Colorectal Carcinoma metastasizing to Scrotum: A series of five cases with unusual presentation and late recurrences from a single tertiary oncology centre of India

doi:10.21203/rs.3.rs-3816250/v1

Download PDF

Research Article

Colorectal Carcinoma metastasizing to Scrotum: A series of five cases with unusual presentation and late recurrences from a single tertiary oncology centre of India

https://doi.org/10.21203/rs.3.rs-3816250/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Background

Colorectal carcinoma (CRC) is a common malignancy, frequently metastasizing to the liver, lungs, and regional lymph nodes. However, metastasis to the scrotum is exceedingly rare, with few cases reported in the literature. In this study, we present a series of five cases of colorectal carcinoma metastasizing to the scrotum, emphasizing their unusual clinical presentation and late recurrences.

Methods

We did a retrospective review of 7 years from 2015–2022 for cases of scrotal metastasis in cases of CRC.

Results

The means age in our study was 38 years (22–61 years) and the median time interval between the primary diagnosis and scrotal metastasis was 31.6 months (0-104 months). Case presentations included scrotal swelling initially misdiagnosed as a hydrocele (case 1), non-healing cutaneous ulcers (cases 3 and 5), a scrotal skin papilloma (case 4), and a cutaneous nodule (case 2).

Conclusion

This series of five cases highlights the rarity and diagnostic challenges associated with colorectal carcinoma metastasizing to the scrotum. The extended latency between primary tumor diagnosis and scrotal metastasis, coupled with atypical clinical presentations, underscores the importance of maintaining a high index of suspicion. Clinicians should be vigilant, especially when evaluating patients with a history of colorectal carcinoma, to promptly identify such uncommon metastatic sites.

Colorectal carcinoma

scrotum

latency

unusual presentation

Worldwide, colorectal carcinoma (CRC) is the third most common cancer in both sexes [1] with 20% of the patients presenting with metastasis at presentation [2]. Another 20% develop metachronous disease after the initial surgery; the commonest sites of metastasis include the liver (70%), thorax (32%), peritoneum (21%) and bone (12%) [3, 4]. Despite the advancement in oncology practice, the prognosis of CRC is extremely poor with a 5-year overall survival of just 4% [3, 5]. Scrotum occupies < 1% of the total body surface area [6]. Lookingbill et al.[7] reported an overall incidence of 0.02% of cutaneous scrotal metastasis from visceral solid malignancies. Hoyt et al.[6] conducted a literature review on 29 patients with scrotal metastasis and found that the most common primary site for scrotal metastasis was the genitourinary tract (13 cases), followed by the gastrointestinal tract (11 cases), with 10 cases arising from the colorectum and one from the stomach. The study also reported that most of the patients presented with advanced stages of the disease and had poor outcomes, emphasizing the importance of early diagnosis and intervention [6]. Most cases of scrotal metastasis are secondary to incisional site seeding following surgical resection [8]. This report presents a series of five cases of colorectal carcinoma (CRC) metastasizing to the scrotum, highlighting the rarity of this site as a metastatic location. The authors also provide a comprehensive review of all previously reported cases of metastatic CRC to the scrotum, summarizing the clinical details of patients, treatments received, and outcomes. The goal of this report is to better understand the pathobiology and prognosis of this rare form of the presentation.

The authors used an electronic search of archived pathology records from 2015–2022 to identify cases of colorectal carcinoma (CRC) with scrotal metastasis. The search used keywords such as "adenocarcinoma", "metastasis", "scrotum", "hydrocele", "metastatic", "colorectal adenocarcinoma", and "mucinous adenocarcinoma" using Boolean logic. The search was done using the search engine portals “Sengine” and “Synoptic search engine”. Cases with testicular metastasis or both testicular and scrotal metastasis were excluded from the study.

