The Unusual Presentation of Gastric Adenocarcinoma as a Testicular Mass: A Favorable Response to Docetaxel and Cisplatin Plus Oral Tegafur/Uracil and Leucovorin

Received 8 June 2009; accepted 25 November 2009.

Gastric cancer is one of the most common malignancies in the world. The routes of metastasis include direct extension, lymphatics, and peritoneal or hematogenous spread. Testicular metastasis is rare. We present here a 23-year-old gastric cancer patient who first presented with right-side testis swelling and pain. Diagnosis of metastatic adenocarcinoma was made after right-side orchiectomy. Gastric adenocarcinoma with ascites and peritoneal seeding was found after esophagogastroscopy and abdominal computed tomography. The patient received chemotherapy consisting of docetaxel 36 mg/m2 and cisplatin 30 mg/m2 on day 1 and day 8, plus oral tegafur/uracil 300 mg/m2/day and leucovorin 90 mg/day on day 1 to day 14 in a 21-day cycle, and he had a partial response to the chemotherapy. Metastatic tumors, especially gastric adenocarcinoma, should be considered in the differential diagnosis of patients presenting with testicular mass and they may respond well to chemotherapy.

Key Words: gastric cancer , metastasis , testis

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References

1. 1 Ferlay J , Bray F , Parkin DM , Pisani P . Globocan 2000: Cancer Incidence and Mortality Worldwide. IARC Cancer Bases No. 5 . Lyon: IARC Press; 2001; .

2. 2 Lau M , Le A , El-Serag HB . Noncardia gastric adenocarcinoma remains an important and deadly cancer in the United States: secular trends in incidence and survival . Am J Gastroenterol . 2006;101:2485–2492 . MEDLINE

3. 3 Turan T, Aykan B, Koc S, Boran N, Tulunay G, Karacay O, et al Analysis of metastatic ovarian tumors from extragenital primary sites . Tumori . 2006;92:491–495 . MEDLINE

4. 4 Kakushima N, Kamoshida T, Hirai S, Hotta S, Hirayama T, Yamada J, et al Early gastric cancer with Krukenberg tumor and review of cases of intramucosal gastric cancers with Krukenberg tumor . J Gastroenterol . 2003;38:1176–1180 . MEDLINE | CrossRef

5. 5 Grignon DJ , Shum DT , Hayman WP . Metastatic tumours of the testes . Can J Surg . 1986;29:359–361 .

6. 6 Kaufman DS , Saksena MA , Young RH , Tabatabaei S . Case records of the Massachusetts General Hospital. Case 6-2007. A 28-year-old man with a mass in the testis . N Engl J Med . 2007;356:842–849 . CrossRef

7. 7 Dutt N , Bates AW , Baithun SI . Secondary neoplasms of the male genital tract with different patterns of involvement in adults and children . Histopathology . 2000;37:323–331 . MEDLINE | CrossRef

8. 8 Haupt HM , Mann RB , Trump DL , Abeloff MD . Metastatic carcinoma involving the testis. Clinical and pathologic distinction from primary testicular neoplasms . Cancer . 1984;54:709–714 .

9. 9 Qazi HA , Manikandan R , Foster CS , Fordham MV . Testicular metastasis from gastric carcinoma . Urology . 2006;68:890; e7–8. . Abstract | Full Text | Full-Text PDF (1336 KB)

10. 10 Niehans GA , Manivel JC , Copland GT , Scheithauer BW , Wick MR . Immunohistochemistry of germ cell and trophoblastic neoplasms . Cancer . 1988;62:1113–1123 .

11. 11 Iczkowski KA , Butler SL . New immunohistochemical markers in testicular tumors . Anal Quant Cytol Histol . 2006;28:181–187 . MEDLINE

12. 12 Shah MA , Schwartz GK . Treatment of metastatic esophagus and gastric cancer . Semin Oncol . 2004;31:574–587 . Abstract | Full Text | Full-Text PDF (159 KB) | CrossRef

13. 13 Ajani JA . Evolving chemotherapy for advanced gastric cancer . Oncologist . 2005;10:49–58 . CrossRef

14. 14 Sulkes A, Smyth J, Sessa C, Dirix LY, Vermorken JB, Kaye S, et al Docetaxel (Taxotere) in advanced gastric cancer: results of a phase II clinical trial. EORTC Early Clinical Trials Group . Br J Cancer . 1994;70:380–383 . MEDLINE

15. 15 Roth AD, Maibach R, Martinelli G, Fazio N, Aapro MS, Pagani O, et al Docetaxel (Taxotere)-cisplatin (TC): an effective drug combination in gastric carcinoma. Swiss Group for Clinical Cancer Research (SAKK), and the European Institute of Oncology (EIO) . Ann Oncol . 2000;11:301–306 . MEDLINE | CrossRef

16. 16 Ohtsu A, Boku N, Tamura F, Muro K, Shimada Y, Saigenji K, et al An early phase II study of a 3-hour infusion of paclitaxel for advanced gastric cancer . Am J Clin Oncol . 1998;21:416–419 . MEDLINE | CrossRef

17. 17 Dank M, Zaluski J, Barone C, Valvere V, Yalcin S, Peschel C, et al Randomized phase III study comparing irinotecan combined with 5-fluorouracil and folinic acid to cisplatin combined with 5-fluorouracil in chemotherapy naive patients with advanced adenocarcinoma of the stomach or esophagogastric junction . Ann Oncol . 2008;19:1450–1457 . CrossRef

18. 18 Ajani AJ, Fodor MB, Tjulandin SA, Moiseyenko VM, Chao Y, Filho SC, et al Phase II multi-institutional randomized trial of docetaxel plus cisplatin with or without fluorouracil in patients with untreated, advanced gastric, or gastroesophageal adenocarcinoma . J Clin Oncol . 2005;23:5660–5667 . CrossRef

a Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.

b Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.

c Division of Genitourology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.

d Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.

e Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.

f Central Clinic Hospital, Taipei, Taiwan, R.O.C.

g National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.

Correspondence to: Dr Chung-Pin Li, Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, R.O.C.

PII: S1726-4901(10)70007-1

doi:10.1016/S1726-4901(10)70007-1

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