Metachronous Development Research Articles

Metachronous development of malignant leydig cell tumor

Leydig cell tumor (LCT), a rare testicular tumor, is malignant in only about 10% of the cases. We report the case of a patient with bilateral malignant LCTs that developed metachronously. After undergoing a right inguinal orchiectomy for a malignant LCT at the age of 43 years, the patient was given cisplatin-based chemotherapy for suspected para-aortic lymph node metastasis. Eighteen months after the right orchiectomy, examination of a left testicular biopsy specimen showed a malignant LCT and a left inguinal orchiectomy was performed. Histologically, the initial malignant LCT exhibited a highly pleomorphic appearance with mitotic figures (58/10 HPF), whereas the second malignant LCT showed fewer mitoses (2/10 HPF). The proliferating cell nuclear antigen (PCNA)-labelling index in these tumors also differed (right-sided tumor, 50%; left-sided tumor, 28%). These findings suggest that the malignant LCT in the left testis developed as a second primary rather than as a metastatic tumor. There have been no known similar cases, although three cases of malignant LCT with contralateral metastasis have been reported.

Synchronous tumors arising in a single major salivary gland

Multiple separate tumors arising in the major salivary glands are distinctly unusual. The records on 25 patients with synchronous unilateral salivary gland tumors on file at St Louis University and at the Armed Forces Institute of Pathology were reviewed with similar cases in the literature. Bilateral tumors arose more frequently than multiple unilateral ones. The most common tumors with bilateral synchronous or metachronous development are the Warthin tumors, with more than 100 reported cases; the mixed tumor with at least 34 cases; and the acinic cell carcinoma, with 12 reported cases. The Warthin tumor also was the most likely tumor to present with multifocal unilateral involvement with 29 tumors having three or more separate foci of tumor. The next most common tumor combinations are a Warthin tumor and a mixed tumor (20 cases), the multifocal membranous basal cell adenoma (12 cases), and multiple oncocytomas (nine cases). Numerous other tumor combinations were found covering the range of salivary gland neoplasia, however one of the tumors usually was a mixed tumor or a Warthin tumor.

Synchronous tumors arising in a single major salivary gland.

Multiple separate tumors arising in the major salivary glands are distinctly unusual. The records on 25 patients with synchronous unilateral salivary gland tumors on file at St Louis University and at the Armed literature. Bilateral tumors arose more frequently than multiple unilateral ones. The most common tumors with bilateral synchronous or metachronous development are the Warthin tumors, with more than 100 reported cases; the mixed tumor with at least 34 cases; and the acinic cell carcinoma, with 12 reported cases. The Warthin tumor also was the most likely to present with multifocal unilateral involvement with 29 tumors having three or more separate foci of tumor. The next most common tumor combinations are a Warthin tumor and a mixed tumor (20 cases), the multifocal membranous basal cell adenoma (12 cases), and multiple oncocytomas (nine cases). Numerous other tumor combinations were found covering the range of salivary gland neoplasia, however one of the tumors usually was a mixed tumor or a Warthin tumor.