Immunohistochemistry (IHC) markers were studied whenever required on the routine formalin-fixed paraffin-embedded sections using a fully automated system (BenchmarkXT system, Ventana Medical System Inc, Tucson, Arizona). The antibody panel included cytokeratin 7 (CK7), cytokeratin 20 (CK20), caudal-related homeobox gene 2(CDX2), special adenine and thymine-rich sequence-binding protein-2 (SATB2), NKX3.1 and Thyroid transcription factor 1(TTF1). Information regarding the Microsatellite-instability panel which includes MutS homolog 2(MSH2), MutS homolog 6(MSH6), Postmeiotic segregation increased 2(PMS2), MutL homolog 1(MLH1) was documented whenever available. The clinical, radiological, follow-up and survival information for all the patients was obtained from the Electronic Medical Records (EMR). The histopathological parameters studied were tumour histology, grade, pattern, necrosis, presence of mucin, and immunohistochemistry details.

The study identified five cases of colorectal carcinoma (CRC) with scrotal metastasis. The mean age of diagnosis of primary CRC was 38 years (range 22–61 years). The clinical profile of the patients is summarized in Table 1. One patient (case 1) presented with a boggy scrotal swelling and was initially diagnosed with a hydrocele. After the excision of the hydrocele sac, histology and immunohistochemistry confirmed it to be metastatic CRC. The patient subsequently underwent additional testing, including a colonoscopy, and was found to have a rectal primary. Two cases (cases 3 and 5) presented with non-healing cutaneous ulcers on the scrotal skin, one case (case 4) presented as a skin papilloma, and case 2 presented as a cutaneous nodule on the scrotal skin. Radiology information was available for two patients. One revealed a right-sided hydrocele (case 1) while the other showed a fluorodeoxyglucose avid lesion in the lateral wall of the scrotum on positron emission tomography. (Fig. 1)

Table 1

Clinical profile of all the patients
Case	Age at diagnosis	Primary tumor	Primary Rx	Clinical manifestation	Radiology	Other sites of metastasis	Interval between primary & scrotal metastasis	Post scrotal metastasis workup	Follow up
1	61 years	AC	APR	Testicular pain and boggy swelling in right sided scrotum	Right sided hydrocele	NA	0 months	CT	2 months; DOD
2	32 years	AC	APR + Adj. CTRT	Cutaneous nodule over left scrotum	NA	Inguinal Lymph nodes	104 months	CTRT + WLE	6 months; DOD
3	46 years	AC	NACTRT + APR	Non-healing lesion at scrotal base	FDG-avid lesion along left lateral body of scrotum	NA	10 months	WLE	4 months; DOD
4	22 years	AC	NACTRT	Skin papilloma over scrotum and groin	NA	NA	8 months	Palliative	15 days; DOD
5	27 years	AC	NACTRT + APR	Slow healing scrotal ulcer	NA	Presacral region	36 months	Palliative	12 months; DOD
Abbreviations: AC: Adenocarcinoma; NA: not available; APR: Abdominoperineal Resection; Adj: adjuvant; CTRT: Chemoradiotherapy; NACTRT: Neo-adjuvant chemoradiotherapy; CT: Chemotherapy; WLE: Wide local excision; DOD: died of diease

Out of the five patients studied, four (80%) had undergone primary tumour resection with adjuvant or neoadjuvant chemotherapy and/or radiotherapy. None of the patients had a distant disease at the time of surgery. The mean time interval between diagnosis of the primary CRC and metastasis to the scrotum was 31.6 months with a range of 0-104 months. Two patients had other sites of metastasis such as the inguinal lymph node (case 2) and pre-sacral soft tissue (case 5). The clinical profile of the patients are summarized in Table 1.

