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+A 24-year-old patient with a twin brother who in December 2005 underwent surgery for a combined neoplasm (mucinous adenocarcinoma and goblet cell carcinoid, T4N2M1) infiltrating the appendicular wall and meso, with multiple peritoneal implants and involvement of 8 of the 29 isolated lymph nodes. He underwent right hemicolectomy, peritonectomy and resection of macroscopic visceral peritoneal implants. Subsequently, adjuvant chemotherapy with mFOLFOX4 was started for 12 cycles, with episodes of diarrhoea after the second and third cycle and a hurticarial reaction after the 7th cycle. At the start of chemotherapy, 5HIAA in 24-hour urine was within normal parameters and body scanning with In.111 pentreotide and SPECT showed no alterations.
+Ten months after surgery, he presented with acute testicular pain. On physical examination, the right testicle was horinzontalised, enlarged, hard and irregular in the upper pole, as well as thickening of the spermatic cord. In the testicular Doppler ultrasound, the right testicle showed increased calibre of the vascular structures, thickened epididymis, hypoechoic and with peripheral vascularisation. Anechoic scrotal content was observed with mobile echogenic content, compatible with complicated hydrocele (pyocele and haematocele...). An urgent surgical exploration was decided, in which haematocele and thickening with induration of the testicular vagina were observed. Intraoperative pathology revealed infiltration by mucinous adenocarcinoma. Radical right orchiectomy with ligation of the cord at the root of the scrotum was performed. Definitive pathology analysis showed a neoplasm of the testicular vagina consisting of mucinous lakes and clusters of epithelial cells, mostly in signet ring morphology, with no involvement of the epididymis or testis.
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+After testicular surgery, chemotherapy was administered with FOLFIRI plus BEVACIZUMAB in the 3rd cycle. Nine months after the orchiectomy, the patient presented hepatic, pancreatic and regional adenopathic progression, presenting subocclusive pictures. He died 21 months after diagnosis.
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