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+This is a 67-year-old patient with a history of depressive syndrome and prostatism, who was diagnosed at the beginning of 2004 with descending colon carcinoma. In March of the same year he underwent a left subtotal colectomy with ileosigmoid anastomosis. The anatomopathological study of the colectomy specimen showed a tumour measuring 4x2 centimetres compatible with a moderately differentiated adenocarcinoma of the colon, infiltrating down to the subserosal fat, with no lymph node involvement and with free surgical edges (pT3NoMo). Postoperatively, he required drainage of an abscess in the abdominal wall, and the rest of the postoperative period was without further complications.
+Preoperative blood tests showed a haematocrit of 47.7, haemoglobin of 15.6, creatinine of 0.91, normal urinalysis, PSA < 4 and a Carcino Embryonic Antigen (CEA) of 91.45 (Normal < 5.00). Preoperative CT was reported as a mass in the descending colon compatible with colon carcinoma with small retroperitoneal adenopathies less than 1 centimetre in diameter, not significant, as well as chronic fibrocicatricial lesions in the chest.
+Four months after the colectomy, the patient began to notice a painful nodular mass in the right testicle. A testicular ultrasound scan was performed which detected a heterogeneous lesion, with solid and cystic areas, at the level of the right epididymal body and which could be affecting the testicle, and the Urology Department was consulted for assessment.
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+The examination revealed that the patient had a painful tumour measuring 1-2 centimetres in the right epididymis, as well as another smaller tumour in the right spermatic cord.
+The lesions were scheduled for surgical exploration under spinal anaesthesia with oncological criteria: inguinal incision, extraction of the right teste and spermatic cord and clamping of the same. Macroscopically we observed, in the middle third of the right epididymis, a nodular lesion of about 2 centimetres in diameter, yellowish in colour and elastic in consistency, firmly attached to the right testicle, from which we detached with difficulty. The testicle appeared macroscopically normal and without infiltration. In the right spermatic cord we palpated another lesion of similar characteristics, which appeared to encompass the cord circumferentially. Intraoperative biopsy was performed and reported as adenocarcinoma, so we decided - after informing the patient who gave his consent - to perform a radical right orchiectomy, including the spermatic cord.
+After studying the surgical specimen, the Pathological Anatomy Service confirmed that it was a tumour measuring 2 centimetres in diameter in the middle third of the right epididymis and another tumour in the right spermatic cord measuring 1.5 centimetres in diameter, corresponding to malignant epithelial neoformations with glandular structures compatible with metastasis of an adenocarcinoma, possibly of the colon. The surgical edges and the right testicle were free of tumour.
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+The postoperative period was uneventful, and the patient was discharged by the Urology Department the day after the operation and transferred to the Oncology Department for complementary treatment with chemotherapy. In the postoperative controls, control CT scans and analyses were performed, and 12 weeks after the orchiectomy a significant elevation of the CEA was detected, which corresponded with the appearance in the imaging tests (CT) of retroperitoneal adenopathies larger than 1 centimetre, pulmonary nodules and a thickening of the colon wall near the anastomosis. The patient is currently alive, although the imaging studies carried out after the operation showed that the evolution is unfavourable despite chemotherapy treatment, with the appearance of multiple mesenteric and hepatic implants and an increase in the number and size of the pulmonary nodules.
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