Primary undifferentiated carcinoma of rete testis with extensive peritoneal carcinomatosis and fatal outcome: Case report

Abstract

Carcinoma of rete testis is an extremely rare malignant tumor arising from its epithelium. Prognosis is poor with mean survival of 8 months. Lymph node metastases and the size of the tumor larger than 5 cm are poor prognostic factors. We report a case of primary undifferentiated carcinoma of the rete testis in a 46-year-old man who presented with testicular enlargement without previous trauma or cryptorchidism, and with extensive peritoneal carcinomatosis, retroperitoneal lymph node metastases and fatal outcome. We present this case because of the rarity of the carcinoma of the rete testis and its challenging diagnosis.

Keywords: Carcinoma; Carcinomatosis; Primary; Rete testis.

Fig. 1

a) Gross examination showing a partially solid, gray-white mass with cystic and hemorrhagic areas. Fig. 1 b) The tumor infiltrating the testicular parenchyma between the seminiferous tubules (H and E x 40) Fig. 1 c) lymphovascular invasion with discohesive malignant cells Fig. 1 d) infiltration of the epididymal parenchyma (H and E x40).

Fig. 2

a) and b) Transition from atypical and dysplastic epithelium of the rete testis to malignant epithelium with an invasive component (H and E x40). Fig. 2 c) and d) Immunohistochemical studies for keratins revealed that the atypical and dysplastic cells demonstrated strong cytoplasmic staining for pancytokeratin and cytokeratin 7. The invasive component showed strong cytoplasmic staining for pancytokeratin and patchy cytoplasmic staining for cytokeratin 7 (x40 magnification).

Fig. 3

a) axial and b) coronal CT scan shows enlarged retroperitoneal and inguinal lymph node conglomerate up to 9 cm in largest diameter.

Fig. 4

Biopsy of retroperitoneal infiltration and peritoneal deposits a) solid growth pattern and discohesive, pleomorphic malignant tumor cells infiltrating peritoneal fat tissue (H and E x20). b) Immunohistochemical studies for keratins revealed that the atypical and dysplastic cells demonstrated cytoplasmic staining for pancytokeratin (CKAE1/AE3) (x10 magnification).