Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2021; 9(17): 4244-4252
Published online Jun 16, 2021. doi: 10.12998/wjcc.v9.i17.4244
Tunica vaginalis testis metastasis as the first clinical manifestation of pancreatic adenocarcinoma: A case report
Yong-Rui Zhang, Dong-Kai Ma, Bao-Shan Gao, Wei An, Kai-Min Guo
Yong-Rui Zhang, Bao-Shan Gao, Wei An, Department of Urology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
Dong-Kai Ma, Department of Gastroenterology, The Qianwei Hospital of Jilin Province, Changchun 130021, Jilin Province, China
Kai-Min Guo, Department of Andrology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
Author contributions: Zhang YR, Gao BS and An W performed the surgery; Guo KM wrote the initial draft; Guo KM and Ma DK reviewed the literature;All authors have read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 81901534.
Informed consent statement: All study participants, provided informed written consent prior to study enrollment. Written informed consent was obtained from all individual participants included in the study.
Conflict-of-interest statement: All other authors have nothing to disclose.
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: Kai-Min Guo, MD, PhD, Chief Doctor, Surgeon, Surgical Oncologist, Department of Andrology, The First Hospital of Jilin University, No. 71 Xinmin Dajie, Chaoyang District, Changchun 130021, Jilin Province, China. gkm7631703@jlu.edu.cn
Received: December 16, 2020
Peer-review started: December 16, 2020
First decision: January 7, 2021
Revised: January 10, 2021
Accepted: March 29, 2021
Article in press: March 29, 2021
Published online: June 16, 2021
Processing time: 160 Days and 1.2 Hours
Abstract
BACKGROUND

Metastases from pancreas or ampullary malignancies are common, but the spread to testicle and paratesticular tissue is exceedingly rare. To the best of our knowledge, fewer than 30 cases have been reported in the literature. More rarely, metastasis to tunica vaginalis testis occurs without involvement of the testes and epididymis.

CASE SUMMARY

A 65-year-old male who complained of painless swelling of the left scrotum for over 1 wk was referred to the Department of Urology. Scrotal ultrasound showed left testicular hydrocele with paratesticular masses. Chest computed tomography revealed lung metastasis and enlarged left supraclavicular lymph node.The blood tumor markersalpha-fetoprotein, human chorionic gonadotropin, and serum lactate dehydrogenase were withinnormal limits.The preoperative diagnosis was left testicular tumor with lung metastasis. Then radical orchidectomy of the left testicle and high ligation of the spermatic cord were performed, and postoperative histopathology suggested metastatic tumors that was confirmed by an abdominal computed tomographic scan. The positive computed tomography findings, in conjunction with the expression of cytokeratin 7 (CK7), CK20, CK5/6, and absence of expression of Wilms’ tumor suppressor gene 1, calretinin, melanocyte, prostate-specific antigen, thyroid transcription factor-1, GATA binding protein 3, caudal type homeobox 2, and napsinA supported the diagnosis of pancreatic adenocarcinoma. The outcome of this patient was unsatisfactory, and he died 3 mo later.

CONCLUSION

This case suggests that pancreatic metastatic carcinoma must be considered in the differential diagnosis of scrotal enlargement. The advanced age of the patient wassuggestive of a secondary testicular tumor.In addition, careful physical examination and ultrasonography as well as radiological examination have become a standard modality.

Keywords: Tunica vaginalis testis; Metastasis; Pancreatic adenocarcinoma; Literature review; Paratesticular tumor; Misdiagnosis; Case report

Core Tip: Secondary paratesticular tumors are extremely rare, especially when they originate from the pancreas or ampullary malignancies. So it must be considered in the differential diagnosis of scrotal enlargement and careful clinical and radiological examination has become a standard modality.