Pathology: A detailed histological examination was performed on all five cases (Table 2). Histology showed a variable morphology ranging from well-formed glands to cribriform architecture lined by columnar intestinal-type epithelium with high-grade cytology. Few cases showed tumours arranged in solid sheets with poor or no glandular architecture and high-grade nuclear features. Extracellular mucin was present in 4 out of five cases; while two cases were mucinous adenocarcinoma with stromal mucin amounting to >50%. Lymphatic emboli or perineurial invasion were not identified in any of these cases. Immunohistochemistry for CK20 and CDX2 were consistently positive in these cases, confirming a colorectal primary. One case was also positive for SATB2; supporting a colorectal origin. (Figure 2 & 3)

Molecular test results were available for three of the cases; two of these showed missense mutations in the KRAS gene and one showed a TP53 mutation. Molecular results for BRAF V600E were available in two cases, both of which were wild-type. The status of mismatch repair (MMR) gene by immunohistochemistry was done in three out of five cases, and all these cases were MMR protein proficient. (Table 2)

Table 2

Pathological details of the cases
Sr No	Histology	Grade	Mucin	CK7	CK20	CDX2/SATB2	MSI status	Molecular
1	Met AC	PD	Absent	Neg	+	+/+	Neg	Missense mutation in KRAS and TP53
2	Met Mucinous AC	NA	Present	Neg	+	+	Neg	ND
3	Met AC	MD	Present	Neg	+	+	NA	ND
4	Mucinous AC	MD	Present	Neg	+	+	Neg	KRAS mutation + BRAF V600E Neg
5	Mets AC	PD	Present	NA	NA	NA	NA	KRAS Neg BRAF V600E Neg

Abbreviation: - AC, Adenocarcinoma; Met, Metastatic; PD, Poorly differentiated; MD, Moderately differentiated; NEG, Negative; POS, Positive; NA, Not available; MSI, Microsatellite instability; +, Present;

Treatment and follow-up:

All the patients in the study were considered to have advanced disease due to the presence of scrotal metastasis, and a palliative treatment strategy was offered to all of them. Three of the patients underwent wide excision of the scrotal lesion, including case 1 who was initially misdiagnosed with a hydrocele and underwent surgery for that. The time interval between the primary diagnosis and scrotal involvement ranged from 0 to 104 months, with a mean of 33 months.

There is limited information available from the various published case reports regarding scrotal metastasis and are often grouped under extrahepatic and/or extrapulmonary metastasis [9]. In general, metastatic carcinoma of the scrotum is extremely uncommon. Cutaneous scrotal metastasis can occur anytime during the disease; usually at an advanced stage or with extensive metastatic disease [10]. Most of these cases have a high tumor burden including metastasis at other sites and are discovered on follow-ups [9]. Kim et al.[11] reported five cases of CRC carcinoma metastasizing to the epididymis. The symptoms are often nonspecific and can mimic other conditions, making them difficult to diagnose. The most common presenting symptoms include swelling, lumps, pain or tenderness, and back pain or nodules or cutaneous lesions. The diagnosis is usually made through a biopsy or excision of the lesion. Regardless of the origin of the underlying tumour, cutaneous metastasis frequently manifests as nodules that often coalesce and resemble epidermal cysts, keratoacanthomas, or pyogenic granulomas. Approximately 10% of nodules develop ulceration. Very rarely they can present as warm erythematous indurated plaques simulating erysipelas, lymphangitis, or cellulitis. It is only after the failure to respond to antibiotics and local therapy in the absence of leukocytosis and fever; that a biopsy or excision is performed unravelling the diagnosis of metastatic disease [12]. Two of our cases presented as ulcers over the scrotum, one presented as a skin papilloma and another case had a nodule over the scrotal skin. Generally, these metastases occur rapidly after the initial diagnosis of primary CRC with a mean interval of five months and a range of 4-24 months [6]. The mean time interval between primary and scrotal disease in our study was 31.6 months and the longest time interval was 104 months; highlighting that metastasis usually develops after a very long time interval and can even mislead the diagnosis.

