Abstract
Signet-ring cell carcinoma is a highly malignant adenocarcinoma consisting of cells characterized as cytoplasmic vacuoles filled with mucin. The most common primary location of this type of cancer is the stomach, but it may also be found in other organs such as prostate, testis, bladder, ovaries, or colon. To date, metastatic signet-ring cell carcinoma of unknown primary (CUP) site to the testis is an extremely rare entity in daily practice. Reviewing the literature, we have been able to detect only three cases of testicular metastases from CUP, two with histological diagnosis of a signet-ring cell carcinoma and one with an adenocarcinoma. In this short paper, we report a case of a 56-year-old man who presented to our Department with testicular mass and ascites. Following a standard diagnostic approach no primary tumor could be identified. CUP was the final clinical diagnosis, histologically characterized as poorly differentiated adenocarcinoma with signet-ring cells involving the peritoneum and the testicular structures.
Highlights
carcinoma of unknown primary (CUP) is a clinical syndrome, which is defined by the presence of metastatic disease without establishment of the primary site
A more favorable prognosis has been associated with lymph nodal disease, female sex, good performance status, normal LDH levels, and small number of metastatic sites [1, 2]
CUP is distinguished between favourable and unfavourable subsets [2]
Summary
CUP is a clinical syndrome, which is defined by the presence of metastatic disease without establishment of the primary site. The diagnostic algorithm is based on patient’s symptoms, clinical examination, laboratory findings, and imaging studies. In order to identify the primary site, a thorough physical examination, a complete medical history, and basic laboratory tests such as complete blood count, serum biochemistry, chest X-ray, CT scans, mammography, and tumor markers should be performed [2, 3]. More accurate methods such as Molecular Tumor Profiling technics (MTP) are available to help oncologists define the primary site [8]. The primary goal of medical oncologists is to rule out the presence of a potentially treatable or curable malignancy (i.e., germ-cell tumors, lymphomas, and breast cancer) [2].
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