Inguinal metastases of testicular cancer. Report of two cases

Abstract

Case description: We present a series of two cases of patients presenting testicular cancer associated to inguinal masses. First, a 28 year-old male with history of bilateral orchidopexy presenting a right abscessed inguinal mass associated to a left testicular mass. Teratoma was diagnosed by the pathological anatomy. The second case is a 52 year-old male patient with a history of bilateral orchidopexy and right inguinal orchiectomy due to seminoma. A PET scan obtained during follow-up, showed a right inguinal mass with enhanced tracer uptake. A biopsy of such mass was performed, reporting metastasis of seminoma. Relevance: Due to the anatomy of the lymphatic drainage of the testes, retroperitoneal nodes constitute the first station for metastases. However, this drainage is modified in patients with history of inguinal or scrotal surgery, as anastomosis with inguinal vessels are formed. Clinical implication: Even though testicular cancer spreads through the lymphatic system to retroperitoneal nodes, in the rare cases that inguinal masses occur, these are considered as distant metastasis, changing the patient´s stage. Conclusion: Although inguinal metastases in testicular cancer are infrequent, they can be present in patients who underwent scrotal surgery. These should be considered as regional and not distant metastases.