The potential routes for metastasis to the spermatic cord, scrotum or para-testicular region include retrograde venous outflows, arterial emboli, retrograde spread via vas deferens, or lymphatics [13]. Other route includes spread via the patent processus vaginalis [14]. For gastrointestinal malignancies, the retrograde lymphatic spread through the retroperitoneal lymph nodes is the likely route of metastatic spread to the scrotum [15]. One of our patients (case 1) presented with a hydrocele with secondary metastasis. There was no other clinical sign or symptoms and was operated for the hydrocele which unfolded the colorectal malignancy. Bryan et al.[16] reported a similar case of sigmoid colon adenocarcinoma presenting as a scrotal mass with hydrocele. In their patient, although there was no patent processus vaginalis; however, there might be microscopic channels from the peritoneum, which can allow for the spread of the tumour through that route. Charles et al.[17] also reported a case of CRC presenting with hydrocele as its primary presentation. Other likely routes for metastasis to the scrotum are venous, emboli and transduction routes [15,16,18]. The reason for the relatively low incidence of scrotal metastasis in cases of visceral cancers is not well understood. However, one theory is that the lower regional temperature of the scrotum may not be conducive for tumour cells to grow. Other factors that may play a role include the blood supply to the scrotal region and the lack of lymphatic drainage in the area [19].

The management of scrotal metastasis from visceral cancers is usually palliative, with treatment modalities such as surgery, chemotherapy, and radiotherapy. However, the survival benefits of these treatments are still controversial and the overall prognosis for patients with scrotal metastasis is poor. Most patients with scrotal metastasis die within 1-1.5 years from the time of diagnosis. The treatment options are usually selected based on the patient's overall health, the size and stage of the tumour, and the patient's preferences. The treatment aims to provide the patient with symptom relief and prolong survival, but a cure is usually not possible [20]. Most of our patients received adjuvant palliative chemotherapy. All our patients died due to the widespread metastasis. The follow-up duration in our cases ranged from 15 days to 12 months with a mean of 4.9 months. Early diagnosis of a scrotal disease can have some impact on survival and management. Research has shown that the survival of patients diagnosed with scrotal metastasis on follow-up is better than those diagnosed at presentation (13 months vs. 4.5 months). The mean survival in our patients was also 4.9 months; similar to the quoted literature. This highlights the importance of regular follow-up and monitoring for patients with a history of visceral cancer, as well as performing a thorough examination of the scrotal area in patients with known or suspected cancer. Early diagnosis and intervention can improve the patient's chance of survival and quality of life [9]. (Table 3)

