1983 Volume 74 Issue 8 Pages 1453-1466
A 29-year-old patient with malignant interstitial cell tumor of the testis was reported. The case showed lung and lymph node metastases of the cancer and gynecomastia. Although plasma testosterone decreased below the lowest value of normal adult male, urinary estrogen was markedly increased, especially urinary estradiol was found 77 times as high as normal level. The metastatic lymph node was examined for steroidgenesis in vitro. From the results of the studies, progesterone, 17α-hydroxyprogesterone and 4-androstenedione were metabolized to testosterone, indication the presence of 17α-phydroxylase, C17-20 lyase and 17β-hydroxysteroid dehydrogenase in the metastatic tumor. The patient died 2 years and three months after admission, despite irradiation and chemotherapy. There was a significant correlation between the plasma alkaline phosphatase level and the degree of tumor growth.
Interstitial cell carcinoma of the testis is extremely rare. To our knowledge, 31 cases have been reported. It may be concluded from the clinical reviews of the cases previously reported as follows.
1. Evaluation of Malignancy: Since there have been some reports that only the tumor associated with metastasis can be regarded as malignant, the malignancy should be evaluated based on histological findings of the primary tumor, namely, mitosis, invasion of the tumor into vessels and the adjacent tissues.
2. Age: The age of the patients averaged 55 year-old, ranged 20 to 82. The malignant tumor has not been recognized in the period of prepuberty.
3. Metastasis Pattern: The tumor usually shows lymph node metastasis, although hematogenic pathways might be secondary to lymphatic pathways. It is noteworthy that bone metastasis has occasionally been reported.
4. Treatment: Lymph node dissection should be performed for patinets without hematogenic metastasis. For the inoperable case, o, p'-DDD is uniquely effective in the treatment for the tumor.
Consequently, it is suggested that interstitial cell carcinoma of the testis is an estrogen producing tumor, and that plasma or urinary estrogens may become a marker of the presence of the tumor.
