RESUMO
Testicular adrenal rest tumours are frequently associated with congenital adrenal hyperplasia (CAH). These ACTH-dependent tumours cannot be easily distinguished histologically from Leydig-cell tumours. We report the case of a 30-year-old man who was explored for infertility, azoospermia and unilateral testicular tumour. High levels of 17-OH progesterone and ACTH, low cortisol and undetectable gonadotropins levels, associated to bilateral adrenal hyperplasia, led to the diagnosis of CAH by 21-OH deficiency with a composite heterozygoty. The testicular tumour was first considered as adrenal rest. However, histological analysis of this unilateral painful tumour showed a steroid-hormone-secreting cell proliferation with atypical and frequent mitosis. To discriminate between a benign adrenal rest tumour and a possible malignant leydigioma, tumoral expression of specific gene products was analyzed by RT-PCR. No 11-beta-hydroxylase nor ACTH receptor mRNAs could be found in the tumour, which did not behave like usual adrenal rest cells. For this unilateral testicular tumour, the lack of adrenal-specific markers associated with a high rate of mitosis and pleiomorphism supported a leydigian origin with malignant potential. However, lack of tumoral LH-R mRNA expression and a tumour-free 3-year follow-up led us to retain the diagnosis of adrenal rest tumour with loss of adrenal gene expression and progressive autonomous behaviour.
Assuntos
Hiperplasia Suprarrenal Congênita/complicações , Hiperplasia Suprarrenal Congênita/diagnóstico , Tumor de Resto Suprarrenal/diagnóstico , Tumor de Células de Leydig/diagnóstico , Neoplasias Testiculares/complicações , Neoplasias Testiculares/diagnóstico , Corticosteroides/sangue , Corticosteroides/genética , Hiperplasia Suprarrenal Congênita/cirurgia , Tumor de Resto Suprarrenal/patologia , Tumor de Resto Suprarrenal/cirurgia , Adulto , Anti-Inflamatórios/uso terapêutico , Azoospermia/etiologia , Biomarcadores Tumorais , Dexametasona/uso terapêutico , Diagnóstico Diferencial , Hormônios Esteroides Gonadais/sangue , Hormônios Esteroides Gonadais/genética , Gonadotropinas/sangue , Humanos , Infertilidade Masculina/etiologia , Tumor de Células de Leydig/patologia , Tumor de Células de Leydig/cirurgia , Masculino , RNA Mensageiro/biossíntese , RNA Mensageiro/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Neoplasias Testiculares/cirurgia , Testículo/patologiaRESUMO
The stage of the tumor is commonly underestimated prior to radical prostatectomy for carcinoma. Can the growth of clinically localized carcinomas beyond their capsule be predicted with the modern medical imaging techniques (MRI and CT)? On the basis of 30 successive prostatectomies, we conclude that CT is ineffective. On the contrary, MRI seems to be an effective technique for this indication. However, no examination yet is better than clinical assessment.
Assuntos
Imageamento por Ressonância Magnética , Neoplasias da Próstata/diagnóstico , Tomografia Computadorizada por Raios X , Humanos , Metástase Linfática , Masculino , Invasividade Neoplásica , Prostatectomia , Neoplasias da Próstata/cirurgia , Estudos RetrospectivosRESUMO
Spread beyond the capsule is a poor prognosis factor in clinically localized carcinomas of the prostate; preoperative diagnosis is difficult and clinical evaluation usually underestimates tumor spread. This prospective study was undertaken to confront results of the conventional workup (rectal examination, transrectal ultrasonography and PSA) and of CT scan and MRI findings with findings upon the pathologic study of operative specimens following radical prostatectomy. Results show that the conventional workup remains the diagnostic gold standard and that CT scan yields no additional information. Technically faultless MRI with sections in the three planes is a good means for analyzing the capsule of the prostate.