Paratesticular metastasis from Wilms tumor associated with a hydrocele

Abstract

Metastatic sites other than the lungs, lymph nodes, and liver are unusual for Wilms tumor (WT). Intra-scrotal metastasis is very rare. We report a 3-year-old boy with stage IIA WT, who experienced paratesticular metastasis 2 months after surgery for an abdominal recurrence. He had right scrotal hydrocele at initial diagnosis. The patient underwent right radical orchiectomy, and pathological examination revealed paratesticular WT metastasis. Intra-abdominal and peritoneal disseminated metastases followed. We considered that tumor cells spread through the patent processus vaginalis and grew at paratesticular space in hydrocele. One month after the end of 12 months of salvage chemotherapy and abdominal radiotherapy, the patient has no evidence of disease.

The Diagnostic and Therapeutic Approach to a Child Having Simultaneous Renal and Testicular Mass

“…The literature analysis suggested retrograde venous or retrograde lymphatic extension as the most common mode of testicular metastasis [1][2][3][4][5][6][7][8][9][10][11][12]24]. Other suggested mode of testicular metastasis are hematogenous and transcoelomic (associated patent processus vaginalis).…”

“…Other suggested mode of testicular metastasis are hematogenous and transcoelomic (associated patent processus vaginalis). Transcoelomic mode is the most probable explanation for testicular metastasis to contra-lateral side of primary renal tumor [1][2][3][4][5][6]. Six cases showed presence of hydrocele at index presentation of WT who developed testicular metastasis, average 6 month after radical nephrectomy.…”

“…Six cases showed presence of hydrocele at index presentation of WT who developed testicular metastasis, average 6 month after radical nephrectomy. These patients develop clinical testicular metastasis with local recurrence after radical nephrectomy, which suggests possible mechanism as tumor spillage and spread through patent process vaginalis [2,[5][6]. The author suggests if there is patent processes vaginalis (PPV), herniotomy should be done at the time of Radical nephrectomy to reduce surgical and tumor related morbidity [8].…”

“…The lymphatic spreads to lymph nodes are the most common. The rare site of metastasis are mediastinum and testis [1][2][3][4][5][6][7][8][9][10][11][12].…”

“…To the best of our search (all languages, both indexed non indexed journal) with the key words testicular metastasis, paratesticular metastasis, metastatic Wilms' tumor in the literature from 1928 to 2016, we found 12 cases of testicular/ paratesticular metastasis of WT [1][2][3][4][5][6][7][8][9][10][11][12]. We excluded the cases of extrarenal scrotal WT (scrotal WT without primary renal involvement) arising from heterotropc anlage [17].…”