精巣上体に転移した膵癌の1例

Abstract

58歳男.左陰嚢部痛の為に近医を受診し抗生物質による治療を行ったが改善しない為入院となった.CTでは精巣上体炎が認められた.左精巣摘出術を施行した.術中精索にも腫瘤が認められた.病理組織学的に精索及び精巣への腺癌の転移と診断された.精査の結果, 原発巣は膵臓に腫瘤が指摘され, 腎及び胃に浸潤していた.胃内視鏡による生検で摘出した精巣上体及び精索の転移性腫瘍と同様の組織像を呈する腺癌が確認された.術後1ヵ月で癌死した

A 58-year-old male who complained of painful left scrotal swelling consulted a local clinic in August 1998. Because his symptoms did not improve after antibiotic therapy, he was transferred and admitted to Jyouhoku City Hospital on September 14, 1998. Pelvic computed tomography (CT) was performed, and revealed left epididymitis. However, antibiotic treatment did not improve the condition. Then, because carcinoma of the epididymis was suspected, left inguinal orchiectomy was performed. We found a tumor in the spermatic cord and another tumor in the epididymis. The pathological diagnosis was adenocarcinoma, and metastatic carcinoma from the digestive tract was suspected. Therefore, examinations were performed to detect the primary cancer. CT and magnetic resonance imaging (MRI) demonstrated an invasive irregular tumor from the pancreas to the left kidney. Irregular mucosa was observed by gastrointestinal fiberscopy. A biopsy was performed and the pathological diagnosis was adenocarcinoma. Based on these findings, the patient was diagnosed as having a metastatic tumor of the epididymis and spermatic cord caused by pancreatic carcinoma. This is the 3rd case of adenocarcinoma of the pancreas that presented as an epididymal nodule, and this is the 12th case of adenocarcinoma of the pancreas that presented as a spermatic cord nodule.