{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T15:30:45Z","timestamp":1788449445640,"version":"build-2803163510"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,4,20]],"date-time":"2020-04-20T00:00:00Z","timestamp":1587340800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2020,4,20]],"date-time":"2020-04-20T00:00:00Z","timestamp":1587340800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Gastroenterol"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The spermatic cord and testis are very rare sites for metastasis from gastric cancer. Although several mechanisms have been suggested to explain this unusual metastasis, the actual mechanism remains unclear. We report a case of right spermatic cord and testicular metastasis, review its imaging findings, and suggest a mechanism of tumor spread.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case presentation<\/jats:title><jats:p>A 61-year-old man complained of a palpable mass in the right inguinal area. He had been treated with distal gastrectomy with chemotherapy for advanced gastric cancer 5\u2009years ago. Computed tomography, ultrasound, and magnetic resonance imaging showed a mass surrounding the right spermatic cord, involving the right testis. Another mass was observed in the aortocaval space, presumed to be a metastatic lymph node. The imaging features of the right testicular lesion were different than those of the primary testicular cancer. The lesions at both sites showed similar radiologic features of abundant internal necrosis, which is consistent with metastatic lesions. Pathology confirmed metastatic adenocarcinoma. He underwent a series of chemotherapy sessions, and all metastatic masses had partially decreased in size at the 5-month outpatient follow-up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The imaging features of testicular mass and spermatic cord involvement are important clues for accurate differential diagnosis of metastasis from other primary tumors in patients with a history of stomach cancer. This unusual metastasis can be explained via retrograde tumor spread along the lymphatic channels in terms of concurrent aortocaval lymph node metastasis. A suspicion of metastasis should not be overlooked, even if a patient has undergone curative treatment, including surgery and adjuvant chemotherapy, many years ago.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12876-020-01269-0","type":"journal-article","created":{"date-parts":[[2020,4,20]],"date-time":"2020-04-20T16:04:19Z","timestamp":1587398659000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Mechanism of metastasis to the spermatic cord and testis from advanced gastric cancer: a case report"],"prefix":"10.1186","volume":"20","author":[{"given":"Soyoung","family":"Park","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung Kyoung","family":"Moon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joo Won","family":"Lim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,4,20]]},"reference":[{"issue":"5","key":"1269_CR1","doi-asserted-by":"publisher","first-page":"E359","DOI":"10.1002\/ijc.29210","volume":"136","author":"J Ferlay","year":"2015","unstructured":"Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359\u201386.","journal-title":"Int J Cancer"},{"issue":"32","key":"1269_CR2","doi-asserted-by":"publisher","first-page":"52307","DOI":"10.18632\/oncotarget.10740","volume":"7","author":"M Riihimaki","year":"2016","unstructured":"Riihimaki M, Hemminki A, Sundquist K, Sundquist J, Hemminki K. Metastatic spread in patients with gastric cancer. Oncotarget. 2016;7(32):52307\u201316.","journal-title":"Oncotarget."},{"key":"1269_CR3","first-page":"8592","volume":"10","author":"W Dai","year":"2017","unstructured":"Dai W, Liu D, Zuo J, Tan J, Wang L, Wu H, et al. Metastatic tumor of male genital system from gastric cancer: a case report and review of literature. Int J Clin Exp Pathol. 2017;10:8592\u20138.","journal-title":"Int J Clin Exp Pathol"},{"issue":"19","key":"1269_CR4","first-page":"30491","volume":"21","author":"A Nazemi","year":"2020","unstructured":"Nazemi A, Daneshmand S. Adult genitourinary sarcoma: a population-based analysis of clinical characteristics and survival. Urol Oncol. 2020;21(19):30491\u20130.","journal-title":"Urol Oncol"},{"issue":"3","key":"1269_CR5","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1148\/rg.283075110","volume":"28","author":"PR Bhosale","year":"2008","unstructured":"Bhosale PR, Patnana M, Viswanathan C, Szklaruk J. The inguinal canal: anatomy and imaging features of common and uncommon masses. Radiographics. 2008;28(3):819\u201335.","journal-title":"Radiographics."},{"issue":"1","key":"1269_CR6","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1097\/00000658-199301000-00012","volume":"217","author":"Y Fong","year":"1993","unstructured":"Fong Y, Coit DG, Woodruff JM, Brennan MF. Lymph node metastasis from soft tissue sarcoma in adults. Analysis of data from a prospective database of 1772 sarcoma patients. Ann Surg. 1993;217(1):72\u20137.","journal-title":"Ann Surg"},{"key":"1269_CR7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1177\/1756287218818029","volume":"11","author":"RA Keenan","year":"2019","unstructured":"Keenan RA, Nic An Riogh AU. Stroiescu a, Fuentes a, Heneghan J, Cullen IM, et al. Paratesticular sarcomas: a case series and literature review. Ther Adv Urol. 2019;11:1\u20138.","journal-title":"Ther Adv Urol"},{"issue":"6","key":"1269_CR8","first-page":"340","volume":"24","author":"K Kanno","year":"1994","unstructured":"Kanno K, Ohwada S, Nakamura S, Ohya T, Iino Y, Morishita Y, et al. Epididymis metastasis from colon carcinoma: a case report and a review of the Japanese literature. Jpn J Clin Oncol. 