A 67-year-old patient with a history of depressive syndrome and prostatism was diagnosed in early 2004 with a descending colon carcinoma.
In March that same year, a left subtotal colectomy with ileosigmoid anastomosis was performed.
The pathological study of the colectomy specimen showed a 4x2 cm tumor compatible with a moderately differentiated adenocarcinoma of the colon (except the non-subserous fat, without lymph node involvement and with surgical margins).
Postoperatively, an abscess was drained in the abdominal wall, and the rest of the postoperative period was uneventful.
Analytical patient had a hematocrit of 47.7, hemoglobin of 15.6, creatinine of 0.91, urine analysis within the limits of PSA < 5.0, preoperative cancer normal (Normal Path) < 91.
Preoperative CT scan was reported as a descending colon mass compatible with colon carcinoma with small retroperitoneal lymph nodes less than 1 cm in diameter, which were not significant, as well as chronic fibrotic lesions in the chest.
Four months after colectomy the patient begins to notice a painful nodular mass in the right testicle.
A testicular ultrasound was then performed to detect a heterogeneous lesion, with solid and cystic areas, at the body level of the right epididymis and that could be affecting the testicle, so we consulted the Service.
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On physical examination, we found that the patient had a painful tumor of 1-2 in the right epididymis, as well as another tumor of smaller size in the cord is a right premium centimeters.
The patient was programmed for exploration of the lesions under spinal anesthesia with oncological criteria: inguinal incision, right test cord extraction and percutaneous clamping.
Macroscopically, we observed, in the middle third of the right epididymis, a nodular lesion of about 2 cm in diameter, which was difficult to brush, with elastic consistency, firmly adhered to the right test.
Apparently, the testicle was macroscopically normal and non-existent.
Another lesion with similar characteristics appeared to encompass the cord circumferentially.
Intraoperative biopsy was performed and informed as adenocarcinoma, because we discovered - after informing the patient who gave his consent - to perform a right radical orchiectomy, including a cord is a persistent right.
The Pathological Anatomy Service after studying the specimen confirmed that it was a 2 cm tumor in diameter in the right middle third of the abdomen and another tumor in the cord neo centimeters with epithelial metastases consistent with adenocarcinoma 1.5 colon.
The surgical margins and the right testicle were tumor free.
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The postoperative period was uneventful, and the patient was discharged from the Urology Department the day after the intervention, passing the patient to the Department of On-therapy and chemotherapy.
Control and analytical CT scans were performed in postoperative controls. At 12 weeks after orchiectomy, a significant elevation of CEA was detected, which corresponded to the appearance of a large colonic lymph nodes nearby 1 cm retroperitoneal wall.
Currently, the patient lives, as seen in the imaging studies performed after the intervention, it was found that the evolution is unfavorable despite the chemotherapy treatment, with the appearance of multiple mesenteric and hepatic implants and increased number and size of pulmonary nodules.
