Solitary seminal vesicle metastasis from ileal adenocarcinoma presenting with hematospermia: A case report

BACKGROUND: Although metastatic adenocarcinoma of the ileum is not uncommon, solitary metastasis to the seminal vesicle has not been reported. We report a patient with recurrent hematospermia diagnosed with metastasis to the seminal vesicle following ileal adenocarcinoma resection, his subsequent management and outcome. CASE SUMMARY: A 46-year-old man presented with recurrent episodes of painless hematospermia. This was not associated with any lower urinary tract symptoms. He had a past medical history of ileal tumor at the terminal ileum with solitary mesenteric lymph node metastasis on presentation, and underwent partial ileectomy and lymphadenectomy 4 years ago. Subsequent investigations included positron-emission tomography and computed tomography imaging confirmed the very unusual diagnosis of a solitary tumor at the left seminal vesicle. Laparoscopic left-sided vesiculectomy was carried out. Histological analysis with immunohistochemistry showed that CDX-2 was positive and CK7 was negative, and the appearance was consistent with the diagnosis of recurrent metastatic adenocarcinoma of his previously treated intestine primary. The patient had an uneventful post-operative recovery. He received adjuvant chemoradiotherapy following surgery. He remained asymptomatic until he developed multiple bone and pulmonary metastases one year after surgery. CONCLUSION: Clinicians should be aware of hematospermia as the first symptom of metastatic recurrence in patients with a history of ileal adenocarcinoma.