Ureteral carcinoma metastasizing to the testicle: Can misdiagnosis of orchiepididymitis be avoided?

Abstract

Testicular metastases from ureteral carcinoma are rare and they are generally mimic orchiepididymitis. For this reason, these are associated to misleading diagnoses and cancer treatment delay. We believe that both timing and knowledge of genital blood and lymph reverse flow routes may represent two important parameters for avoiding misleading diagnoses and speed proper anticancer treatment. We describe a case and discuss pathophysiological data and relevant literature.

Testicular metastasis from urothelial carcinoma: case report and literature review

“…We retrieved 15 cases reported of UC with testicular metastasis in PubMed from 1984 to the present. As shown in Table 1 , 10 cases originated from the bladder ( 6 , 8 , 10 , 12 , 13 , 15 – 19 ), while four cases originated in the upper urinary tract (pelvis, calyceal cavity, and ureter) ( 7 , 11 , 14 , 20 ). In the 10 cases that originated from the bladder, seven patients had confirmed invasion of the prostate before the occurrence of testicular metastasis ( 6 , 8 , 10 , 12 , 13 , 15 , 19 ).…”

“…Gazouli et al. reported a case of UTUC with testicular metastasis treated with pembrolizumab postoperatively, but disease progression was observed despite immune checkpoint inhibitor administration ( 20 ). Therefore, identifying suitable biomarkers to predict the efficacy of immune checkpoint inhibitors is crucial.…”

“…Interestingly, in four cases originating from the upper urinary tract, the patients had primary left UTUC and eventually spread to the left testicle (7,11,14,20). Anatomically, the right testicular vein drains into the inferior vena cava, while the left testicular vein drains into the left renal vein (9).…”

“…However, to date, the efficacy of immune checkpoint inhibitors in patients with testicular metastasis from UC has not been confirmed in prospective trials with evidence limited to individual case reports. Gazouli et al reported a case of UTUC with testicular metastasis treated with pembrolizumab postoperatively, but disease progression was observed despite immune checkpoint inhibitor administration (20). Therefore, identifying suitable biomarkers to predict the efficacy of immune checkpoint inhibitors is crucial.…”