|LETTER TO THE EDITOR
|Year : 2015 | Volume
| Issue : 3 | Page : 264-265
Advanced prostate cancer presenting as bilateral testicular hydrocele
S Gupta, A Mehta, J Kaur
Internal Medicine, Providence Hospital, Washington DC, USA
|Date of Web Publication||18-Feb-2016|
Internal Medicine, Providence Hospital, Washington DC
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gupta S, Mehta A, Kaur J. Advanced prostate cancer presenting as bilateral testicular hydrocele. Indian J Cancer 2015;52:264-5
Prostate cancer is the most frequently diagnosed neoplasm in men. The most common sites for the metastasis are lymph nodes (68%), bones (66.8%), and lungs (49.1%). Despite its significant metastatic potential and close proximity of the testes, metastatic involvement of the testes by the prostate cancer is very rare (0.18%) and has been described in few case reports., Here, we present a very rare case of advanced prostatic cancer presenting as bilateral testicular masses and hydrocele.
A 65-year-old African American male with medical history of hypertension presented with progressively enlarging scrotal swelling and obstructive urinary symptoms present for a year. On examination, he had a 12 × 10 × 8 cm sized fluctuating and trans-illuminating swelling consistent with hydrocele on the right side of the scrotum and a smaller hydrocele on the left side. The spermatic cords were bilaterally normal on palpation. On digital rectal examination, he had an indurated and enlarged prostate gland. Testicular ultrasound showed bilateral hydroceles with multiple masses within the testes [Figure 1]a and [Figure 1]b. His Prostate Specific Antigen (PSA) level was markedly high (5848 ng/ml). Transurethral prostatic biopsy confirmed the diagnosis of adenocarcinoma of prostate (Gleason score of 8). Further metastatic workup showed the involvement of the bony pelvis, thoraco-lumbar vertebrae, and para-aortic lymph nodes.
|Figure 1: Ultrasonogram of the Right (a) and Left (b) testes showing hydrocele (Shown by H) surrounding the testicle and multiple masses representing the tumor (Shown by T) within the testicle|
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The patient underwent bilateral orchiectomy for therapeutic and diagnostic purposes. On gross examination of orchiectomy specimen, both the testes were hard in consistency. Their cut section revealed multiple masses within both the testicles effacing the testicular parenchyma [Figure 2]a and [Figure 2]b. Histopathologically, testicular masses were found to be of prostate primary, which was confirmed by PSA and Prostate Specific Acid Phosphatase staining [Figure 2]c and [Figure 2]d. [Figure 2]e shows the H and E, stained section of the right testicle. There was no involvement of the spermatic cord or epididymis.
|Figure 2: Cut Section of the Left (a) and Right (b) testis – tumor is shown by a thin arrow, and the normal testicular parenchyma is shown by the broad arrow. c, d, and e – ×40 micrographs of the Prostate Specific Acid Phosphatase, Prostate Specific Antigen, and (H and E). (e) stained sections of the testicles showing darkly stained tumor portion (Broad Arrow) invading the lightly staining normal testicular stroma (thin arrow)|
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It has been postulated that vas deferens may have a role in the spread of prostate cancer to the testes. Spread can occur through the lymphatic connections on the vas deferens between prostate and testes or through the lumen of the vas or directly along its wall. In our patient, vas deferens was not involved grossly or microscopically. Hematogenous spread through arterial or venous routes could have played some role. The clinical implications and the prognosis of the patients with testicular metastasis is largely unknown, but in a study done by Korkes et al., a small subset of patients of prostate carcinoma with metastatic involvement of the testis had 100% mortality within 8 months as compared to a 5-year survival of around 25% in otherwise advanced prostate cancers.
This patient is still alive and having good functional status even 8 months after the surgical orchiectomy and thus suggests that timely intervention is helpful in otherwise poor prognosis patients with testicular metastasis of prostate cancer.
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[Figure 1], [Figure 2]