Table 3 : A comprehensive review of literature

Sr. No	Author	Study type	Age	Primary Rx	Local exam of scrotum	Other sites of metastasis	Interval betwn primary and metastasis (months)	Post scrotal metastasis workup	Follow-up (months)	S Status
1	Lookingbill et al.[7] 1990	Case report	NR	NA	Nodules	NA	0	NR	NR	NR
2	Bryan et al.[16] 1996	Case report	75	Orchidectomy	Hydrocele with nodule adjacent to epididymal cyst	Peritoneal seedings, lymphadenopathy and liver	0	Sigmoid colectomy	3	Died
3	Shetty et al.[21] 1988	Case report	60	APR	Multiple nodes	Lymph nodes, groin nodes	18	NR	NR	NR
4	Boucher et al.[22] 2001	Case report	30	NACTRT + APR	Ulcerated papules and plaques	Lung	NR	NR	NR	NR
5	Melis et al.[12] 2002	Case report	41	NACTRT + APR	Erythematous plaques	Anal sphincter, prostate, hepatic lobes, lymphatic and vascular vessels	NR	NR	NR	NR
6	Hayashi et al.[23] 2003	Case report	50	Sx	Slightly reddish nodules	Inguinal lymph node	4	NR	7	NR
7	Reuter et al.[24] 2007	Case report	69	NACTRT + APR	Erythematous soft plaques	Groin, generalized lymphogenic spread	5	NR	6	Died
8	Gazoni et al.[25] 2008	Case series	55	NR	NR	Liver, lung	NR	Palliative	NR	NR
			72	NR	NR	Nr	NR	Palliative	NR	NR
			78	NR	NR	Liver	NR	Palliative	NR	NR
9	Mcweeny et al.[26] 2009	Case report	72	Sx + Adj CTRT	Nodules	Mesorectal lymph node, liver	11	WLE	NR	NR
10	Goris gbenou et al.[27] 2011	Case report	79	Sx	Papule	Penis, pubis	33	Palliative	6	Died
11	Balta et al.[28] 2012	Case report	46	Sx	Multiple eroded nodules and ulcer	Left inguinal, perianal regon, prostate	12	NR	NR	NR
12	Ozgen et al.[20] 2013	Case report	65	Sx + Adj CTRT	Hazelnut sized reddish nodules	Rectal recurrences, spermatic cord	22	CT	12	alive
13	Udkoff et al.[29]2016	Case report	56	Sx + Adj CTRT	Papules and nodules	Abdomen skin		CT	18
14	Dehal et al.[10] 2016	Case report	47	Palliative	Nodules	Aortocaval,left inguinal and retroperitoneal lymphadenopathy,	16	Palliative radiation therapy	12	Alive
15	Wu et al.[30] 2016	Case report	36	APR	Ulcerated papules and plaques	Penis, liver	28	Palliative chemotherapy	12	Died
16	Swofford et al.[31] 2017	Case report	74	Sx + Adj CTRT	Mass, necrotic wound and sinus	Penis,liver,lungs, peritoneum,bone	0	Palliative	NR	NR
17	Moghimi et al.[32] 2018	Case report	59	Sx + Adj CTRT	Nodulo-papular lesion	Prostate, brain	13	CT	3	Died
18	Abdollahi et al.[33] 2022	Case report	58	NACTRT + APR	Indurated erythema	NR	10	CT	NR	Alive
19	Schroeder et al.[8] 2021	Case report	74	CTRT	Skin thickening and vesicles	Liver, inguinal lymph nodes, right iliac bone, peritoneum, penis	3	Palliative	1	Died
20	Kasahara et al.[34] 2022	Case report	75	Sx + Adj CTRT	Scrotal swelling with tenderness	Lung, liver, lymph nodes, spermatic cord	12	Orchiectomy	2	Died
21	Yadav et al. 2023	Case series	61 years	Surgery for hydrocele	Boggy swelling in right sided scrotum	NA	0	Ct	2	DOD
			32 years	APR + Adj CTRT	Cutaneous nodule over left scrotum	NA	0	CTRT + WLE	6	DOD
			46 years	Sx + Adj CTRT	Non healing lesion at scrotal base	Lymph nodes	104	WLE	4	DOD
			22 years	NACTRT	Skin papilloma over scrotum and groin	NA	10	Palliative	15 days	DOD
			27 years	NACTRT + APR	Ulcer	NA	8	Palliative	12	DOD

Abbreviations:- NR, Not recorded; APR, Abdominoperineal resection; Sx, Surgery; NCR, Neo-adjuvant chemoradiation; F/B, followed by; Adj., Adjuavant; CTRT, Chemoradiation; CT, Chemotherapy; NA, Not available; EXAM, Examination; Met, Metastasis; Dx, Diagnosis

In conclusion, scrotal metastasis from colorectal cancer is an extremely rare event, with limited information available in the literature. Our study highlights the need for a high index of suspicion for scrotal metastasis in patients with known colorectal cancer, especially in cases of persistent or recurrent scrotal lesions. The clinical presentation of scrotal metastasis is variable, and the diagnosis is often delayed due to its rarity and nonspecific symptoms. Histopathological examination and immunohistochemistry are essential for confirmation of the diagnosis. The management of scrotal metastasis is mainly palliative, and wide excision of the scrotal lesion is the mainstay of treatment.

Competing Interest: I declare that the authors have no competing interests as defined by Springer, or other interests that might be perceived to influence the results and/or discussion reported in this paper.

