or metastatic hereditary medullary thyroid cancer. J Clin Oncol 2010, 28:767-772.
• [15]Torino F, Paragliola RM, Barnabei A, Corsello SM: Medullary thyroid cancer: a promising model for targeted therapy. Curr Mol Med 2010, 10:608-625.
• [16]Roy M, Chen H, Sippel RS: Current understanding and management of medullary thyroid cancer. Oncologist 2013, 18:1093-1100.
• [17]Haupt HM, Mann RB, Trump DL, Abeloff MD: Metastatic carcinoma involving the testis. Clinical and pathologic distinction from primary testicular neoplasms. Cancer 1984, 54:709-714.
• [18]Tiltman AJ: Metastatic tumours in the testis. Histopathology 1979, 3:31-37.
• [19]Dutt N, Bates AW, Baithun SI: Secondary neoplasms of the male genital tract with different patterns of involvement in adults and children. Histopathology 2000, 37:323-331.
• [20]Pienkos EJ, Jablokow VR: Secondary testicular tumors. Cancer 1972, 30:481-485.
• [21]García-González R, Pinto J, Val-Bernal JF: Testicular metastases from solid tumors: an autopsy study. Ann Diagn Pathol 2000, 4:59-64.
• [22]Grignon DJ, Shum DT, Hayman WP: Metastatic tumours of the testes. Can J Surg 1986, 29:359-361.
• [23]Patel SR, Richardson RL, Kvols L: Metastatic cancer to the testes: a report of 20 cases and review of the literature. J Urol 1989, 142:1003-1005.
• [24]Bhasin SD, Shrikhande SS: Secondary carcinoma of testis–a clinicopathologic study of 10 cases. Indian J Cancer 1990, 27:83-90.
• [25]Sharma MC, Sudha K, Singh MK, Chahal R, Sood R: Metastatic carcinoma involving the testes. Indian J Pathol Microbiol 1996, 39:293-296.
• [26]Lu LY, Kuo JY, Lin ATL, Chang YH, Chen KK, Pan CC, Chang LS: Metastatic Tumors Involving the Testes. J Urol ROC 2000, 11:12-17.
• [27]Ulbright TM, Young RH: Metastatic carcinoma to the testis: a clinicopathologic analysis of 26 nonincidental cases with emphasis on deceptive features. Am J Surg Pathol 2008, 32:1683-1693.
• [28]Nistal M, Gonzalez-Peramato P, Paniagua R: Secondary testicular tumors. Eur Urol 1989, 16:185-188.
• [29]Hanash KA, Carney JA, Kelalis PP: Metastatic tumors to testicles: routes of metastasis. J Urol 1969, 102:465-468.
• [30]Wang WS, Chiou TJ, Lu SH, Liu SM, Chen PM: Non-small cell lung cancer with testicular metastasis: a case report. Chin Med J (Taipei) 1996, 58:54-57.
• [31]Moore JB, Law DK, Moore EE, Dean CM: Testicular mass: an initial sign of colon carcinoma. Cancer 1982, 49:411-412.
• [32]Wishami MM: Detailed anatomy of the internal spermatic vein and ovarian vein: Human cadaver study and operative spermatic venography: clinical aspects. J Urol 1991, 145:780-784.
• [33]Price EB, Mostofi FK: Secondary carcinoma of the testis. Cancer 1957, 10:592-595.
• [34]Salesi N, Fabi A, Di Cocco B, Marandino F, Pizzi G, Vecchione A, Cognetti F: Testis metastasis as an initial manifestation of an occult gastrointestinal cancer. Anticancer Res 2004, 24:1093-1096.
• [35]Bart J, Groen HJ, van der Graaf WT, Hollema H, Hendrikse NH, Vaalburg W, Sleijfer DT, de Vries EG: An oncological view on the blood-testis barrier. Lancet Oncol 2002, 3:357-363.
• [36]Mital P, Hinton BT, Dufour JM: The blood-testis and blood-epididymis barriers are more than just their tight junctions. Biol Reprod 2011, 84:851-858.
• [37]Huang E, Teh BS, Mody DR, Carpenter LS, Butler EB: Prostate adenocarcinoma presenting with inguinal lymphadenopathy. Urology 2003, 61:463.
• [38]Komeya M, Sahoda T, Sugiura S, Sawada T, Kitami K: A case of metastatic prostate adenocarcinoma to an inguinal lymph node. Central Eur J Urol 2012, 65:96-97.
• [39]Ismail M, Zaman F, Baithun S, Nargund V, Pati J, Masood J: Inguinal lymph node metastases from a testicular seminoma: a case report and a review of the literature. J Med Case Rep 2010, 4:378. BioMed Central Full Text
• [40]Corby HM, Lynch TH, Fitzpatrick JM, Smith JM: Inguinal lymph node metastases from a testicular tumor. Br J Urol 1996, 77:923-924.
• [41]McGraw S, Thakkar J, Mehta D: Inguinal lymph node metastasis of colon cancer. Indian J Med Paediatr Oncol 2011, 32:168-170.
• [42]Barbet J, Campion L, Kraeber-Bodéré F, Chatal JF, The GTE Study Group: Prognostic impact of serum calcitonin and carcinoembryonic antigen doubling-times in patients with medullary thyroid carcinoma. J Clin Endocrinol Metab 2005, 90:6077-6084.
• [43]Laure Giraudet A, Al Ghulzan A, Aupérin A, Leboulleux S, Chehboun A, Troalen F, Dromain C, Lumbroso J, Baudin E, Schlumberger M: Progression of medullary thyroid carcinoma: assessment with calcitonin and carcinoembryonic antigen doubling times. Eur J Endocrinol 2008, 158:239-246.