Upper Gastrointestinal Bleeding Due to a Duodenal Metastasis from Primary Testicular Squamous Cell Carcinoma
Juan J. Gonzalez, Ahsan Wahab, Emelie Gonzalez, Aaron M. Udager, Zachery R. Reichert
Department of Internal Medicine, Division of Hospital Medicine, University of Michigan, Ann Arbor, MI, USA
Am J Case Rep 2020; 21:e922007
Available online: 2020-04-06
Primary squamous cell carcinoma of the testis (tSCC) is exceptionally rare. To date, only 5 cases have been described in the literature. We report the first case of upper gastrointestinal bleeding due to a duodenal metastasis from tSCC.
CASE REPORT: We report a male patient who presented with marked swelling of his left scrotum. Inguinal orchiectomy demonstrated keratinizing squamous cell carcinoma (SCC). All surgical margins were negative, and germ cell neoplasia in situ was not identified. PET/CT showed retroperitoneal metastasis. He underwent surgical resection. Three months later, surveillance imaging revealed progression of metastatic disease, including a mass between the transverse duodenum and inferior vena cava invading the duodenal wall without obstruction. Two days later, he presented to the hospital due to gastrointestinal bleeding. CT of the abdomen was negative for a retroperitoneal bleed or intraluminal bleed with stable metastatic retroperitoneal lymph nodes. Esophagogastroduodenoscopy (EGD) showed a fungating and oozing mass in the second portion of the duodenum. Biopsies confirmed metastatic SCC. Palliative radiation and adjuvant chemotherapy were initiated.
CONCLUSIONS: tSCC, though rare, is an aggressive malignancy and requires prompt and aggressive combined oncological treatment. Most of the cases have been reported to develop from an epidermal cyst, chronic hydrocele, or epididymis. This malignancy can lead to unexpected phenomena such as gastrointestinal bleeding or intestinal obstruction due to its unique metastatic pattern.
Keywords: Carcinoma, Squamous Cell, Gastrointestinal Hemorrhage, Neoplasm Metastasis, Testicular Neoplasms, general surgery, Chemotherapy, Adjuvant, Radiotherapy, Adjuvant