Late-onset metastatic adenocarcinoma of the spermatic cord from primary gastric cancer

Abstract

Background: Metastatic cancers of the paratesticular tissue are very rare; however, the most frequent primary site of spermatic cord metastasis is the gastrointestinal tract.

Case presentation: We recently observed two cases of late-onset metastatic adenocarcinoma of the spermatic cord. Both patients complained of groin discomfort with a palpable mass in the scrotum and inguinal area. Radical orchiectomy and adjuvant chemotherapy were performed in both patients. Although the prognosis of patients with metastatic adenocarcinoma of the spermatic cord is typically poor, the prognosis of our patients was favorable after follow-up for 14 to 18 months.

Conclusions: In patients with groin discomfort or swelling and a history of gastric cancer, metastatic adenocarcinoma should be included in the differential diagnosis for early detection of tumors.

Figure 1

Ultrasonography, CT, and MRI. (a) Case 1: scrotal ultrasonography revealed an ill-defined heterogeneous mass (white arrow) in the spermatic cord and epididymis. (b) Case 2: inguinal ultrasonography revealed an ill-defined heterogeneous mass (white arrow) of the spermatic cord in the inguinal area, and (c,d) CT and MRI revealed an ill-defined enhancing mass (white arrows), longitudinally along the inguinal tract. CT, computed tomography; MRI, magnetic resonance imaging.

Figure 2

Gross examination. Gross examination showed an ill-defined grayish-white solid mass (white arrows) in the epididymis and spermatic cord. (a) Case 1. (b) Case 2.

Figure 3

Histological analysis. Histological analysis revealed an adenocarcinoma with signet ring cells. (a) Case 1: epididymal tubules. (b) Case 2: stomach (H & E staining, 400×). Immunohistochemical staining revealed a cytokeratin 7-positive mass. (c) Case 1: epididymal tubules. (d) Case 2: stomach (400×). H & E, hematoxylin and eosin.