Extramedullary multiple myeloma in the spermatic cord: A case report

Abstract

Background: Tumors arising from the spermatic cord are typically lipomas or sarcomas, and treatment with radical orchiectomy and high ligation of the spermatic cord is the standard of care. Very few cases of metastatic spread to the spermatic cord from other malignancies have been described. Herein we report a case of a patient with a spermatic cord tumor that was found after radical orchiectomy to be an extramedullary site of a known multiple myeloma. Case: A 62-year-old man undergoing Bispecific T-cell Engager (BiTE) therapy for relapsing multiple myeloma was found on surveillance imaging to have a new enhancing mass in his left spermatic cord. He underwent left radical orchiectomy. Pathologic examination revealed the tumor to consist of neoplastic plasma cells consistent with extramedullary spread of multiple myeloma and a paucity of T-cells. There was no involvement of the left testicle. He had no surgical complications but was found to have systemic disease progression despite ongoing therapy. He ultimately elected for palliative care and died six months after surgery. Discussion: This is a case of relapsing multiple myeloma manifesting as an enlarging spermatic cord tumor. Although proceeding to radical orchiectomy is the standard approach to most spermatic cord tumors, this scenario highlights a potential need for further diagnostic workup when the spermatic cord tumor is found in a patient with another active pre-existing malignancy. If metastasis is high on the differential, obtaining a tissue diagnosis via biopsy should be considered, especially in patients for whom testosterone production and fertility preservation are a high priority.

Keywords

• Spermatic cord tumor
• Multiple myeloma
• Bispecific T-cell engager therapy
• Radical orchiectomy