Abstract
A rare case of papillary adenocarcinoma of the rete testis with a papillo-tublar adenocarcinoma of the urethra is reported.
A 67-year-old male was admitted to the Urologic Clinic, the Aoto Hospital, an affiliated hospital with the Jikei-University, on September 8 in 1977, because of a swelling of his right scrotal contents and urination disturbance. The results of laboratory examinations including serum alphafetoprotein and urinary HCG were all within normal limits.
Excretory urography showed a normal upper urinary tract and a slight elevation of bladder floor. Retrograde urethrography showed a filling defect on the prostatic urethra. Endoscopic examination revealed a normal bladder interior and a bean sized nodular tumor on the prostatic urethra.
Right high inguinal orchidectomy and trans-urethral resection of the urethral tumor were performed on September 20 in 1977 under the diagnosis of right testicular tumor and tumor of the urethra. Grosslo multiple papillary growth from 3 to 10mm in diameter were noted in the dilated rote testis. They were confined in the rete testis showing no involvement in the adjacent testicular or epididymal tissues. Micro-scopically, multiple branching papillary growth composed of tall columnar cells and central vascular core were found within the cystic spaces showing a transition to the normal epithelial lining cells of the rete tesis. Electron microscopic investigation showed the resemblances of the testicular tumor cells to the epithelial cells of the normal rete testis.
The significance of characteristic concentric circular structures which consisted of a continuation of tiny round bodies was not known. However, they may be derived from rough surfaced endoplasmic reticulum. The urethral nodular tumor revealed admixture of tublar and papillary structures, although papillaly branching was not prominent. The tumor had pale cytoplams with many PAS positive secretion vacuoles and was associated with chronic glandular urethritis. The patient was doing well as of March 23 in 1980 without any evidence of recurrence.
Papillary adenocarcinoma of the rete testis is extremery rare, and only 21 Gases were found in the literatures. The authers' case seemed to be the 22nd in the world and the 1st in Japan. Choice of treatment and degree of malignancy are briefly discussed.
