Krukenberg tumor with concomitant ipsilateral hydronephrosis and spermatic cord metastasis in a man: A case report

Figure 1 Tumor imaging and excision. A: Contrast-enhanced computed tomography of the abdomen reveals an irregular mass at the left spermatic cord extending to the epididymis; B: Intraoperative photograph of the indurated mass measuring 4.0 cm × 1.7 cm on the spermatic cord and epididymis, without invasion to the testis. A biopsy was obtained from the spot indicated by the pointer.

Figure 2 Ipsilateral hydronephrosis. A: Retrograde lymphatic metastasis-related left hydronephrosis in November 2019; B: Left hydronephrosis showed regression in March 2020, after systemic chemotherapy.

Figure 3 Left ureteral stenosis. Left retrograde pyelography showed multiple stenosis and narrowing points along middle to lower ureter, which led to left hydronephrosis and hydroureter.

Figure 4 Histopathology. A: Hematoxylin and eosin–stained section showed fibrovascular tissue with infiltration of nests of poorly differentiated adenocarcinoma; B: The immunohistochemically stained section was diffusely and strongly positive for CDX2, which is a marker indicative of adenocarcinoma of intestinal origin.

Figure 5 Tumor scan. Whole-body tumor scan from the skull vertex to upper thighs was performed at 60 min after injection of ¹⁸F-fluorodeoxyglucose. Purple arrow indicates gastric stump recurrence. Multiple faint nodules were observed in the pelvic cavity, suggesting peritoneal dissemination, as well as the cause of ureteral stenosis.