title: [SUCCESSFUL INGUINAL ORCHIECTOMY IN A PATIENT WITH A PAINFUL METASTATIC SPERMATIC CORD TUMOR: A CASE REPORT].
abstract: A 71-year-old man was referred to our department due to inflammation in the right scrotum. A tumor in the right spermatic cord was suspected on palpation, and abdominal computed tomography revealed a 4-cm mass in the tail of the pancreas and a low-density lesion in the liver segment 6. In addition, the patient's serum level of CA19-9 was high, at 135.7 U/mi. We referred the patient to our institution's Department of Gastroenterology, where he was diagnosed as having a liver metastasis from pancreatic cancer. Despite three courses of gemcitabine and erlotinib combination therapy for pancreatic cancer, his serum level of CA19-9 increased to 744.0 U/m, indicating no response to chemotherapy. Because uncontrollable pain developed in the right scrotum and right inguinal area during the course of treatment, inguinal orchiectomy was performed for pain management and pathological diagnosis. Careful examination revealed a hard, whitish tumor occupying the right spermatic cord and extending from the epididymis to the internal inguinal ring. Because a palpable mass in the peritoneum near the internal inguinal ring was detected, part of the peritoneum was resected concurrently. Pathological findings were remarkable with spermatic cord metastasis and peritoneal dissemination from pancreatic cancer. Pain subsided postoperatively and no analgesics were needed. Pancreatic cancer accompanied by spermatic cord metastasis and peritoneal dissemination is extremely rare. Surgical resection in the present case provided effective treatment of the intractable pain due to spermatic cord metastasis. To the best of our knowledge, this is only the 14th case reported in Japan of spermatic cord metastasis from pancreatic cancer as a primary cancer.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Shin
authors.forename: Gaku
authors.initials: G
authors.lastname: Arai
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Iwahata
authors.forename: Keisuke
authors.initials: K
authors.lastname: Suzuki
authors.forename: Yuko
authors.initials: Y
authors.lastname: Sadaoka
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Ota
authors.forename: Koujirou
authors.initials: K
authors.lastname: Nishio
authors.forename: Ryo
authors.initials: R
authors.lastname: Sato
authors.forename: Makoto
authors.initials: M
authors.lastname: Kawaguchi
authors.forename: Yoshitomo
authors.initials: Y
authors.lastname: Kobori
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Ashizawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yagi
authors.forename: Shuji
authors.initials: S
authors.lastname: Yamagishi
authors.forename: Shigehiro
authors.initials: S
authors.lastname: Soh
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Okada
mesh_terms: D000368:Aged; D005834:Genital Neoplasms, Male / Q000556:secondary / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D064847:Multimodal Imaging; D009919:Orchiectomy; D010146:Pain / Q000209:etiology*; D010190:Pancreatic Neoplasms / Q000473:pathology*; D013085:Spermatic Cord / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome