Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 16, 2022; 10(32): 12028-12035
Published online Nov 16, 2022. doi: 10.12998/wjcc.v10.i32.12028
Primary testicular neuroendocrine tumor with liver lymph node metastasis: A case report and review of the literature
Tong Xiao, Long-Hua Luo, Liang-Fei Guo, Li-Qin Wang, Liang Feng
Tong Xiao, Long-Hua Luo, Liang-Fei Guo, Li-Qin Wang, Liang Feng, Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China.
Author contributions: Xiao T and Luo LH contributed equally to this work; Xiao T, Luo LH, and Feng L designed the research study; Xiao T, Luo LH, Guo LF and Wang LQ performed the research; Xiao T and Luo LH contributed new reagents and analytic tools; Guo LF, Wang LQ and Xiao T analyzed the data and wrote the manuscript; all authors have read and approved the final manuscript.
Supported by Support Plan of Jiangxi Provincial Department of Science and Technology, China, No. 20133BBG70062.
Informed consent statement: Informed written consent was obtained from the patient and his family for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Liang Feng, Doctor, Chief Physician, Professor, Department of Urology, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Donghu District, Nanchang 330006, Jiangxi Province, China. fengliang6503@163.com
Received: August 7, 2022
Peer-review started: August 7, 2022
First decision: August 22, 2022
Revised: August 29, 2022
Accepted: October 17, 2022
Article in press: October 17, 2022
Published online: November 16, 2022
Processing time: 92 Days and 18.9 Hours
Abstract
BACKGROUND

Primary testicular neuroendocrine tumors (TNETs) are sporadic, accounting for only 0.23% of all testicular tumors. Few cases have been reported in the literature, and no uniform treatment protocol exists. We report a case of a primary TNET with liver lymph node metastasis diagnosed at the age of 24 years and discuss its clinicopathological features, diagnosis, differential diagnosis, treatment, and prognosis.

CASE SUMMARY

We report the case of a 24-year-old patient with a primary TNET with liver lymph node metastasis. The patient was found to have a right testicular swelling of about 3 cm × 4 cm in size with unclear borders and no testicular pressure pain seven years ago without any examination or treatment. One month ago, an ultrasound examination was performed for persistent enlargement of the right testis, which showed an occupying lesion of the right testis approximately 110 mm × 102 mm × 82 mm in size. Magnetic resonance imaging scan of the testis (plain scan) showed that the right testis was an occupying lesion with inhomogeneous density and mixed signal, the boundary was still clear, and the possibility of seminoma was considered; chest X-ray and computed tomography did not show any apparent abnormalities. The patient underwent radical orchiectomy, and the pathological examination suggested a right TNET with a typical carcinoid tumor histological type. One month after the surgery, the patient received nine cycles of lanreotide chemotherapy at a dose of 90 mg/mo without adverse effects. No distant lymph node or other organ metastases were detected at follow-up. He is in good physical condition and attends regular follow-up visits.

CONCLUSION

Neuroendocrine tumors are rare in clinical practice, and the diagnosis mainly relies on the characteristics of microscopic tumor cells and immunohistochemical features. Treatment involves radical orchiectomy. If it is accompanied by distant lymph node metastasis and the metastatic lesion can be resected, it should be surgically removed; if it cannot be resected, growth inhibitor analog octreotide or lanreotide chemotherapy can be administered to obtain good results, with close postoperative follow-up to prevent recurrence and metastasis.

Keywords: Testis; Neuroendocrine tumor; Immunohistochemistry; Differential diagnosis; Somatostatin analog; Lanreotide; Liver metastasis; Treatment; Case report

Core Tip: Neuroendocrine tumors are rare in the clinic, and the diagnosis mainly depends on the characteristics of tumor cells and immunohistochemistry. Radical orchiectomy is the main treatment. If it is accompanied by distant lymph node metastasis and the metastatic lesion can be resected, it should be removed. If it cannot be resected, it can be treated with somatostatin analog octreotide or lanreotide chemotherapy. Good results can be obtained. Close follow-up can be conducted to prevent recurrence and metastasis.