Spermatic cord metastasis from prostatic cancer.

AS Bawa, R Singh, VK Bansal, RS Punia 
 

Correspondence Address:
A S Bawa

Full Text

Sir,

An eighty five year old man presented with lower urinary tract symptoms (LUTS) due to prostatic enlargement. The total prostate specific antigen (PSA) levels were 2250 ng/ml. Histopathology examination of the transrectal sextant biopsy specimen was reported as adenocarcinoma prostate. A bone scan confirmed the presence of widespread metastasis. Bilateral orchiectomy with flutamide therapy i.e. maximal androgen blockade was instituted.

Gross examination of the orchiectomy specimen revealed a 3-cm unilocular cyst at upper pole of both testes. The cut section of the remaining testis was unremarkable. The histopathological examination of the excised testis revealed age-related degenerative changes in the form of mild peritubular fibrosis. The upper pole cysts were reported as mesothelial cysts. In addition, a focus of infiltrating adenocarcinoma was found in the wall of the vas deferens of left testis.

The incidence of metastatic deposits to the spermatic cord is very rare. In a recent retrospective study [1] of 13,500 autopsy specimens and 641 biopsy and orchiectomy specimens, only 2 cases of metastasis to the spermatic cord were found. None of these were from the prostate. The commonest primary for spermatic cord metastasis is located in the gastrointestinal tract, followed by the prostate (28.5%) and kidney.[2]

The usual mode of spread to the spermatic cord is haematogenous, with lymphatic permeation also postulated. Retrograde extension through the vas, either along its lumen or direct extension via the wall of the vas,[3] is also possible. Transperitoneal seeding through a patent processus vaginalis[4] implies peritoneal involvement first. In our patient, haematogenous spread is the most likely mode of spread. The presence of widespread bony metastasis and the histopathological finding of an isolated nest of malignant cells support this possibility.

Metastasis from carcinoma prostate respond to androgen deprivation, and this forms the mainstay of treatment. Since the average survival after tumour detection is 9 months only,[2] radical resection of the deposit is not warranted.

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