1994;24(6):340\u20134.","journal-title":"Jpn J Clin Oncol"},{"key":"1269_CR9","first-page":"747261","volume":"2015","author":"D Hirano","year":"2015","unstructured":"Hirano D, Ohkawa M, Hasegawa R, Okada N, Ishizuka N, Kusumi Y. Metastatic tumor of the spermatic cord in adults: a case report and review. Case Rep Urol. 2015;2015:747261.","journal-title":"Case Rep Urol"},{"issue":"21","key":"1269_CR10","doi-asserted-by":"publisher","first-page":"6764","DOI":"10.3748\/wjg.v21.i21.6764","volume":"21","author":"B Li","year":"2015","unstructured":"Li B, Cai H, Kang ZC, Wu H, Hou JG, Ma LY. Testicular metastasis from gastric carcinoma: A case report. World J Gastroenterol. 2015;21(21):6764\u20138.","journal-title":"World J Gastroenterol"},{"issue":"4","key":"1269_CR11","doi-asserted-by":"crossref","first-page":"890 e7","DOI":"10.1016\/j.urology.2006.04.025","volume":"68","author":"HA Qazi","year":"2006","unstructured":"Qazi HA, Manikandan R, Foster CS, Fordham MV. Testicular metastasis from gastric carcinoma. Urology. 2006;68(4):890 e7\u20138.","journal-title":"Urology"},{"issue":"2","key":"1269_CR12","doi-asserted-by":"publisher","first-page":"2141","DOI":"10.3390\/cancers3022141","volume":"3","author":"T Akagi","year":"2011","unstructured":"Akagi T, Shiraishi N, Kitano S. Lymph node metastasis of gastric cancer. Cancers (Basel). 2011;3(2):2141\u201359.","journal-title":"Cancers (Basel)"},{"issue":"2","key":"1269_CR13","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1007\/s10120-011-0041-5","volume":"14","author":"Japanese Gastric Cancer association","year":"2011","unstructured":"Japanese Gastric Cancer association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14(2):101\u201312.","journal-title":"Gastric Cancer"},{"issue":"3","key":"1269_CR14","doi-asserted-by":"publisher","first-page":"668","DOI":"10.1148\/rg.2019180113","volume":"39","author":"JJ Young","year":"2019","unstructured":"Young JJ, Pahwa A, Patel M, Jude CM, Nguyen M, Deshmukh M, et al. Ligaments and lymphatic pathways in gastric adenocarcinoma. Radiographics. 2019;39(3):668\u201389.","journal-title":"Radiographics"},{"issue":"1","key":"1269_CR15","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1148\/rg.311105072","volume":"31","author":"B Pano","year":"2011","unstructured":"Pano B, Sebastia C, Bunesch L, Mestres J, Salvador R, Macias NG, et al. Pathways of lymphatic spread in male urogenital pelvic malignancies. Radiographics. 2011;31(1):135\u201360.","journal-title":"Radiographics"},{"issue":"2","key":"1269_CR16","doi-asserted-by":"publisher","first-page":"400","DOI":"10.1148\/rg.352140097","volume":"35","author":"C Coursey Moreno","year":"2015","unstructured":"Coursey Moreno C, Small WC, Camacho JC, Master V, Kokabi N, Lewis M, et al. Testicular tumors: what radiologists need to know--differential diagnosis, staging, and management. Radiographics. 2015;35(2):400\u201315. https:\/\/doi.org\/10.1148\/rg.352140097.","journal-title":"Radiographics"},{"issue":"2","key":"1269_CR17","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1002\/1097-0142(20000715)89:2<255::AID-CNCR8>3.0.CO;2-N","volume":"89","author":"N Shiraishi","year":"2000","unstructured":"Shiraishi N, Inomata M, Osawa N, Yasuda K, Adachi Y, Kitano S. Early and late recurrence after gastrectomy for gastric carcinoma. Univariate and multivariate analyses. Cancer. 2000;89(2):255\u201361.","journal-title":"Cancer"},{"issue":"10","key":"1269_CR18","doi-asserted-by":"publisher","first-page":"2730","DOI":"10.1245\/s10434-007-9479-4","volume":"14","author":"YW Moon","year":"2007","unstructured":"Moon YW, Jeung HC, Rha SY, Yoo NC, Roh JK, Noh SH, et al. Changing patterns of prognosticators during 15-year follow-up of advanced gastric cancer after radical gastrectomy and adjuvant chemotherapy: a 15-year follow-up study at a single korean institute. Ann Surg Oncol. 2007;14(10):2730\u20137.","journal-title":"Ann Surg Oncol"},{"key":"1269_CR19","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1186\/1477-7819-12-128","volume":"12","author":"JH Kim","year":"2014","unstructured":"Kim JH, Kim DS, Cho HD, Lee MS. Late-onset metastatic adenocarcinoma of the spermatic cord from primary gastric cancer. World J Surg Oncol. 2014;12:128.","journal-title":"World J Surg Oncol"}],"container-title":["BMC Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-020-01269-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12876-020-01269-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-020-01269-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,30]],"date-time":"2023-09-30T04:11:28Z","timestamp":1696047088000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcgastroenterol.biomedcentral.com\/articles\/10.1186\/s12876-020-01269-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,4,20]]},"references-count":19,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["1269"],"URL":"https:\/\/doi.org\/10.1186\/s12876-020-01269-0","relation":{},"ISSN":["1471-230X"],"issn-type":[{"value":"1471-230X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,4,20]]},"assertion":[{"value":"24 October 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 April 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 April 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Not applicable.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient for publication of this case report.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"119"}}