An unusual case of a metastatic tumor of the spermatic cord, which waS the first manifestation of bladder cancer, is reported

Ishida, Akira

Konami, Teruo

Pak, Kyun

Takeuchi, Hideo

Tomoyoshi, Tadao

Watanabe, Jin

Kyoto University Research Information Repository

Title Metastasis to the spermatic cord as the first sign of bladdercarcinomaAuthor(s)Ishida, Akira; Watanabe, Jin; Takeuchi, Hideo; Konami, Teruo;Pak, Kyun; Tomoyoshi, TadaoCitation泌尿器科紀要 (1988), 34(7): 1269-1271Issue Date1988-07URL http://hdl.handle.net/2433/119627RightType Departmental Bulletin PaperTextversionpublisherKyoto UniversityActa Urol. Jpn. 34: 1269-1271, 1988 1269 METASTASIS TO THE SPERMATIC CORD AS THE FIRST SIGN OF BLADDER CARCINOMA Akira ISHIDA and Jin WATANABE From the Department of Urology, Uii-Tokushukai Hospital (Chi~f: Dr. A. Ishida) Hideo TAKEUCHI, Teruo KONAMI, Kyun PAK and Tadao TOMOYOSHI From the Department of Urology, Shiga University of Medical Science (Director: Prof. T. Tomo),oshi) An unusual case of a metastatic tumor of the spermatic cord, which waS the first manifesta· tion of bladder cancer, is reported. Key words: Metastatic spermatic cord tumor, Bladder carcinoma, First sign INTRODUCTION Spermatic cord tumors are rather rare and primary tumors are usually sarcomas such as leiomyosarcoma, rhabdomyosar-coma, fibrosarcoma and liposarcoma!). Metastatic tumors of the spermatic cord are very rare and approximately 50 cases have been documented in the literature2- 6). Primary sites of these tumors are the sto-mach (28 cases), prostate (6 cases), kidney (5 cases), colon (5 case), pancreas (2 cases), rectum (I case), testis (1 case), and epididymis (1 case). The bladder as the primary site of metastatic tumors to the spermatic cord is not included in the literature. An extensive review of autop-sies of bladder cancer in the literature showed tha t the spermatic cord is not reported as the location of metastasis?>. Here, we report a case of the metastatic spermatic cord tumor which was the first manifestation of bladder carcinoma. CASE REPORT A 71-year-old man was admitted to our hospital with the complaint of a painless firm mass in the right inguinal region on February 27,1984. He had noted the tumor a few months prior to admission. He had noted neither inguinal pain nor gross he-maturia. Past history and family history were not cotributory. Physical examination revealed a nontender, firm, round mass with a somewhat irregular surface in the right inguinal region. The mass measured 2 x 3 cm, showed negative transillumination and was not fixed to the skin. Bilateral scrotal contents were normal and the digital examination of the prostate was unremarkable. Superficial lymph nodes were not swollen. Results of laboratory data including carcinoembryonic antigen and alpha-fetoprotein were within normal limits and uninalysis was negative. A chest x-ray and excretory urogram were normal. Upon the diagnosis of the spermatic cord tumor, a high inguinal orchi-ectomy was performed on the right side. During the operation, a whitish, hard mass was identified just below the external inguinal ring and the scrotal contents were normal. The surgical specimen weigh-ed 40 grams and the section of the tumor showed a whitish homogeneous surface (Fig. 1). Histological examination revealed undifferentiated carcinoma (Fig. 2), There-fore, the other primary site of the tumor had to be investigated. Abdominal CT scans and ultrasonograms were normal. The patient had been complaining of fre-quent urination and occasional nocturnal enuresis. As urinary cytology showed class V, a cystoscopy was performed. It dis-closed multiple nonpapillary tumors at the posterior wall of the bladder and the 1270 Acta Urol. Jpn. V ol. 34 No.7, 1988 20 Fig. I. Specimen o btained at ri ght hi gh inguinal orchi ec tomy. Note a tumor in the co rd (arr owhead s ). Fig. 2. Light microgr aph of the spermati c cord tumor showin g poorly differenti ated car-cinom a suspec ted of metasta tic tumor. Fig. 3. Li ght micrograph of the bl adder tumor showing transti onal cell carcinom a in situ and poorl y differentiated ca rcino-m a. capacity of the bladder was reduced to barely 150 m!. As histological examination of the biopsied specimen revealed poorly differentiated carcinoma, a subsequent total cystectomy and bilateral cutaneous ureterostomies were performed on April 12, 1984. The histopathological diagnosis was verified by Armed Forces Institute of Pathology (AFIP, 1929783-7) as follows: (I ) bladder, transitional cell carcinoma, grade II ~ III, in situ and poorly differen-tiated carcinoma, infiltrating muscle and perivesical fat, and with superficial