Metastasis of the epididymis and spermatic cord from pancreatic adenocarcinoma: A rare entity. Description of a case and revision of literature

  • Carmelo Agostino Di Franco | carmelo_difranco@tiscali.it Department of Urology, University Hospital IRCCS Policlinico S.Matteo of Pavia, Italy.
  • Bruno Rovereto Department of Urology, University Hospital IRCCS Policlinico S.Matteo of Pavia, Italy.
  • Daniele Porru Department of Urology, University Hospital IRCCS Policlinico S.Matteo of Pavia, Italy.
  • Valeria Zoccarato Department of Urology, University Hospital IRCCS Policlinico S.Matteo of Pavia, Italy.
  • Cesare Regina Department of Urology, University Hospital IRCCS Policlinico S.Matteo of Pavia, Italy.
  • Tiziano Cebrelli Department of Urology, University Hospital IRCCS Policlinico S.Matteo of Pavia, Italy.
  • Nicolò Fiorello Department of Urology, University Hospital IRCCS Policlinico S.Matteo of Pavia, Italy.
  • Alessandra Viglio Department of Pathology, University Hospital IRCCS Policlinico S.Matteo of Pavia, Italy.
  • Lavinia Galvagno Language and Translation Services, Enna, Italy.
  • Carlo Marchetti Department of Urology, University Hospital IRCCS Policlinico S.Matteo of Pavia, Italy.
  • Andrea Ringressi Department of Urology, University Hospital IRCCS Policlinico S.Matteo of Pavia, Italy.
  • Davide Barletta Department of Urology, University Hospital IRCCS Policlinico S.Matteo of Pavia, Italy.
  • Giovanni Giliberto Department of Urology, University Hospital IRCCS Policlinico S.Matteo of Pavia, Italy.

Abstract

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.

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Published
2018-03-31
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Issue
Section
Case Reports - Oncology
Keywords:
Urology, Andrology, spermatic cord, pancreas, cancer, pancreatic metastasis, Italy, Oncology, Epididymis, metastasis, scrotal cancer
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  • PDF: 272
  • Supplementary Material: 141
How to Cite
Di Franco, C., Rovereto, B., Porru, D., Zoccarato, V., Regina, C., Cebrelli, T., Fiorello, N., Viglio, A., Galvagno, L., Marchetti, C., Ringressi, A., Barletta, D., & Giliberto, G. (2018). Metastasis of the epididymis and spermatic cord from pancreatic adenocarcinoma: A rare entity. Description of a case and revision of literature. Archivio Italiano Di Urologia E Andrologia, 90(1), 72-73. https://doi.org/10.4081/aiua.2018.1.72