Cushing's Syndrome Caused by Malignant Tumor in the Scrotum: Clinical, Pathologic and Biochemical Studies

ABSTRACT Malignant retroperitoneal tumors were removed from a 57-yr-old man with signs and symptoms of Cushing's syndrome associated with marked edema and hypokalemia. Pathologic evidence at autopsy suggested that the neoplasm was primary in the testis. Slices of the tumor were incubated with pregnenolone-7α-3H and steroids biosynthesized were identified by the carrier dilution technique. Radioactive progesterone, cortisol, corticosterone and dehydroepiandrosterone were identified. Corticosterone was the most prominent compound formed by the tumor. It is suggested that the tumor was derived from adrenocortical rest cells in the scrotum, and that the clinical manifestations may be accounted for by the overproduction of corticosterone as well as cortisol. The clinical, morphologic and biochemical findings are discussed.