lym-phatic invasion (Fig. 3) ; (2) right spermatic cord , metastasis , poorly differentiated carClI10ma. Postoperative irradiation or chemothe-rapy was not performed because of liver dysfunction and ileus. Six months after the operation, the patient complained of a left inguinal mass, and a left high ingui-nal orchiectomy showed metastasis of bladder cancer to the spermatic cord . He died of disseminated intravascular coa-gulation on February 14, 1985 and an autopsy was refused. DISCUSSION The usual sites of metastasis of bladder cancer are reported in order of decreasing frequency by statistical survey of 2,561 autopsy cases as follows; lymph nodes 1,110 (43.3%) , lung 877 (34.2%) , liver 792 (30_9%) , bones 431 (16.8%) , perivesical cavity 299 (11.7%) , peritoneum 289 (11.3 %) and adrenals 228 (8.9%)7). No cases of metastasis to the spermatic cord are included in this analysis. There are six possible routes of meta-stasis to the spermatic cord; ( I) retro-grade lymphatic extension, (2) retrograde venous extension or embolism, (3) arterial embolization, (4) retrograde ductal exten-sion, (5) extension by direct peritoneal implant, (6) direct invasion from conti-guous growths8- 10) _ For instance, metastasis from the stomach is supposed mainly by route (I ) and (5) , that from the prostate by routes ( I) , (2) , (3) and (4) , and that from the kidney by routes (1) and (2) _ Metastasis of bladder cancer to the intra-scrotal contents is infrequent, and it is generally accepted that the route of meta-stasis of bladder cancer to the testis is via the prostate invaded by carcinoma. In this case, the prostate, vessels of the cord and the spermatic duct were not invaded by tumor cells. Therefore, retro-grade lymphatic extension is a possible route of metastasis of bladder cancer to Ishida et al.: Metastatic bladder carcinoma to spermatic cord 1271 the spermatic cord. This case is unique because a mass in the spermatic cord was the first manife-station of bladder cancer. This patient did not note gross hematuria which is the most common symptom of bladder cancer， and this was the reason why diagnosis was delayed. In cases of carcinoma in situ， however， symptoms such as frequency， urgency and dysuria are the most charac-teristic symptoms. In this case， the patient complained only about abnormal voiding frequency with enuresis， probably due to decreased capacitγ. Pathological findings were also interest-ing enough， that out of the two compo-nents of transitional cell carcinoma and undi佐rentiated carcinoma identified in the bladder，the latter metastasized to the spermatic cord. When spermatic cord tumor is histologically carcinoma， the primary site should be investigated be-cause carcinoma of the spermatic cord is mostly metasttaic. REFERENCES 1) BIitzer PH， Dosoretz DE， Proppe KH and Shipley WV: Treatment of malignant tumors of the spermatic cord: a study of 10 cases and a review of the literature. J Urol 126: 和文抄録611， 1981 2) Monn L and Poticha SM: Metastatic tumors of spermatic cord. Urology 5: 821 1975 3) AIgaba F， Santaularia JM and ViIlavicencio H: Metastatic tumor of the epididymis and spermatic cord. Eur Urol 9: 56， 1983 4) Markovic B， Opric M， Prica V， Colovic V‘ Mandic R and Jeremic A: Metastasis to the funiculus spermaticus as the first sign of renal ceII carcinoma. World J Surg 7: 669， 1983 5) Ohi T， Tabayashi Y and Tuchiya A: Meta-static tumors of the spermatic cord: case report. Jpn J Clin Urol 24: 631， 1970 6) Nishimura K， Yoshimura N， Yamamoto SヲNakagawa T and Miyaoka T: A case of a metastatic tumor of the spermatic cord from cecal cancer. Acta Urol Jpn 29: 907， 1983 7) Saitoh Hヲ日idaM， Wakabayashi T， Iida T and Satoh T: Metastasis of urotheliaI tumors of the bladder: correlation between sites and number of organs involved. Tokai J Exp Clin Med 7: 517， 1982 8) Pienkos EJ and Jablokow VR: Secondary testicular tumors. Cancer 30: 481， 1972 9) Johnson DEヲ JacksonL and Ayala AG: Secondary carcinoma of the testis. South Med J 64: 1128， 1971 10) Lewis LG， Goodwin WE and Ra吋 a1WS: Carcinorna of thc spcr皿 aticcord and epi-didymis extension from primary carcinoma of the stomach. J Urol 51: 75， 1944 (Accepted for publication July 20， 1987) 原発巣(勝目光癌)の診断に先行し発見された転移性精索腫療の 1例宇治徳洲会病院泌尿器科(医長:石田 章〉石田 章矢渡辺 仁料滋賀医科大学泌尿器科学教室〔主任友吉唯夫教授〕竹内秀雄，神波照夫，ホ卜 勺，友吉唯夫転移性精索臆療は稀な疾患である.今回われわれは， た転移性精索腫蕩の I例を経験したので報告する.勝脱癌を原発とし，原発巣の診断に先行して発見され 転移性精索腫蕩の原発巣としてはほとんどが消化器癌*現:滋賀医科大学泌尿器科学教室料現:郡立高島病院であり，勝目指癌を原発巣としたものは自験例が本邦第1例目と思われる.(泌尿紀要 34: 1269-1271， 1988) 

原発巣(膀胱癌)の診断に先行し発見された転移性精索腫瘍の1例

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原発巣(膀胱癌)の診断に先行し発見された転移性精索腫瘍の1例

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