The Tunica vaginalis testis metastasis as the first clinical manifestation of pancreatic adenocarcinoma: a case report and and literature review

Background: Metastases from pancreas or ampullary malignancies are common, but spread to the testicle and paratesticular tissue is exceedingly rare. To our knowledge, few than 30 cases have been previously reported in the literature. More rarely, it is to be found with tunica vaginalis testis metastasis without involvement of testicle and epididymis. Case presentation: A 65-year-male with complaints of left painless scrotal swellings for over 1 week was referred to the Department of Urology . Scrotal ultrasound demonstrated a left sided hydrocele with paratesticular masses.The chest computed tomography showed lung metastases and left enlarged supraclavicular lymph node. The preoperative diagnosis was left testicular tumor with lung metastasis.Then, a left radical orchidectomy was performed with high ligation of the spermatic cord and postoperative histopathology showed that it was suggestive of metastatic tumors. Abdominal computed tomography revealed the presence of a tumor in the tail of the pancreas. Tumor markers cancer antigen CA 19-9 were elevated almost 6-fold levels. The outcome of this patient was unsatisfactory and died 3 months later. Conclusions: This case highlighted that metastatic carcinoma from the pancreas must be considered in the differential diagnosis of scrotal enlargement. Older patient age is suggestive of a secondary testicular tumor. In addition, careful clinical and radiological examination has become the imaging modality.