Gastric cancer metastasizing to the male reproductive system

A 71-year-old male patient underwent a radical gastrectomy for gastric cancer two years prior and subsequently received regular postoperative chemotherapy with capecitabine and oxaliplatin. Six months before admission, he experienced the onset of swelling in the right inguinal region, accompanied by pain in the right lower abdomen during ambulation. He was admitted to the hospital due to the progressive enlargement of the swelling and the onset of severe abdominal pain. Physical examination revealed a protruding mass in the right groin, which was apparent upon standing and did not recede upon compression of the internal ring orifice. During the unilateral inguinal hernia repair procedure, multiple nodular masses were identified at the internal ring's opening, with the largest measuring approximately 2 cm in diameter and exhibiting a hard texture. Subsequent tissue excision for pathological analysis revealed heterogeneous cellular structures and swelling that extended along the spermatic cord, reaching the vas deferens and spermatic vessels, and invading the peritoneum. The hernial sac was smooth and devoid of hernial contents, leading to the resection of the affected peritoneum. During the surgical procedure, the spermatic cord was transected and ligated proximal to the testis, followed by its removal. Subsequently, the posterior wall of the inguinal canal was reinforced with sutures, the surgical field was irrigated with no evidence of active bleeding, and the incision was closed. Histopathological analysis revealed metastatic involvement of the spermatic cord and testis by gastric cancer, thereby confirming ectopic metastasis of the malignancy.