Journal of Surgical Oncology 24:322-324 (1983)

Epididymal Metastasis From Prostatic Cancer

DEBA P. SARMA, MI), MARSHALL WEINER, MD, AND THOMAS G. WEILBAECHER, MD

From the Department of Pathology, Louisiana State University Medical School and Veterans Administration Medical Center, New Orleans, and the Department of Urology,

Tulane University Medical School, New Orleans

.. .

A case of prostatic adenocarcinoma metastasizing to the epididymis is described, and the literature is reviewed.

KEY WORDS: epididymal tumor, secondary epididymal tumor, unusual metastasis of prostate cancer, metastatic epididgmal cancer

INTRODUCTION CASE REPORT A 59-year-old black man presented with a complaint

Epididymal metastasis from carcinoma of the prostate of increased freauencv with nocturia and Door urinary is very rare. Only nine single cases have been reported in the English literature 11-91. We describe an additional case and review the literature.

Accepted for publication April 18. 1983. Address reprint requests 1601 Perdido Street, New Orelans, LA 70146.

Debs p, Sarma, MD, VA Medical Center,

Fig. I . Pcriductal infiltration by prostatic adcnocarcinoma in the tail of epididyinis ( H & E . X 80)

(1 1983 Alan R. Liss. Inc.

Metastatic Epididymal Cancer 323

TABLE I . Reported Case\ of Prostatic Carcinoma Metastasizing to Epididyniis

Agelracc Locdtion Author (yedr\) (\ ldC)

Humphrey 1 1 I hRiWhitc Lett

Brotherus 121 55 / W h itc >

Broth ct ill 131 Xl iWhi te L c I t

Wilcnius and

Kovi et a1 151

Puigvcrt et a1 161 Talbot and Me-

Cann 171 Addonizio and

Theli i io 1x1

Scppancn 141

Cia et al 191

Sarrna ct al. 1983 (present case)

SY/White

7OiBlacL

67IWhitc 70/White

67IWhitc

73 lWhi tc

S9/Black

Right

Left

I,eft Right

Right

Right and Left

Right

"TU K. t ransurcthral resect ion

stream. On rectal examination, the prostate was felt to be hard and enlarged. An intravenous pyelogram showed normal upper urinary tracts. Laboratory data revealed a normal complete blood count (CBC) and normal results of urinalysis. Serum acid phosphatase was elevated to 11 IU/L (normal 1-3 IU/L) and serum alkaline phosphatase was slightly elevated to 45 IU/L (normal 9-35 IU/L). The rest of the serum chemistry values were normal.

The patient underwent transurethral prostatic resection (TUR). Thirty-five grams of prostatic chips were re- moved, all of which revealed diffusely infiltrating, poorly-differentiated adenocarcinoma on microscopic examination.

A total body bone scan was performed that revealed osteoblastic activity involving pelvis. lumbar and tho- racic spine. and skull. Thc patient was thought to have a stage D prostatic carcinoma on the basis of the findings of adenocarcinoma on resection. abnormal bone scan, and elevated serum acid phosphatase value.

One week after the initial TUR, the patient underwent a bilateral orchiectomy. The left testis was normal; how- ever, the grossly normal right testis on microscopic ex- amination revealed a metastatic prostatic adenocarcinoma involving the tail of the epididymis (Fig. 1).

The patient was discharged on oral estrogen therapy to be followed in the clinic. Eighteen months later the pa- tient expired with disseminated cancer.

Poorly differentiated adcnocarciiionia o t prostate diagnosed h month\ earlier. treated hy TUR" and radiotherapy. Alive 7 nionths after diagnosis.

lar metastasis was diagnosed at the admission.

pro\tatc

adenocarcinonia.

Estrogen therapy.

Prostatic ciircinoiiii i with left supraclavicu-

TUR" revealed adenocarcinorna of

Kccdle biopsy showed prostatic

Needle hiopsy showed prostatic cancer.

Necdle biopsy s h o w d prostatic cancer. Prostate biopsy revealed aden(~carCii1oiiia.

Prostate cancer diagnosed 4 yriirs carlier was treated u.ith T l j R " and ehtrogen therapy. Died 1 years after diagnosis.

agnoscd I .S yciirs earlier. Pa p i I lii r) ade nocarc i noiii;i o f pro\ tc d I -

Poorly differentiated prostatic ; ide~~ocarci- noniii l iwnd on TUR". 1'1-catcd with or- chiectoniy and cstrogcnh. Died I .S year\ later.

. ~-

DISCUSSION

Table 1 lists the essential features of nine reported cases in the English literature and one additional case from the present communication.

Most of the reported patients were white and their ages ranged from 55 to 81 years. Almost all the cases were known to have prostatic carcinoma at the time of presen- tation. Palpable epididymal mass was noted in about half of the cases, and in the other half metastatic carcinoma was histologically identified in the orcheictomy speci- mens. Unilateral involvement of thc epididymis was noted in all cases with equal distribution between the right and left sides, except one case with bilateral involvement [91.

Prostatic cancer can spread to epididymis via venous, arterial, lymphatic, or intraductal routes. In our case, because of the extensive involvement of the vertebral bones, the venous and/or lymphatic spread to the epidid- ymis is most likely. Although epididymal metastasis in- dicates advanced disease, one patient has survived up to 2 years after diagnosis [8]. Our patient died eighteen months after orchiectomy.

REFERENCES 1 . Humphrey MA: Metastasis in the cpididymis from cancer of the

2. Brotherus JV: Metastatic tumors of the epididymis and the sper- prostate: Case report. J Urol 51:641-642. 1944.

matic cord. J Urol 83:171-175, 1960.

324 Sarma, Weiner, and Weilbaecher

3. Broth G, Bullock WK, Morrow J: Epididymal tumors: I . Report of 15 new cases including review of literature. 2. Histochemical study of the so-called adenomatoid tumor. J Urol 100:530-536, 1968.

4. Wilcnius R. Seppanen J: Two unusual cases of metastasis of prostatic cancer: metastasis to the spermatic cord and the epidid- ymis. Ann Chir Gynaecol Fenn 5X: 172-175, 1969.

5. Kovi J, Jackson AG. Jackson MA, Sampson CC: Solitary epidid- p a l metastask from carcinoma of prostate. Urology 3:641-645, 1974.

6. Puigvert A, Vasquez LM, Santaularia JM: Metastasis of prostatic carcinoma in the epididymis. Eur Urol 4:220-221, 1978.

7. Talbot RW, McCann BG: Secondary prostatic tumor of the spcr- matic cord and epididymis S years after prostatectomy and vasec- tomy. Br J Urol 51:48, 1979.

8 . Addonizio JC, Thelmo W: Epididymal metastasis from prostatic carcinoma. Urology 18:490-491, 1981.

9. Cia EMM, Moriyama H, Billis A, Ferreira AA: Metastases in epididymes from papillary adenocarcinoma of prostate. Urology 18:607-608, 1981.