Funding sources: None of the authors have any relevant financial disclosures

Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F.,. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer. CA Cancer J Clin. 2021;71:209-249.
van der Geest LG, Lam-Boer J, Koopman M, Verhoef C, Elferink MA, de Wilt JH.,. Nationwide trends in incidence, treatment and survival of colorectal cancer patients with synchronous metastases. Clin Exp Metastasis. 2015;32:457-465.
Alfred, J.A., Wyatt, J., Anuar, A.E., Williams, R., Titley-Wilson, G., Ahmed, S., & Altaf, K. (2022). Colorectal Cancer Metastases In The Reproductive Tract – A Systematic Review.
Riihimaki M, Hemminki A, Sundquist J, Hemminki K. Patterns of metastasis in colon and rectal cancer. Sci Rep. 2016;6:1-9. doi:10.1038/srep29765
Rawla P, Sunkara T, Barsouk A. Epidemiology of colorectal cancer: Incidence, mortality, survival, and risk factors. Prz Gastroenterol. 2019;14(2):89-103. doi:10.5114/pg.2018.81072
Hoyt BS, Cohen PR. Cutaneous scrotal metastasis: Origins and clinical characteristics of visceral malignancies that metastasize to the scrotum. Int J Dermatol. 2013;52(4):398-405. doi:10.1111/j.1365-4632.2012.05717.x
Lookingbill DP, Spangler N, Sexton FM . Skin involvement as the presenting sign of internal carcinoma. A retrospective study of 7316 cancer patients. J Am Acad Dermatol. 1990;22(1):19-26.
Schroeder T, Plambeck B, Bowdino C, DiMaio D, Christiansen A. Metastasis of Rectal Adenocarcinoma to the Penis and Scrotum in an Adult. Cureus. 2021;13(10):e18454 doi:10.7759/cureus.18454
Aravind B, Kumar R, Basnyat P. Cutaneous metastases secondary to colorectal carcinoma may not be as ominous as previously thought: A case report and review of the literature. BMJ Case Rep. Published online 2013:1-4. doi:10.1136/bcr-2013-008556
Dehal A, Patel S, Kim S, Shapera E, Hussain F. Cutaneous Metastasis of Rectal Cancer: A Case Report and Literature Review. Perm J. 2016;20(1):74-78. doi:10.7812/TPP/15-078
Kim JH, Kim DS, Cho HD, et al. Late-onset metastatic adenocarcinoma of the spermatic cord from primary gastric cancer. World J Surg Oncol 2014;12:128 10.1186/1477-7819-12-128.
Melis M, Scintu F, Marongiu L, Mascia R, Frau G, Casula G. Inflammatory cutaneous metastasis from rectal adenocarcinoma: Report of a case. Dis Colon Rectum. 2002;45(4):562-563. doi:10.1007/s10350-004-6239-4
Monn L, Poticha SM . Metastatic tumors of spermatic cord. Urology. 1975;5:821-823.
Talbot RW, McCann BG. ,. Secondary prostatic tumour of the spermatic cord and epididymis 5 years after prostatectomy and vasectomy. Br J Urol. 1979;51:48.
Paravastu SCV, Batra M, Ananthakrishnan K. Colonic carcinoma masquerading as scrotal swelling: a case report and review of literature. ScientificWorldJournal. 2007;7:855-859. doi:10.1100/tsw.2007.156
Bryan NP. Carcinoma of the sigmoid colon presenting as a scrotal swelling. Postgrad Med J. 1997;73(855):47-48. doi:10.1136/pgmj.73.855.47
Charles W, Joseph G, Hunis B, Rankin L . Metastatic colon cancer to the testicle presenting as testicular hydrocele. J Clin Oncol. 2005;23:5256-5257. doi:10.1200/JCO.2005.95.111
Liu M, Fan Y, Zhu S, Zhu S. Paratesticular metastasis arising from colonic mucinous adenocarcinoma: a rare case report. J Int Med Res. 2022;50(5): 3000605221101332 doi:10.1177/03000605221101332
