Metastatic tumour of the tunica vaginalis testis from carcinoma of the stomach

A 50-year-old man with advanced inoperable gastric adenocarcinoma and diffu se peritoneal metastasis received six cycles of palliative chemotherapy and responded clinically with weight gain. Two months after the completion of chemotherapy, however, he developed a left hydrocele. Aspiration yielded 70 ml of yellowish hydrocele fluid, which contained metastatic adenocarcinoma cells, consistent with a gastric primary tumour. A diagnosis of malignant hydrocele was made. Two weeks later he developed a painful recurrent left h ydrocele with increasing pain and swelling. Left orchidectomy was performed . Tiny white mural nodules measuring 1 mm in size were noted on the tunica vaginalis. No focal lesion was noted in the testis. On microscopic examinat ion, the tunica vaginalis showed reactive mesothelial hyperplasia and exten sive lymphatic permeation by poorly differentiated adenocarcinoma, consiste nt with a gastric primary tumour.