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

Epididymal Metastasis From Prostatic Cancer

DEBA P. SARMA, MD, MARSHALL WEINER, MD, AND THOMAS C. 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 epididymal cancer

CASE REPORT A 59-year-old black man presented with a complaint Epididymal metastasis from carcinoma of the prostate Of increased frequency with nocturia and poor urinary is very rare. Only nine single cases have been reported in the English literature [1-9]. We describe an additional Accepted for publication April 18, 1983. Address reprint requests to Deba P. Sarma, MD. VA Medical Center. case and review the literature. 1601 Perdido Street. New Orelans. LA 70146.
INTRODUCTION

Fig. 1. Pcriductal infiltration b\ prostatic adenocarcinoma in the tail ot'cpididsmis (H&E. x80). 1983 Alan R. Liss, Inc.

Metastatic Epididymal Cancer TABLE I. Reported Cases of Prostatic Carcinoma Metastasizing to Epididymis
Author Humphrc) [ I Age/race (years! 63/White Location (side) Lett Comment

323

Brotherus |2|

55/White

Broth et al |3] Wilenius and Seppunen |4| Kovi ct a I |5| Puigvert el al |6| Talhot and McCann |7| Addonizio and Thelmo|8| Ciael al |9|

81/White 59/White 70/Black 67/White 70/White 67/Whit

Left Right Lett Left Right Rich!

Poorly differentiated adenocarcinoma of prostate diagnosed 6 months earlier. treated by TUR J and radiotherapy. Alive 7 months after diagnosis. Prostatic carcinoma with left supraclavicular metastasis was diagnosed at the admission. TUR'' revealed adenocarcinoma of prostate. Needle biopsy showed prostatic adenocarcinoma. Needle biopsy showed prostatic cancer. Estrogen therapy. Needle biopsy showed prostatic cancer. Prostate biopsy revealed adenocarcinoma. Prostate cancer diagnosed 4 years earlier was treated with TUR'' and estrogen therapy. Died 2 \ears after diagnosis. Papillary adenocarcinoma of prostate diagnosed 1.5 years earlier. Poorly differentiated prostatic adenocarcinoma found on TUR''. Treated with orchiectomy and estrogens. Died 1.5 years later.

Sarma ct al. 1983 (present easel

73/White

Right and Left Riaht

59/Black ''TUR. transurethral resection.

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 removed, all of which revealed diffusely infiltrating, poorlydifferentiated adenocarcinoma on microscopic examination. A total body bone scan was performed that revealed osteoblastic activity involving pelvis, lumbar and thoracic spine, and skull. The 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; however, the grossly normal right testis on microscopic examination 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 patient expired with disseminated cancer.

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 presentation. Palpable epididymal mass was noted in about half of the cases, and in the other half metastatic carcinoma was histologically identified in the orcheictomy specimens. Unilateral involvement of the epididymis was noted in all cases with equal distribution between the right and left sides, except one case with bilateral involvement [9]. 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 epididymis is most likely. Although epididymal metastasis indicates 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 epididymis from cancer of the prostate: Case report. J Uro! 51:641-642, 1944. 2. Brotherus JV: Metastatic tumors of the epididymis and the sper matic cord. J Uro! 83:171-175. 1960.

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Sarma, Weiner, and Weilbaecher

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 spermatic cord and epididymis 5 years after prostatectomy and vasectomy. 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.

3. Broth G. Bullock WK. Morrow J: Epididymal tumors: 1. 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. Wilenius R. Seppanen J: Two unusual cases of metastasis of prostadc cancer: metastasis to the spermatic cord and the epididymis. Ann Chir Gynaecol Fenn 58:172-175. 1969. 5. Kovi J. Jackson AG. Jackson MA. Sampson CC: Solitary epididymal metastasis from carcinoma of prostate. Urology 3:644-645. '1974. "'

Sarma DP, Wiener M, Weilbaecher TG(1983): Epididymal metastasis from prostate cancer. J Surg Oncol 24:322-324. PMID: 6361390 [PubMed - indexed
for MEDLINE]