RESUMEN
INTRODUCTION: Metastatic epididymal and spermatic cord adenocarcinoma from epithelial tumors are a rare condition. The most frequent primary cancers are prostate, lung, kidney, gastrointestinal tumors and breast. In literature, there are very low number of cases reporting metastasis from pancreatic cancer to epididymis and spermatic cord. CASE DESCRIPTION: We report a case of 70-years old man with history of left orchiectomy for undescended testicle, who presented to our department with a palpable nodule in the right scrotum. Scrotal ultrasound revealed an inhomogeneous hypoechoic nodule of epididymis and/or spermatic cord. Neoplastic markers showed high levels of CEA (carcinoembryonic antigen) and bHCG (beta Human Chorionic Gonadotropin). The patient underwent right surgical scrotal exploration with orchifunicolectomy. Pathologic examination revealed pathologic tissue showing rare glandular structures. Immunohistochemistry profile was compatible with malign epithelial neoplasm with glandular differentiation. Total body CT-scan revealed pathologic tissue in pancreas between head and body and a suspect pathologic lesion in liver and 18-FDG PET-scan confirmed the pancreatic neoplastic mass and a suspect secondary hepatic lesion. Biopsy of pancreatic pathologic area was positive for ductal pancreatic adenocarcinoma. The patient was sent to oncologic evaluation and started chemotherapy. CONCLUSIONS: Malignancies of epididymis and spermatic cord are rare entities and, in literature, very low number of cases of metastasis from pancreatic carcinoma to epididymis and spermatic cord are described. Early differential diagnosis is fundamental mostly in those patients with age range unusual for testis cancers.
Asunto(s)
Adenocarcinoma/patología , Carcinoma Ductal Pancreático/patología , Epidídimo/patología , Neoplasias de los Genitales Masculinos/secundario , Neoplasias Pancreáticas/patología , Cordón Espermático/patología , Adenocarcinoma/cirugía , Anciano , Carcinoma Ductal Pancreático/diagnóstico por imagen , Carcinoma Ductal Pancreático/cirugía , Epidídimo/diagnóstico por imagen , Epidídimo/cirugía , Neoplasias de los Genitales Masculinos/diagnóstico por imagen , Neoplasias de los Genitales Masculinos/cirugía , Humanos , Masculino , Metástasis de la Neoplasia , Orquiectomía , Neoplasias Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/cirugía , Tomografía de Emisión de Positrones , Cordón Espermático/diagnóstico por imagen , Cordón Espermático/cirugía , Neoplasias PancreáticasAsunto(s)
Trasplante de Hígado/métodos , Donantes de Tejidos , Neoplasias Urogenitales/diagnóstico , Carcinoma de Células Renales/diagnóstico , Femenino , Humanos , Hallazgos Incidentales , Neoplasias Renales/diagnóstico , Trasplante de Hígado/efectos adversos , Masculino , Neoplasias de la Próstata/diagnóstico , Factores de Riesgo , Obtención de Tejidos y ÓrganosRESUMEN
Primary testicular leiomyosarcoma is an uncommon tumor with only few cases described in literature. In young people this rare tumor seems to be related to radiotherapy and anabolic steroids abuse. In older people there are apparently no risk factors. We describe one further case in a 77-years old man with full histological and ultrastructural evaluation. A short term follow-up of one year signals no recurrence of the disease.