[Testicular metastases as primary manifestation of malignant melanoma at known melanocytoma].
BACKGROUND: Secondary tumors of the testes are rare. In about 15 % of the cases they are metastases of a malignant melanoma, there are about 30 reports of such cases in the literature. Most of them describe findings at post-mortem, in only 4 of the previously described cases testicular metastases were the first manifestation of a melanoma. The transformation of a benign, meningeal melanocytoma into a malignant melanoma has only been described once world-wide. The problems in the diagnosis and therapy of this extremely rare tumor are discussed on the basis of a further patient with metastases of the testes as primary manifestation of a malignant melanoma. CASE REPORT: We report on a 74-year-old man who presented with a relatively rapidly developing but less painful swelling of the left testicle. The case history disclosed operations 10 and 3.5 year earlier for an apparently benign melanocytoma at the level of the 11th and 12th thoracic vertebrae, a local recurrence with paraparesis was known at the time of admission. Sonography revealed an inhomogeneous tumor effecting the entire left testicle. Therapy comprised an inguinal, radical orchiectomy. The correct diagnosis was made histologically. Shortly after the operation, a diffuse, subcutaneous and hepatic metastases occurred. CONCLUSION: In the case of a primary manifestation a correct preoperative diagnosis is unusual. Radical orchiectomy is the treatment of choice for a suspected primary testicular tumor. The prognosis is accordingly poor. In elderly patients with unclear testicular tumors metastases from an (occult) tumor disease must be taken into consideration.