Primary adenocarcinoma of the rete testis with elevated serum CA19-9 antigen levels

Abstract

Primary adenocarcinoma of the rete testis is an extremely rare tumor with a poor prognosis. Herein, we report a case of primary adenocarcinoma of the rete testis accompanied by elevated serum carbohydrate antigen 19-9 (CA19-9) antigen levels in a 44-year-old man who presented with left scrotal swelling. Para-aortic lymph node swelling was observed on the computed tomography scan. Germ cell tumor markers were within the normal range, but serum CA19-9 antigen levels were high. Radical orchiectomy was performed, and histological examination revealed primary adenocarcinoma of the rete testis with no evidence of other primary carcinomas. The patient underwent three lines of chemotherapy, although no reports suggest the use of gemcitabine and oxaliplatin (GEMOX) in a patient with adenocarcinoma of the rete testis. Unfortunately, he developed metastasis at multiple sites and passed away due to adenocarcinoma 13 months after undergoing orchiectomy. Some reports suggest that CA19-9 antigen levels are elevated in patients with adenocarcinoma of the rete testis, although it has not been clarified whether elevated CA19-9 antigen levels reflect the progression of adenocarcinoma of the rete testis. In this case, as CA19-9 antigen levels increased with progression, CA19-9 might be a marker for primary adenocarcinoma of the rete testis. GEMOX chemotherapy as a line of treatment in primary adenocarcinoma of the rete testis has not been reported. Therefore, further studies must evaluate the efficacy of the aforementioned chemotherapy regimen.

Keywords: Adenocarcinoma; Carbohydrate antigen 19-9; Combined chemotherapy; Orchiectomy; Rete testis.

Fig. 1

Computed tomography scan showing left testicular swelling with calcification and a hydrocele (a), and para-aortic lymph node swelling (b)

Fig. 2

Histological findings of the primary tumor (a–c) and metastatic lung tumor (d–l). a In the primary tumor, small acinar or fused glands that were moderately differentiated adenocarcinoma in the rete testis. (H&E staining, ×200 magnification) The tumor was positive for both cytokeratin 7 (b) and cytokeratin 20 (c). d–l histological findings of the metastatic lung tumor. Well-to-moderately differentiated adenocarcinoma was found in the lung (d). The tumor was negative for WT-1 (e), TTF-1 (f), napsin A (g), Oct3/4 (h), and CD30 (i). The tumor was positive for CA19-9 (j) and p53 (k)

Fig. 3

Change in serum carbohydrate antigen 19-9 levels after radical orchiectomy