Angiosarcoma of the testis with retroperitoneal metastasis
While uncommon, angiosarcomas predominately occur in superficial soft tissue and rarely present in the viscera, furthermore, primary angiosarcoma of the testis is even rarer.

Published in the journal Urology Case Reports, the authors describe a case of a patient was a 58-year-old male who presented with a 3-month history of bilateral hip and low back pain.

Eventually an MRI of his spine was performed, demonstrating a questionable lesion at the L5 level. A follow up CT revealed a large necrotic retroperitoneal mass causing right hydronephrosis and compression of the IVC.

Urology was consulted and physical exam was significant for a large, bilobar, right testicular mass. Scrotal ultrasound confirmed a testicular mass with an adjacent scrotal mass and normal left testis. Retrograde right ureteral stenting was attempted to relieve the right hydronephrosis. However, a stent was unable to be passed beyond the level of obstruction.

Subsequently, a right nephrostomy tube was placed with improvement in the patient's renal function. The patient underwent a right inguinal radical orchiectomy.

Pathology demonstrated atypical tumor cells with elongated nuclei in a background of lymphocytes and histiocytes. Numerous stains were utilized to elucidate the pathologic diagnosis. Significantly, the specimen was negative for OCT3/4 and AFP staining suggesting no GCT component. The tumor was diffusely positive for CD10, CD31, and vimentin, and was negative for cytokeratin AE1/3, MDM-2, desmin and myoD1.

Given the presumed diagnosis of metastatic angiosarcoma, the patient was referred to Oncology for systemic treatment. Biopsy of a bone lesion confirmed metastatic angiosarcoma with a final stage of pT3N1M1. The patient elected to pursue palliative chemotherapy and succumbed to his disease 6 months after initial presentation.

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