Case report – Prostatic carcinoma presenting as an epididymal nodule

International Urology and Nephrology 33: 511, 2001.© 2002 Kluwer Academic Publishers. Printed in the Netherlands.

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Case report – Prostatic carcinoma presenting as an epididymal nodule

V.C. Mishra & S.F. TindallDepartment of Surgery, Scunthorpe General Hospital, Scunthorpe, UK

Introduction

Metastatic neoplasms to the epididymis or spermaticcord are uncommon and are either incidental findingsor a part of a generalized disseminated disease, seldomoccurring as the presenting sign of an occult cancer.We present such a case here.

Case report

A 50-year-old man with no significant past medicalhistory presented with a short history of a painful lefttestis without any urinary symptoms.

Physical examination revealed a hard tender leftepididymis and a hard nodular prostate. His PSAwas elevated at 29 ng/ml. An ultrasound scan ofthe renal tracts and scrotum revealed normal kidneys,an enlarged prostate with a minimal post-micturitionresidue and a nodular lesion in the left epididymis.

A transrectal trucut biopsy of the prostate showedinvasive adenocarcinoma of Gleason’s grade 3+4 andan isotope bone scan revealed a metastatic lesion inthe right pelvis, which however was entirely asympto-matic.

The patient responded initially to an anti-androgenand his PSA fell to 2.3 ng/ml. However, a yearlater he presented with worsening pain in left epidi-dymis and an epididymectomy was performed. Histo-logy showed metastatic adenocarcinoma of primaryprostatic origin.

The patient deteriorated gradually despite con-tinued hormone deprivation and died a few monthslater.

Conclusions

Epididymal metastasis from prostatic carcinoma isuncommon. Review of literature suggests that prob-ably fewer than 20 cases have been reported world-wide since it was first reported by Humphrey in 1944[1].

Epididymal metastasis indicates a locally advancedand poorly or moderately differentiated disease [2]and the mean survival after diagnosis is 9 months[3]. We presume that the epididymal metastasis waspresent when the patient was first seen and there-fore we believe that ours is the first reported case ofepididymal metastasis at presentation in the absenceof obstructive urinary symptoms.

References

1. Wiebe B, Warnoe H, Klarlund M, Krag J. Epididymal meta-stasis from prostatic carcinoma. Scand J Urol Nephrol 1993;27: 553–555.

2. Sneiders A, Heller JE. Epididymal metastasis from prostaticcarcionma. Br J Urol 1990; 66: 325–326.

3. Algaba F, Santaularia JM, Villavicencio H. Metastatic tumourof the epididymis and spermatic cord. Eur Urol 1983; 9: 56–59.

Address for correspondence: Mr V. C. Mishra, Department ofUrology, Wexham Park Hospital, Slough SL2 4HL, UKE-mail: vibhashmishra@hotmail.com