BERKELEY, CA (UroToday.com) - Squamous cell carcinoma (SCC) is a common type of cancer in the scrotal skin. A 59-year-old male patient presented with the diagnosis of SCC of the scrotal wall. Initially, he had a warty scrotal lesion and ulcer on the right scrotal wall, which had presented some 15 years earlier and might have been the genesis of the scrotal cancer. Excision of the scrotal tumour confirmed the diagnosis of SCC on histopathology.
But, in this case, during the operative procedure, it was clearly evident that there was a blood supply into the scrotal wall tumour from a branch of the testicular artery, and this was ligated and separated. In all the literature to date, we have not any reported case of this kind of unusual presentation. The testicular artery supplies blood into the testis and lymph nodes. Blood follows the testicular artery and drains into the para-aortic lymph node. However we did not find any para-aortic lymphadenopathy and no positive groin nodes.
We have kept this gentleman in our follow-up. He visited our outpatient department some10 months following the procedure and we examined him with an abdominal and pelvic CT scan, but there was no para-aortic lymphadenopathy and no lesion found on testicular palpation. We have kept him in our follow up and will continue to do so for next few years to exclude any association of testicular involvement.
Testicular cancer can spread into the blood system or lymph vessels, which is possible in stage- 2 disease, and it can also invade into the scrotum in advanced stage-4 (TNM staging system) disease. But in this case, we did not find any detectable lesion on the testis or any raised significant tumour marker (beta-HCG or alpha-fetoprotein). So, it was a dilemma as to how a scrotal tumour could have a blood supply from the testicle. We did FNAC from the groin as scrotal lymphatics can involve the groin, but no suspicious feature was found on cytology.
Finally, this was an unusual presentation for scrotal tumour, which needs to be addressed. The key point to keep in mind is that a scrotal lesion can be fed by a testicular vessel, and in this scenario, patients need longer follow up to exclude any testicular lesion or lymph node metastasis in the future.
Debashis Sarkar as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Department of Urology, Wirral University Teaching Hospital, Wirral, UK
Unusual presentation of a scrotal tumour - Abstract