Open Access

RESIDENT’S CORNER

Hydrocele: an atypical presentation of metastatic sarcomatoid renal cell carcinoma

Marc R. Walker, Alexander J. Ernest Jr, Leah P. McMann

Department of Surgery, Urology Service, Tripler Army Medical Center, Honolulu, Hawaii, USA
Address correspondence to Dr. Marc R. Walker, Department of Surgery, Urology Service, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu HI 96859-5000 USA

Canadian Journal of Urology 2011, 18(3), 5742-5744.

Abstract

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 fi ndings 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.

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