Une nouvelle observation d’une métastase testiculaire d’un adénocarcinome prostatique: Aspects diagnostiques et éthiopathogéniques

Testicular metastases from prostatic adenocarcinoma are rare. They are often asymptomatic and diagnosed incidentally or at autopsy after orchidectomy in more advanced stages of the disease. The authors report a new case and review the diagnosis and aetiopathogenesis of these metastases. A 67-year-old patient with prostatic adenocarcinoma presented with painless right testicular mass for two months with no inflammatory signs. Germ cell tumour serum markers were negative. Scrotal ultrasound showed a large testicular tumour measuring 7×4×3cm. Histological examination revealed a solid non-differentiated tumour, not suggestive of primary testicular tumour. The immunohistochemical panel confirmed the prostate as the primary site due to the positivity of cytokeratins, PSA and PSAP and the negativity of classical markers of germ cell tumours. Testicular metastases from prostatic adenocarcinoma are rare, but their incidence is currently on the increase. They are often asymptomatic and discovered after pulpectomy. This diagnosis must be considered in the case of a testicular mass in patients over the age of 50 with a history of prostatic adenocarcinoma. The diagnosis was established after orchidectomy by histological examination and immunohistochemical tests.     

Récidive testiculaire isolée d’un adénocarcinome prostatique révélée par TEP/TDM 18F-fluorocholine

With the development of new PET tracers, nuclear medicine has become a central element in the search for prostate cancer recurrence. A 75-year-old patient followed for a prostate adenocarcinoma was referred to our center for biological recurrence, with a gradual rise of prostatic specific antigen (PSA). A pelvic MRI and ¹⁸F-fluorocholine PET/CT were performed, both showing no strong evidence of local recurrence. This last examination however revealed an intense pathological radiotracer uptake only in the left testicle. After performing a complementary ultrasound imaging, orchiectomy revealed a metastatic testicular localization of the prostatic adenocarcinoma. PSA control after surgery had normalized. This case emphasizes one of the unusual presentations of metastatic prostatic disease to be aware of.     

Radiothérapie interne vectorisée par 177Lu-PSMA-617 de l’adénocarcinome prostatique métastatique résistant à la castration : à propos d’un cas et revue de la littérature

The prostate-specific membrane antigen (PSMA) is a type II glycoprotein which is over-expressed in prostate cancer tissue, especially in high grade tumours, metastatic disease, as an effect of androgen-deprivation therapies and in castrate-resistant prostate cancer (CRPC). Recent studies about radioligand therapy using PSMA ligands labeled with lutetium-177 (¹⁷⁷Lu) in CRPC patients have suggested its interest as a third line of treatment after second generation anti-androgens and chemotherapy by taxane. We present the case of a CRPC patient who was treated by iterative radioligand therapy using PSMA-617 ligand labeled with ¹⁷⁷Lu. This case illustrates on the one hand the efficacy of the treatment, and on the other hand the fragility of the patients who are at an advanced stage of their disease. Then we present a short review of the literature on this topic, focusing on the published efficacy and tolerance of ¹⁷⁷Lu-PSMA radioligand therapy of CRPC patients.     

Ostéite tuberculeuse de l’os frontal simulant une métastase lytique d’un carcinome papillaire de la thyroïde : à propos d’un cas

The authors report a case of patient followed for papillary thyroid carcinoma with osteolytic calvarial image at left frontal bone. Bone metastasis of thyroid carcinoma is suspected in the first. Histopathological examination of the material of craniotomy revealed granulomatous lesion in favour of tuberculous osteitis. Such an association is exceptional and only histology allows a definitive diagnosis.     

Ectopie testiculaire croisée: à propos d’un cas

Crossed testicular ectopia, also called transverse testicular ectopia, is an uncommon congenital anomaly in which both testes migrate through a single inguinal canal toward the same hemiscrotum. More than 100 cases have been reported in the literature. This rare syndrome is commonly associated with abnormalities of genitourinary development, especially inguinal hernia and defective Müllerian regression. A conservative approach is recommended, now performed via laparoscopy. Long-term follow-up is required for assessment of fertility and early detection of testicular malignancy. The authors report a new case of crossed testicular ectopia in a 4-year-old boy who presented with right inguinal hernia and impalpable left testis.     

Métastases gingivales d’un carcinome thyroïdien différencié

The differentiated thyroid carcinoma metastases concern habitually the lymphatic chains, the bone, the lung, and to a lesser degree the other organs. We report a rare case of gingival metastasis of differentiated thyroid carcinoma with bony invasion, in a 50 year-old patient, in whom the gingival metastasis revealed the thyroid carcinoma. Such extension follows a protracted course. Metastasis clinically appears years after the diagnostic of initial tumour. The lack of any specific sign, makes them to be mistaken for inflammatory or infectious pathologies. Their prognosis is in general good, if they are early and accurately diagnosed.     

La citréomontanine,nouvelle α-pyrone polyéthylénique isolée de Penicillium pedemontanum

Citreomontanin, a new polyene 2-pyrone was isolated from the mycelium of P. pedemontanum. Based upon spectral data, it was assigned the structure: (all-E)-4-methoxy-5-methyl-6-(7,9,11- trimethyl-1,3,5,7,9,11-tridecahexaenyl)-2 H-pyran-2-one.     

Etude d’un modèle expérimental d’infection de l’appareil génital mâle

Injection of uropathogenic E. coli into the rat cauda epididymidis results in chronic epididymitis in 74.2% of cases, accompanied by necrotic orchitis (16.1% of cases) or non-infectious testicular lesions (45.2% of cases). Injection of killed bacteria caused the same noninfectious testicular lesions, most probably due to toxic damage. Injection of bacteria into the seminal vesicles caused a vesiculitis which regressed after seven days and disappeared progressively. Simultaneously, the prostate was invaded by polymorphonuclear leucocytes, an infection which persisted for more than three months. E. coli injection in association with bilateral castration gave rise to the formation of chronic vesicular abscesses. Examination of the male genital tract lymphatic system allowed explanation of the spread of infection from the epididymis to the testis, and from the seminal vesicle to the prostate. The epididymis is an organ with poor defense against against infection whereas the seminal vesicle is able, owing to the activity of its epithelium, to fight infection. On the other hand, prostatitis secondary to vesiculitis is immediately chronic.     

Un adénocarcinome mucineux non kystique (carcinome colloïde) du pancréas de découverte fortuite à la TEP-TDM au 18F-FDG : à propos d’un cas

Colloid carcinoma (CC) of the pancreas, also known as mucinous noncystic carcinoma, is a rare histological variant of pancreatic cancer which had been included in the past under the category of ordinary ductal carcinoma, a tumor with a dismal prognosis, or was frequently misdiagnosed as mucinous cystadenocarcinoma. As CC has a better prognosis than pancreatic ductal carcinoma, early detection of CC by 18 FDG PET SCAN is of great value for the therapeutic management of patients. We report the case of a 66-year-old patient who underwent 18 FDG PET SCAN as part of a post-therapy evaluation of a moderately differentiated carcinoma of the stomach treated with surgery and chemotherapy, in whom a hypermetabolic focus of the body of the pancreas was discovered incidentally. The anathomopathological diagnosis was in favor of a low-grade mucinous noncystic carcinoma of the pancreas. Thus, 18 FDG PET SCAN allowed the discovery of an infraradiological CC synchronous with a gastric adenocarcinoma and provided information on its metabolic activity as well as locoregional and distant staging, which are important prognostic markers and which could improve the therapeutic management of the patient.