435 Retrograde and Contralateral Metastasis of Clear Cell Renal Cell Carcinoma to the Spermatic Cord: A Case Report

Introduction/Objective Contralateral, retrograde metastases of Clear Cell Renal Cell Carcinoma (ccRCC) are rare. Seventeen cases of ccRCC metastatic to the spermatic cord have been reported in the literature, one of which was contralateral. We present a case of right kidney ccRCC with retrograde, contralateral metastasis to the left spermatic cord. Methods/Case Report The patient is a 78-year-old male with a history of right ccRCC treated with radical nephrectomy. He presented with a growing, uncomfortable left inguinal mass which was previously noted on CT imaging within the left spermatic cord. Scrotal ultrasound showed a solid, heterogenous structure measuring 7.8 cm. The patient subsequently underwent left radical orchiectomy with excision of the mass. Gross examination demonstrated a 7.0 cm well-defined, golden-yellow mass confined within the spermatic cord. Microscopic examination of the specimen revealed metastatic ccRCC with extensive venous involvement. Results N/A Conclusion Contralateral spermatic cord metastases of ccRCC are rare, with only one prior reported case. CcRCC is thought to spread hematogenously. This route of contralateral metastasis occurs through the vertebral venous plexus to the spermatic cord vessels. The vertebral venous plexus is a complex, valveless, bidirectional system connecting the pelvic, thoracic, and vertebral venous systems. This important venous route facilitates the contralateral and retrograde metastatic dissemination of ccRCC.