LEFT HYDROCELE DUE TO TESTICULAR METASTASIS AS FIRST CLINICAL EVIDENCE OF IPSILATERAL RENAL CANCER

Pubblicato da il Mar 18, 2013 in | Commenti disabilitati su LEFT HYDROCELE DUE TO TESTICULAR METASTASIS AS FIRST CLINICAL EVIDENCE OF IPSILATERAL RENAL CANCER

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CASO CLINICO.
A caucasian male, 48 y.o., due to left scrotal swelling with cutaneous reddening, underwent scrotal ultrasound (US) confirming inflammation; an antibiotic treatment was started with no real benefit. Then the patient was referred to us: both clinical and US features lead to the diagnosis of hydrocele with possible associated pachivaginalitis. The patient underwent an operation to correct the condition and a biopsy from the tunica vaginalis was taken revealing metastasis of “indeterminated urological origin”. Work up studies started with an abdominal US which revealed a huge left renal tumor, confirmed by a CT (with enlarged nodes). The patient was then treated with left nephrectomy + lymphnode dissection and orchidectomy. Pathology report revealed renal clear cell cancer (RCC), Furhman IV, pT3 N+, with no involvement of the testicle. Subsquently the patient was treated with a receptor tyrosine kinase inhibitor (Sunitinib). After a 12-month follow up period the patient is still alive, but suffering from hepatic an pulmonary metastases.
COMMENT.
Metastatic testicular involvement by tumors arising from the kidney is very rare. The pathologic diagnosis of renal cancer metastatic to the testis almost always reveals a clear cell tumor pathology [1]. To our knowledge only six cases of testicular metastases from RC have been reported within the last years; in one of them there was a contralateral chromophobe RCC metastatic to the testis, six years after nephrectomy. Our case is to be considered the seventh, with the primary discovered after the metastatic location of the tumor had provided clinical symptoms.
BIBLIOGRAPHY.
[1] Sountolides P et al., Journal of Medical Case Reports 2011, 5:429

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