Abstract
A 72-year-old man presented with a two month history of rectal bleeding. Colonoscopy demonstrated synchronous lesions at 3 cm and 40 cm with histological analysis confirming synchronous adenocarcinomata. He developed bilobar hepatic metastases while undergoing neoadjuvant chemoradiotherapy. Treatment was complicated by Fournier's gangrene of the right hemiscrotum which required surgical debridement. Eight months later he re-presented with an ulcerating lesion on the right hemiscrotum. An en-bloc resection of the ulcerating scrotal lesion and underlying testis was performed. Immunohistological analysis revealed metastatic adenocarcinoma of large bowel origin. Colorectal metastasis to the urogenital tract is rare and here we report a case of rectal carcinoma metastasizing to scrotal skin.
Highlights
Colorectal cancer is the second commonest non-cutaneous cancer diagnosed in the Republic of Ireland, with over 1800 new cases annually
Tumour cell seeding or implantation is thought to be the most likely pathogenesis where there is metastasis to incisions made at laparoscopic or open colectomy for colorectal cancer resection
Metastases in incision sites typically occur in the incision made at time of cancer resection surgery rather than in a pre-existing scar [5]
Summary
Colorectal cancer is the second commonest non-cutaneous cancer diagnosed in the Republic of Ireland, with over 1800 new cases annually. Patients will present with metastatic deposits in unusual sites including the skin [2]. We describe a 72 year-old male with low rectal cancer who developed metastases to the scrotal skin. Radiological staging with endo-anal ultrasound demonstrated a 2.2 cm diameter mass lesion in the rectum extending beyond the rectal wall.
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