South Asian Journal of Cancer

LETTER TO THE EDITOR
Year
: 2017  |  Volume : 6  |  Issue : 3  |  Page : 101-

Testicular metastasis in Wilms' tumor


Shikha Dhal, Maitrik J Mehta, Ankita Parikh, Maitri Bhagat, Aryakumar Banidutta 
 Department of Radiation Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India

Correspondence Address:
Shikha Dhal
Department of Radiation Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat
India




How to cite this article:
Dhal S, Mehta MJ, Parikh A, Bhagat M, Banidutta A. Testicular metastasis in Wilms' tumor.South Asian J Cancer 2017;6:101-101


How to cite this URL:
Dhal S, Mehta MJ, Parikh A, Bhagat M, Banidutta A. Testicular metastasis in Wilms' tumor. South Asian J Cancer [serial online] 2017 [cited 2017 Dec 18 ];6:101-101
Available from: http://journal.sajc.org/text.asp?2017/6/3/101/214586


Full Text

Dear Editor,

We report a rare case of a 2-year-old male child with Wilms' tumor with unusual left testicular metastasis. The patient presented with fever, pain abdomen, and left flank mass of approximate size 8.0 cm × 8.0 cm, of 7 months duration. Computed tomography (CT) scan revealed a 7.8 cm × 7.0 cm × 7.8 cm mass in the left kidney. He underwent left radical nephrectomy in August 2015 and final diagnosis was stage I with tumor size of 8.0 cm × 6.5 cm, favorable histology, and with blastemal component on histopathology report. He received five cycles vincristine and cyclophosphamide-based adjuvant chemotherapy at another hospital. In June 2016, he presented with 7.6 cm × 8.6 cm × 9.6 cm retroperitoneal mass with multiple lung metastasis. The boy was given salvage chemotherapy with alternating cycles of cyclophosphamide, etoposide and doxorubicin, and vincristine for two cycles. CT scan at the end of salvage chemotherapy shows complete resolution of lung metastasis and retroperitoneal mass remained unchanged. He received 21.6 Gy/12 fractions to local disease and 12 Gy/8 fractions as lung bath. One month later, a left testicular swelling was detected. Ultrasonography (USG) done in August 2016 showed left testicular mass of size 2.7 cm × 2.6 cm with heterogeneous enhancement. Fine-needle aspiration cytology from testicular mass confirmed metastatic Wilms' tumor. Patient was then given radiotherapy (10.8 Gy/6 fractions) to scrotum in August 2016. USG of scrotum showed decrease in the mass up to 2 cm × 1.6 cm (partial response). Additional radiotherapy of 19.8 Gy was given followed by chemotherapy (ifosfamide, carboplatin, and etoposide).

This is an interesting case since testicular metastasis in Wilms' tumor is rare, ipsilateral spread can be caused through spermatic vein, and use or radiation therapy is feasible (with partial response) even after multiple recurrences.[1],[2],[3] It also teaches us that retrograde venous and transcoelomic spread may potentially be prevented by spermatic vein ligation immediately before nephrectomy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Dew H. Sarcomatous tumors of the testicle. Surg Gynecol Oncol 1928;46:447-58.
2Ansari S, Miri-Aliabad G, Rakhshani N. Bilateral wilms' tumor metastasis to right spermatic cord. Int J Hematol Oncol Stem Cell Res 2013;7:45-8.
3Kajbafzadeh AM, Javan-Farazmand N, Baghayee A, Hedayat Z. Paratesticular metastasis from Wilms tumor: The possible routs of metastasis and literature review. J Pediatr Hematol Oncol 2011;33:e347-9.