BACKGROUND Metastases from pancreas or ampullary malignancies are common, but the spread to testicle and paratesticular tissue is exceedingly rare. To the best of our knowledge, fewer than 30 cases have been reported in the literature. More rarely, metastasis to tunica vaginalis testis occurs without involvement of the testes and epididymis. CASE SUMMARY A 65-year-old male who complained of painless swelling of the left scrotum for over 1 wk was referred to the Department of Urology. Scrotal ultrasound showed left testicular hydrocele with paratesticular masses. Chest computed tomography revealed lung metastasis and enlarged left supraclavicular lymph node.The blood tumor markersalpha-fetoprotein, human chorionic gonadotropin, and serum lactate dehydrogenase were withinnormal limits.The preoperative diagnosis was left testicular tumor with lung metastasis. Then radical orchidectomy of the left testicle and high ligation of the spermatic cord were performed, and postoperative histopathology suggested metastatic tumors that was confirmed by an abdominal computed tomographic scan. The positive computed tomography findings, in conjunction with the expression of cytokeratin 7 (CK7), CK20, CK5/6, and absence of expression of Wilms’ tumor suppressor gene 1, calretinin, melanocyte, prostate-specific antigen, thyroid transcription factor-1, GATA binding protein 3, caudal type homeobox 2, and napsinA supported the diagnosis of pancreatic adenocarcinoma. The outcome of this patient was unsatisfactory, and he died 3 mo later. CONCLUSION This case suggests that pancreatic metastatic carcinoma must be considered in the differential diagnosis of scrotal enlargement. The advanced age of the patient wassuggestive of a secondary testicular tumor.In addition, careful physical examination and ultrasonography as well as radiological examination have become a standard modality.

Introduction Pancreatic mucinous neoplasms, which mainly include mucinous cystic neoplasms (MCNs) and intraductal papillary mucinous neoplasms (IPMNs), possess a potentially malignant tendency. It remains diffi cult to adopt reliable methods in predicting the malignancy progression of the conditions. 1 Endoscopic ultrasonography (EUS) can present relatively high diagnostic value in respect of sensitivity and specifi city. 2 However, its value in predicting their malignancy is unclear yet. Methods The data of EUS features of 21 patients with pancreatic mucinous neoplasms (18 males and 3 females) were reviewed. All the patients were admitted in Changhai hospital between January 1998 and December 2007. Surgical resection were completed and confi rmed by subsequent surgical pathology in all the patients. Of them, 11 were IPMNs (5 benign, 2 borderline, 4 malignant) and 10 were MCNs (2 benign, 8 malignant). With the SPSS10.0 statistical software, independent sampler t test was performed on the norm variables in mean±SD form, while enumeration data in fourfold table was verifi ed by χ 2 test with Fisher exact probabilistic method. Area under the receiver operating characteristic curve (ROC) for all data was calculated and the optimal cut-off values were determined by Youden Index. A p value of less than 0.05 was considered to be statistically signifi cant. Results It was found that the main pancreatic duct with a diameter of ≥11.0 mm can predict the malignancy of IPMNs with a sensitivity of 75% and specifi city of 100%, and the mural nodule with a height of ≥4.3 mm can predict the malignancy of IPMNs with a sensitivity of 100% and specifi city of 100%. Cystic wall with a thickness of ≥2.4 mm can predict the malignancy of MCNs with a sensitivity of 100% and specifi city of 100%, and mural nodule with a height of ≥8.9 mm can predict the malignancy of MCNs with a sensitivity of 87.5% and specifi city of 100%. Conclusion EUS features are of high value in predicting the malignancy of MCNs and IPMNs. Competing interests None. Keywords endoscopic ultrasonography, intraductal papillary mucinous neoplasm, mucinous cystic neoplasm, pancreatic cystic neoplasm.