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

Keywords

Urology; Andrology; spermatic cord; pancreas; cancer; pancreatic metastasis; Italy; Oncology; Epididymis; metastasis; scrotal cancer

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Submitted: 2018-01-06 17:57:19
Published: 2018-03-31 00:00:00
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Copyright (c) 2018 Carmelo Agostino Di Franco, Bruno Rovereto, Valeria Zoccarato, Cesare Regina, Nicolò Fiorello, Alessandra Viglio, Daniele Porru, Giovanni Giliberto

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