Urol Int 1990;45:186-187 © 1990 S. Kargcr AG, Basel 0042-1138/90/0453-0186S2.75/0 Isolated Testicular Métastasés from Renal Cell Carcinoma R. Indudharaa, S.K. Sharmaa, A. Rajwanshib, Amarjeet Shonki3 Departments of “Urology and bCytology, Postgraduate Institute of Medical Education and Research, Chandigarh, India Key Words. Testis • Métastasés • Renal cell carcinoma Abstract. Testicular metastasis from renal cell carcinoma is very rare. Herein we report a case of left-side renal cell carcinoma initially diagnosed to be clinically stage II, which developed left-side testicular métastasés 2 months following radical nephrectomy. High inguinal orchiectomy was carried out. The patient was asymptomatic 2 months later. Although renal vein involvement in renal cell carcinoma is common and its extension into inferior vena cava well documented, tumour invasion of spermatic veins is rare. Introduction Metastasis to the testes is a rare condition [ 1 -3]. Non- lymphomatous testicular métastasés may occur as part of a widespread carcinomatosis or when a primary tumour elsewhere is known to be present in which case the diag nosis is easy. Rarely, the secondaries may be the only or the initial sign of a primary lesion elsewhere; these cases can prove difficult to diagnose histologically. The com mon primary sources, in decreasing order of frequency, include prostate, bronchus, bowel, pancreas, malignant melanoma of bladder, and carcinoma of bladder and kidney [4], Testicular metastasis from renal cell carcinoma is very rare, it being just given passing reference in several standard books [4-6]. This rarity of renal cell carcinoma metastasising into the testis and also the fact that it may explain one of the modes of spread of renal cell carci noma in its natural history of progression prompted us to report this case. Case Report A.S., a 67-year-old male patient, presented with painful enlarge ment of the left testis of 6 days’ duration. Two months earlier he had undergone left radical nephrectomy for stage II renal cell carcinoma (fig. 1). At that time, there was no evidence of lymph node or renal vein involvement. He had no varicocele. Since nephrectomy speci men revealed breach in Gerota’s fascia at one place, he was given external radiation of 3,500 rad in 3 weeks to the renal fossa imme diately following nephrectomy. On examination, the left testis was enlarged to twice the size of its counterpart, and was tender. The spermatic cord was indurated throughout its extent. No lump was felt in the abdomen. The nephrectomy scar had healed well. The chest X-ray was normal. A course of antibiotics and anti-inflamma tory agents did not improve his condition. Fine needle aspiration cytology from the left testis revealed metastatic deposits consistent with renal cell carcinoma (fig. 2). A left high inguinal orchiectomy was performed. The entire tes tis and the cord up to the internal inguinal ring was replaced by tumour tissue. Histopathology revealed classical features of renal cell carcinoma replacing the normal testis. In view of distant metas- tases, the patient was started on injection Proluton weekly. Eight weeks later, he was asymptomatic, with no evidence of local or sys temic recurrence. Discussion Approximately one third of patients with renal cell carcinoma have haematogenous métastasés at the time of diagnosis [5]. The common sites for métastasés in decreasing order of frequency include the lungs (50%), bones (30%; which are osteolytic), liver (30%), brain and thyroid (25%). Local invasion into adrenals, spleen, dia phragm is present in about 30-40% of cases [5]. Lym phatic extension to regional lymph nodes is yet another mode of spread.