Smallman LA, Odedra JK .. Primary carcinoma of sigmoid colon metastasising to epididymis. Urology. 1984;23:598-599.
Ozgen A, Karakaya E, Bozdoǧan N. Scrotal skin metastasis from rectum adenocarcinoma. Rare Tumors. 2013;5(4):194-195. doi:10.4081/rt.2013.e60
Shetty MR, Khan F. Carcinoma of the Rectum with Scrotal Metastases. Br J Urol 1988;62:612.
Boucher KW, Heymann WR. Ulcerated papules of the scrotum. Arch Dermatol 2001;137:495-500.
Hayashi H, Shimizu T, Shimizu H . Scrotal metastases originating from colorectal carcinoma. Clin Exp Dermatol. 2003;28:226-227.
Reuter J, Bruckner-Tuderman L, Braun-Falco M. Epidermotropic scrotal metastasis of colorectal cancer. Int J Colorectal Dis. 2007;22(9):1133-1134. doi:10.1007/s00384-006-0140-7
Gazoni LM, Hedrick TL, Smith PW, et al. Cutaneous metastases in patients with rectal cancer: A report of six cases. Am Surg. 2008;74(2):138-140. doi:10.1177/000313480807400210
McWeeney DM, Martin ST, Ryan RS, Tobbia IN, Donnellan PP, Barry KM. Scrotal metastases from colorectal carcinoma: A case report. Cases J. 2009;2(1):1-3. doi:10.1186/1757-1626-2-111
Goris Gbenou MC, Wahidy T, Llinares K, Cracco D, Perrot A, Riquet D. Atypical phimosis secondary to a preputial metastasis from rectal carcinoma. Case Rep Oncol. 2011 Sep;4(3):542-6. doi: 10.1159/000334747.
Balta I, Vahaboglu G, Karabulut AA, et al. Cutaneous metastases of rectal mucinous adenocarcinoma mimicking granuloma inguinale. Intern Med. 2012;51(17):2479-2481. doi:10.2169/internalmedicine.51.7802
Udkoff J, Cohen PR. Adenocarcinoma of the colon presenting with scrotal metastasis: case report and review of the literature. Dermatol Online J. 2016 Jan 15;22(1):13030/qt1jg0t4kw. PMID: 26990476.
Wu G, Gu BJ, Nastiuk KL, Gu J, Wu DL. Metastasis to scrotal skin as the initial manifestation in a patient with rectal adenocarcinoma: A rare case report and literature review. Asian J Androl. 2016;18(3):492-493. doi:10.4103/1008-682X.157394
Swofford BP, Dragovich T. Sigmoid Adenocarcinoma with Regional Scrotal Metastasis. Case Rep Oncol. 2017;10(2):416-419. doi:10.1159/000474936
Moghimi M, Aryanfar A, Vahedian-Ardakani H, Joukar F. Scrotal lesions of metastatic rectal adenocarcinoma: Case report and literature review. Acta Med Iran. 2019;57(4):262-266. doi:10.18502/acta.v57i4.1847
Abdollahi A, Saeedi A, Azadmanesh Y, Etezadpour M, Zandbaf T. Rare Metastasis of Rectal Cancer to Scrotal Skin: A Case Report, and Literature Review. Iran Red Crescent Med J. 2022;24(5):5-7. doi:10.32592/ircmj.2022.24.5.1489
Kasahara M, Shimizu T, Aoki H, et al. Colon Cancer Metastasis to the Right Testis: Case Report and Review of Literature. Case Rep Urol. 2022;2022:1-4. doi:10.1155/2022/2649259

No competing interests reported.

Download PDF

Version 1

posted

You are reading this latest preprint version

Colorectal Carcinoma metastasizing to Scrotum: A series of five cases with unusual presentation and late recurrences from a single tertiary oncology centre of India

Status:

Version 1

Abstract

Background

Methods

Results

Conclusion

Figures

Introduction

Methodology

Results

Discussion

Conclusion

Declarations

References

Additional Declarations

Status:

Version 1