Spermatic Cord Tumor Metastatic from Stomach Cancer 1 Year after Curative Gastrectomy

• Published in: Journal of Nippon Medical School Vol. 80; no. 4; pp. 318 - 323
• Main Authors: Kanazawa, Yoshikazu, Kato, Shunji, Fujita, Itsuo, Onodera, Hiroyuki, Takata, Hideyuki, Onda, Munehiko, Naito, Zenya, Uchida, Eiji
• Format: Journal Article
• Language: English
• Published: Japan The Medical Association of Nippon Medical School 2013
• Subjects: Adenocarcinoma - chemistry; Adenocarcinoma - secondary; Adenocarcinoma - surgery; Aged; Biomarkers, Tumor - analysis; Biopsy, Fine-Needle; Gastrectomy; gastric cancer; Gastroscopy; Genital Neoplasms, Male - chemistry; Genital Neoplasms, Male - secondary; Genital Neoplasms, Male - surgery; Humans; Immunohistochemistry; Lymph Node Excision; Lymphatic Metastasis; Male; Neoplasm Staging; peritoneal dissemination; Positron-Emission Tomography; Reoperation; Spermatic Cord - chemistry; Spermatic Cord - pathology; Spermatic Cord - surgery; spermatic cord metastasis; Stomach Neoplasms - chemistry; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Time Factors; Treatment Outcome
• ISSN: 1345-4676; 1347-3409
• DOI: 10.1272/jnms.80.318

We report a case of advanced stomach cancer metastatic to the spermatic cord 1 year after curative distal gastrectomy. The patient underwent distal gastrectomy with D2 lymph node dissection. There was no metastasis to the liver or peritoneum, and cytologic examination of the peritoneal lavage fluid was negative for cancer cells (CY0). Histological examination revealed a moderately differentiated tubular adenocarcinoma that had penetrated the serosa (T4a). Postoperative staging was T4aN1M0, stage IIIA, according to the Japanese gastric carcinoma classification scale. One year after the operation, the patient was readmitted with right groin pain. Percutaneous fine needle aspiration biopsy of the inguinal tumor revealed a tubular adenocarcinoma. Extirpation of the inguinal tumor with wedge resection of the right iliac-femoral vein was performed. Pathological examination revealed a moderately differentiated tubular adenocarcinoma that had diffusely infiltrated the connective tissue surrounding the spermatic cord. Immunohistochemical studies showed the tumor cells were reactive for CK7 but not for CK20. These findings were consistent with the diagnosis of a spermatic cord tumor metastatic from a known gastric primary cancer. Laparoscopic exploration showed invagination of the peritoneum with small nodules from the median umbilical fold to the lateral umbilical fold and a markedly decreased distance between the folds. Pathological examination in this area revealed a tubular structure consisting of mesothelial cells within the cancer tissue which was associated with dense fibrosis, suggesting that the invagination of the peritoneum had been caused by minimal peritoneal metastasis.