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

Resume

Les métastases testiculaires des adénocarcinomes prostatiques sont rares. Elles sont souvent asymptomatiques et découvertes fortuitement ou à un stade évolutif avancé. Nous rapportons une observation de métastases d’un adénocarcinome de la prostate au niveau du testicule droit chez un patient de 67 ans.

Cette observation illustre le fait que la métastase d’un adénocarcinome prostatique doit faire partie des hypothèses diagnostiques devant une tumeur du testicule après 50 ans. Elle souligne l’importance de la confrontation anatomoclinique et l’immunohistochimie dans la démarche étiopathogénique.

Abstract

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.