Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 6, 2021; 9(1): 278-283
Published online Jan 6, 2021. doi: 10.12998/wjcc.v9.i1.278
Krukenberg tumor with concomitant ipsilateral hydronephrosis and spermatic cord metastasis in a man: A case report
Shu-Han Tsao, Cheng-Keng Chuang
Shu-Han Tsao, Cheng-Keng Chuang, Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan
Author contributions: Tsao SH is the first author; Tsao SH wrote the case report and completed the literature review; Chuang CK performed the final editing and prepared the paper for approval by the authors; All authors read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient to publish this case report and the accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Cheng-Keng Chuang, MD, PhD, Chief Doctor, Professor, Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, No. 5 Fuxing Street, Guishan District, Taoyuan City 333, Taiwan. chuang89@cgmh.org.tw
Received: October 7, 2020
Peer-review started: October 7, 2020
First decision: October 27, 2020
Revised: November 3, 2020
Accepted: November 13, 2020
Article in press: November 13, 2020
Published online: January 6, 2021
Abstract
BACKGROUND

Tumors of the spermatic cord are rare, and approximately 25% are malignant neoplasms. Metastatic spermatic cord tumors are even rarer. Several studies have revealed that the most frequent primary tumors metastasizing to the spermatic cord and peritesticular tissues are neoplasms of the stomach and prostate. Furthermore, metastasis to the spermatic cord or epididymis may occur via retrograde lymphatic and hematic routes. We present the case of a man with gastric cancer that metastasized to the spermatic cord and epididymis, with concomitant ipsilateral hydronephrosis after surgical resection and chemotherapy for his primary tumor.

CASE SUMMARY

A 71-year-old man underwent total gastrectomy for pT4aN2 poorly differentiated gastric adenocarcinoma in December 2016. Two months after surgery, he received adjuvant chemotherapy with TS-1 from February 2017 to February 2018. Surveillance computed tomography (CT) was performed in June 2018, which did not reveal any sign of tumor recurrence. In November 2019, he presented with left lower quadrant abdominal pain and a palpable left inguinal-scrotal mass. CT revealed left mild hydronephrosis and a left scrotal mass measuring 4.0 cm × 1.7 cm. Tumor biomarkers, including alpha-fetoprotein (AFP), lactate dehydrogenase (LDH), beta-human chorionic gonadotropin (βHCG), carcinoembryonic antigen (CEA), and carbohydrate antigen 19-9 (CA19-9) were all normal. Renal and testicular echography showed left hydronephrosis and a left peritesticular soft tissue lesion with blood flow. Diagnostic ureteroscopy showed left lower ureter narrowing without an intraluminal lesion. A biopsy was obtained for the indurated spermatic cord and epididymis, which showed poorly differentiated adenocarcinoma. Immunohistochemical staining demonstrated that the tumor was diffusely and strongly positive for homeobox protein CDX2. The features were consistent with metastatic adenocarcinoma of a primary gastric tumor.

CONCLUSION

In patients with a history of primary cancer, an inguinal mass of unknown cause with accompanying ipsilateral hydronephrosis may be a sign of distant metastasis from a primary tumor, especially of gastrointestinal origin.

Keywords: Case report, Epididymis, Gastric cancer, Krukenberg tumor, Male, Spermatic cord

Core Tip: Gastric cancer rarely metastasizes to the spermatic cord, but when it does, the prognosis is typically unfavorable. Ipsilateral hydronephrosis caused by retrograde lymphatic metastasis is a possible manifestation of distant metastasis of gastric cancer. Additionally, a preexisting inguinal mass and earlier detection of hydronephrosis could also contribute to a more favorable outcome.