Hydrocele: an atypical presentation of metastatic sarcomatoid renal cell carcinoma

• Published in: Canadian journal of urology Vol. 18; no. 3; p. 5742
• Main Authors: Walker, Marc R, Ernest, Jr, Alexander J, McMann, Leah P
• Format: Journal Article
• Language: English
• Published: Canada 01-06-2011
• Subjects: Carcinoma, Renal Cell - diagnosis; Carcinoma, Renal Cell - secondary; Carcinoma, Renal Cell - therapy; Combined Modality Therapy; Drug Therapy; Fatal Outcome; Genital Neoplasms, Male - diagnosis; Genital Neoplasms, Male - secondary; Genital Neoplasms, Male - therapy; Humans; Kidney Neoplasms - pathology; Male; Middle Aged; Testicular Hydrocele - diagnosis; Testicular Hydrocele - surgery; Tomography, X-Ray Computed; Urologic Surgical Procedures, Male
• ISSN: 1195-9479

Herein is a case of a 55-year-old man who presented with epididymitis. He subsequently failed medical management for the suspected infection and progressed to develop an acute scrotum and sonographic findings consistent with a pyocele. Concurrent computed tomography (CT), obtained for persistent abdominal pain, revealed a large enhancing upper pole renal mass suspicious for malignancy. He was taken for emergent scrotal exploration to drain the presumptive pyocele. However, during scrotal exploration, no purulence or evidence of infection was seen. Although, seemingly unrelated to the renal mass, the thickened hydrocele sac was excised and sent as a specimen. Pathology of the sac revealed a diagnosis of metastatic sarcomatoid renal cell carcinoma. Appropriate chemotherapy was initiated based on the scrotal pathology, circumventing the need for a CT directed retroperitoneal lymph node biopsy or nephrectomy.