What happened, in summary

A 49-year-old man developed a gradually enlarging mass above the right testis after having been free of recurrence for 7 years following treatment for gastric cancer. His original cancer had been a mucinous gastric adenocarcinoma with signet-ring cell features, classified as Stage IV. He had undergone subtotal gastrectomy with adjacent colon resection followed by 6 cycles of 5-fluorouracil plus cisplatin.

Evaluation of the new mass led to radical inguinal orchiectomy. Pathology showed adenocarcinoma with signet-ring cells involving the epididymis, spermatic cord and surrounding soft tissue, with findings consistent with recurrence of the previous gastric cancer. Systemic evaluation did not identify another primary tumor.

He then received 8 courses of FOLFOX chemotherapy. At 26 months after orchiectomy, he was doing well with no evidence of recurrence. This placed him more than 9 years beyond his original gastric-cancer surgery despite the late metastatic recurrence.