Scrotal wall metastasis as the first manifestation of primary gastric adenocarcinoma

FIG 1. (a) Longitudinal and (b) transverse sonography of the right scrotum showing a solid extra-testicular mass separated from the normal-looking right testis. (c) Increased vascularity was evident on Doppler study. (d) Axial and (e) coronal computed tomographic images of the scrotum revealing bilateral scrotal soft-tissue thickening (arrows). (f) The oesophagogastroduodenoscopy reveals an irregular ulcerative tumour (*) over the lower part of gastric body A B S T R A C T Metastases to the scrotal wall are very rare, and being the initial manifestation of occult primary tumours is even rarer. We report on a patient presenting with painless scrotal swelling, attributed to a solid extra-testicular mass found on ultrasonography. Subsequent investigations and surgical exploration revealed it to be a scrotal wall metastasis from an occult gastric primary. To our knowledge, this is the first report of a scrotal wall metastasis from gastric adenocarcinoma. The ensuing discussion and literature review highlight the diagnostic challenges posed by an extra-testicular scrotal metastasis from an occult primary tumour.