胃惡性腫瘤的單側副睪轉移：病例報告

曹書瀚、莊正鏗

林口長庚紀念醫院 泌尿科

Unilateral epididymis metastasis from gastric cancer: A case report

Shu-Han Tsao, Cheng-Keng Chuang

Department of Urology, Chang Gung Memorial Hospital, Taipei, Taiwan

               A 71-year-old male received total gastrectomy due to gastric cancer in 2016/12 with pathology demonstrating poorly differentiated adenocarcinoma, pT4aN2, negative margins. Two month after his surgery, he received adjuvant chemotherapy with TS-1 from 2017/02 to 2018/02. Surveillance CT scan was done in 2018/06, which did not reveal any sign of tumor recurrence. In 2019/11, he presented with left lower quadrant abdominal pain and CT revealed left mild hydronephrosis and a left scrotal mass. Tumor markers were checked and showed AFP: 2.5; LDH: 265; betaHCG< 1.0; CEA: 3.95; CA19-9: 16.6. Renal and testicular echo were done and showed left hydronephrosis and left peri-testicular soft tissue lesion with blood flow. Diagnostic ureteroscopy showed left ureter stricture and biopsy was done for the indurated spermatic cord and epididymis with pathology demonstrating metastatic poorly differentiated adenocarcinoma, favor gastric origin. H&E sections show fibrovascular tissue with infiltration of nests of poorly differentiated adenocarcinoma which are diffusely and strongly positive for CDX2. The features are consistent with metastatic adenocarcinoma of gastric primary.

            Whole body tumor scan was arranged after surgery and revealed gastric stump recurrence, positive celiac lymph nodes and distant metastasis of spines, ribs, sternum, pelvic bones, bilateral scapulae and left epididymis. For multiple metastasis, the patient started treatment with xeloda and radiation therapy was also applied for bone pain.