Rare Case of Metastatic Primary Testicular Angiosarcoma

Testicular angiosarcoma is a very rare malignancy. We present an additional case with multiple distant metastasis. No specific local clinical findings. This proves their aggressive biological behavior. A 50-year-old patient with a single nodule palpable in the left testicle, no redness of the skin, pain or fever. With uneven surface, hard consistency and is slightly painful on palpation. Right testicle physical examination reveals smaller nodule. Ultrasound examination revealed a heterogeneous nodular structure of both testicles.  Laboratory investigation - normal blood count, biochemistry and normal values of tumor markers. The patient was informed that both testicles are with pathological findings and bilateral orchiectomy should be performed, but the idea wasn’t accepted. A left radical inguinal orchiectomy was performed. Pathohistological and immunohistochemical examination of the specimen revealed primary testicular angiosarcoma. Primary testicular angiosarcoma is an extremely rare histologic subtype of testicular tumors. The presence of multiple general metastasis - cerebral, lungs, suprarenal glands, left kidney and right testis proves their aggressive biological behavior. There were no clinical findings of previous testicular germ cell tumor. The pathohistological identification and immunohistochemical verification are decisive for the diagnosis and the treatment.