case_images: PMC5308049_01
case_images: Gallium-68 prostate-specific membrane antigen-positron emission tomography/computed tomography clearly showing tracer uptake in the left testis, in correlation with the pathological findings
case_images: UA-9-89-g001.jpg
case_images: PMC5308049_01_UA-9-89-g001.jpg
case_images: F1
case_images: As serum prostate-specific antigen (PSA) continued to rise, reaching 20 ng/mL, gallium-68 prostate-specific membrane antigen-positron emission tomography/computed tomography (68 Ga-PSMA PET/CT) was performed, showing high uptake in the left testis and retrovesical space [Figure 1].
case_images: Pelvic magnetic resonance on sagittal view confirming the presence of a 2.2 cm nodule circumscribed to the left epididymis, hypointense in T2 sequence
case_images: UA-9-89-g002.jpg
case_images: PMC5308049_01_UA-9-89-g002.jpg
case_images: F2
case_images: Pelvic magnetic resonance confirmed the presence of a 2.2 cm solid, heterogeneous nodule, hypointense in T2 sequence, with arterial vascularization [Figure 2].
case_images: Histopathological examination of the radical left orchiectomy specimen. (a) Macroscopy: Nodule in epididymal tail (arrow). (b and c) Histology (H and E, x100): Epididymal metastasis infiltrating epididymal ducts (b) and neurovascular structures (c). (d) Immunohistochemistry (PSA, x200): Diffuse cytoplasmic immunoreactivity
case_images: UA-9-89-g003.jpg
case_images: PMC5308049_01_UA-9-89-g003.jpg
case_images: F3
case_images: The lesion was confined to the epididymis, sparing the testicular parenchyma [Figure 3a]. On histological examination, the lesion was composed of malignant glands infiltrating around the epididymal ducts [Figure 3b] as well as the adipose tissue/neurovascular structures [Figure 3c]. Immunohistochemical staining for PSA demonstrated strong diffuse cytoplasmic immunoreactivity in the neoplastic glands [Figure 3d].