S6289 From Groin to Gastrum: A Rare Case of Scrotal Cancer Metastasis to the Stomach

Introduction: Scrotal cancer is a rare and aggressive cancer affecting 0.3-1.8 in 1000,000 males per year. The most common subtype is squamous cell cancer (SCC), also known as the chimney sweeps’ carcinoma. Other risk factors include viruses such as human papillomavirus and HIV, psoralens and ultraviolet A radiation (PUVA), radiation and exposure to carcinogens. We present a rare case of distant metastasis of scrotal cancer to the stomach resulting in upper gastrointestinal bleeding. Case Description/Methods: A 41-year-old man patient with history of HIV/AIDS not compliant with highly active retroviral therapy, anal condylomas status post resection, and widely metastatic SCC of the scrotum invading into the anal canal with metastasis to lungs, pelvic and mediastinal lymph nodes, status post scrotectomy and scrotoplasty with intermittent radiation and chemotherapy (Nigro protocol) presented with complaints of melena, hematochezia and hematemesis for 1 week. On arrival, the patient was afebrile, vitals were: heart rate 101 bpm, blood pressure 142/98 mm Hg, and saturating at 100% on room air. Hemoglobin was 12.8 g/dL, with a 2 g/dL drop over 24 hours, HIV viral load 98,841, CD4 45/μL. On inspection, skin breakage was noted with purulence over the left groin as well as evidence of previously known scrotal SCC with condylomata in rectum with groin adenopathy. Patient refused a colonoscopy. Esophagogastroduodenoscopy revealed a 2 cm friable mass with central cratered ulcer with pigmented spot in the greater curvature of the gastric body with oozing on contact and old blood was seen in the stomach without active bleeding, so treatment was not required. Biopsies confirmed the lesion to be P40, P16, CK7 positive HPV-related squamous cell carcinoma. Ill-defined tumor nodules were seen infiltrating the lamina propria with strong nuclear reactivity for P40 and diffuse nuclear and cytoplasmic reactivity for P1. Discussion: SCC of the scrotum is rare, with an incidence of 1.5 per 1 million persons. A 2008 study identified only 151 cases of SCC via the SEER cancer registry from 1973-2002. Reports of metastasis to the stomach could not be identified in the literature. A British cancer clinic reported metastasis to the liver in 20% of cases. SCC of the scrotum can progress given patients can delay in seeking medical care due to embarrassment, ignorance or both. As gastric metastasis is not reported before, it is vital for gastroenterologists to recognize its presentation for early diagnoses as it can change the prognosis and management of the malignancy.