these extrahepatic lesions are most commonly found in the lungs , lymph nodes , and bones .
there have been reports of extrahepatic lesions found in urogenital sites , such as the kidneys , testes , and bladder [ 24 ] .
we encountered a patient with a metastatic hcc lesion presenting as a tender right inguinal mass .
to the best of our knowledge , this case represents the first such report in the english language literature .
a 57-year - old man was referred to our urology out - patient department from a gastrointestinal doctor because of a tender inguinal mass that had become progressively larger over the previous one and half months .
the patient had a past history of hcc ( underwent radiofrequency ablation in july 2004 and transcatheter arterial chemoembolization in november 2004 ) , hepatitis b virus infection , rightside inguinal hernia ( status postherniorrhaphy in 2007 ) , a cholecystectomy in 2000 , and a vasectomy in the 1990s .
he noticed a painful hard mass in the right inguinal area one and half months prior to visiting our department .
physical examination revealed a 2  2 centimeter hard , movable , tender mass in the right inguinal area .
an excision biopsy was performed , and the pathological report revealed tumor cells with abundant amphophilic to pale eosinophilic cytoplasm , round nuclei , mitosis , and focal necrosis , and the cells were hep par 1 positive as determined by immunohistochemical staining ( figure 1 ) .
due to a persistent , painful sensation in the right inguinal area , removal of the right inguinal metastatic mass was arranged . during inguinal exploration
a right radical orchiectomy was performed because the tumor could not be freed from the spermatic cord .
the pathological report showed multiple metastatic hcc tumor nodules and tumor emboli in the lymphatic and blood vessels of the spermatic cord and peritesticular soft tissue ( figure 2 ) .
hcc is commonly seen in taiwanese hospitals due to high incidence of hepatitis b and c in taiwan .
most documented extrahepatic metastatic lesions have been found in the lungs followed by the lymph nodes , bones , and adrenal glands , but there are cases of distal metastasis to the genitourinary system , such as the kidneys and bladder [ 1 , 3 , 4 ] .
similar to other metastatic lesions , the clinical presentation of extrahepatic metastatic lesions depends on their location and the affected areas .
presentations include hematuria , flank pain , and testicular pain ; these signs and symptoms are very similar to those of other common genitourinary diseases [ 14 ] . in our case , this patient presented with a painful inguinal mass .   when patients present with an inguinal mass , we need to take into consideration several differential diagnoses ranging from benign to malignant lesions .
malignant tumors , including primary tumors and metastases , are extremely rare [ 68 ] .
painless scrotal or lower inguinal mass was the most common clinical presentation in the metastatic spermatic cord tumors .
the metastatic spermatic cord tumors could be misdiagnosed as hydrocele , hernia , and testis tumor . when a tumor is found in the inguinal area in patients with a history of malignancy or peritoneal carcinomatosis ,
retrograde extension through the vas deference and transperitoneal seeding had been reported .    in this case
a metastatic tumor originating from hcc was confirmed after excision biopsy . according to the national comprehensive cancer network clinical practice guideline for metastatic hcc , only sorafenib ( for child - pugh class a or b ) , supportive care , or clinical trials
because of persistent pain in the inguinal area and progressive enlargement of the tumor , a radical orchiectomy was performed .     
what kind of treatment is suitable for tumor emboli in the surgical margin of the spermatic cord ? according to previous reports , palliative radiation therapy has been used to treat hcc with brain and bone metastasis with successful symptom control .
hawkins and dawson showed that radiation therapy can prolong survival for hcc patients with portal vein thrombus . because of the lack of a standard treatment for metastatic lesions of hcc , we used radiation therapy for local control , and no recurrence was found after 6 months .   in conclusion , we report the first case of metastatic hcc in the spermatic cord , which presented as a painful inguinal mass .
palliative radiation therapy is a choice for the treatment of metastatic hcc with tumor emboli in the surgical margin .
 most spermatic cord masses are benign , and malignant spermatic cord tumors are uncommon . 
 spermatic cord metastases originating from hepatocellular carcinoma ( hcc ) have not been previously reported in the english language literature as determined by a pubmed search . 
 we report a male patient who presented with a painful palpable mass in the right inguinal area . 
 the patient was diagnosed with hcc in 2004 and undertook a nonsurgical approach to control the cancer . 
 a radical orchiectomy was performed , and the pathological report showed metastatic hcc in the spermatic cord . 
 the patient received palliative radiation therapy because of a positive surgical margin . 
 no recurrence was noted after 6 months of followup . 
1. Introduction
2. Case Report
3. Discussion