British Journal of Urology (1998), 82, 311–312

CASE RE PORT

Embryonal carcinoma of the testis producing carbohydrateantigen 19-9T. SODA, D. HORI, S. HIGASHI and M. MIYAKAWADepartment of Urology, Shimada Municipal Hospital, Shizuoka, Japan

Case report

A 27-year-old man presented with a left testicular swell-ing. Scrotal ultrasonography revealed a heteroechoicmass in the left testis. The CT scan showed no lymphnode swelling, but there was one pulmonary nodule,1 cm in diameter, in the right lower lobe. The tumourmarker levels were: AFP, 12.37 g/mL (normal<20 ng/mL); b-hCG, 3.41 ng/mL (normal <0.1); LDH,3249 IU/L (normal 211–419); and carbohydrate anti-gen (CA) 19-9, 138.2 U/mL (normal <37). Embryonalcarcinoma was detected in the pathological specimenobtained both from high orchidectomy and from thoraco-scopic resection of the lung tumour. Immunoperoxidasestaining of the testicular and pulmonary tumours waspositive for CA19-9 (Fig. 1). All the tumour markersbecame normal after surgery and the administration ofadjuvant chemotherapy.

Comment

CA 19-9 is a useful tumour marker in patients withgastrointestinal malignancies and its value in urologicalcarcinomas has also been studied [1]. However, there is

a

bno previous report of testicular embryonal carcinoma

Fig. 1. Immunoperoxidase staining (labelled streptavidin-biotinproducing CA 19-9. On the other hand, recent studies method) was positive for carbohydrate antigen 19-9 both in a,have shown that sialyl Lewis A antigen group, including testicular and b, pulmonary tumour.CA 19-9, can serve as a ligand for the cell adhesionmolecule E-selectin (endothelial cell leucocyte adhesionmolecule) and plays an important role in the process ofhaematogenous metastasis of carcinomas in vitro [2]. ReferencesOthers have reported that CA 19-9 expression of

1 Abel PD, Cornell C, Buamah PK, Williams G. Assessment ofcarcinomas, especially in colorectal cancers, correlatedserum CA 19.9 as a tumour marker in patients with

with poor prognosis [3]. Considering pulmonary met-carcinoma of the bladder and prostate. Br J Uro1 1987;

astasis with no lymph node involvement, expression of 59: 427–9CA 19-9 might have contributed to haematogenous 2 Takada A, Ohmori K, Yoneda T et al. Contribution ofspread of disease in this case. We will carefully follow carbohydrate antigens sialyl Lewis A and sialyl Lewis X tothis patient, including a regular assessment of serum adhesion of human cancer cells to vascular endothelium.

Cancer Res 1993; 53: 354–61CA 19-9 level.

311© 1998 British Journal of Urology

312 CASE REPORT

3 Shimono R, Mori M, Akazaki K, Adachi Y, Sugimachi K. AuthorsImmunohistochemical expression of carbohydrate antigen T. Soda, MD, Urologist.19-9 in colorectal carcinoma. Am J Gastroenterol 1994; D. Hori, MD, Urologist.89: 101–5 S. Higashi, MD, Urologist.

M. Miyakawa, MD, Chief of Department.Correspondence: Dr T. Soda, Department of Urology, ShimadaMunicipal Hospital, 1200-5 Noda, Shimada City, Shizuoka427, Japan.

© 1998 British Journal of Urology 82, 311–312