A 16-year-old male was admitted to the urology clinic, complaining of right testicular pain for one week. He had a history of trauma to the right testis leading to ipsilateral pain and hematoma nearly 3 months before referral. At the time of current presentation, the testis size was not reduced to its normal size.
On examination, he had a hard and large mass instead of right testis and a small, firm, and well-defined mass in the upper border of the left testis, markedly suggestive of bilateral testis tumor.
Ultrasound examination showed a mixed echogenic mass occupying the majority of the right testis measuring 45 × 47 × 31 mm with 4 mm calcification and an isoechoic mass; 14 × 24 mm for the upper part of the left testis.
In order to diagnose any possible metastasis, chest X ray and testis tumor markers (lactate dehydrogenase, beta human chorionic gonadotropin, alpha-fetoprotein) were used, all of which appeared to be normal. Right radical orchidectomy was subsequently performed.
The testis was entirely replaced by the tumor. It was decided to wait for the right testis tumor pathology and to arrange sperm freezing before any procedures for the left testis tumor.
On macroscopic view, there was a 4.5-cm well-defined creamy mass lesion with solid and firm lobulated cream cut sections bearing hemorrhagic and necrotic foci.
Pathology review showed a well demarcated tumor composed of monomorphic cells hosted in a nested trabecular manner. The neoplastic cells had granular chromatin and rarely with mitotic features. Immunohistochemistry survey showed positive staining with, Pan-CK, synaptophysin, and chromogranin.
No Calretinin or Vimentin were detected in the tumor. Proliferative activity (Ki67) was not significant. These features were compatible with a pure well-differentiated carcinoid tumor. The tumor was confined to testis capsule without any lymphovascular invasion.
Chest, abdomen and pelvis CT scan revealed no significant finding regarding para-aortic and iliac lymphadenopathy or pulmonary abnormality.
Complete gastroenterology work up was performed to rule out the possibility of testicular metastasis from an extra-testicular carcinoid tumor and a sample of the patient’s semen was frozen.
In order to verify the pathology in the contralateral testis, it was decided to use nuclear scan. Because of unavailability of nuclear octreotide scan, a MIBG (meta-iodobenzyl-guanidine) scan was requested, which was positive on the left hemiscrotum.
With diagnosis of bilateral primary testis carcinoid tumor, the patient was admitted for left partial orchiectomy. Partial orchiectomy was performed classically and a pale, creamy white, firm mass with sharp borders was excised from left testis after separating the head of the epididymis. Surprisingly, the pathologist reported dermoid cyst without any carcinoid content.
After 5 years of follow-up, the patient was good with acceptable spermogram. No tumor marker, including urinary 5-hydroxyindoleacetic acid (5-HIAA) or imaging was positive although these tests are not considered to be very specific (