title: Hydrocele: an atypical presentation of metastatic sarcomatoid renal cell carcinoma.
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 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.
authors.affiliation: Department of Surgery, Urology Service, Tripler Army Medical Center, Honolulu, Hawaii, USA.
authors.forename: Marc R
authors.initials: MR
authors.lastname: Walker
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Ernest
authors.forename: Leah P
authors.initials: LP
authors.lastname: McMann
mesh_terms: D002292:Carcinoma, Renal Cell / Q000175:diagnosis* / Q000556:secondary* / Q000628:therapy; D003131:Combined Modality Therapy; D004358:Drug Therapy; D017809:Fatal Outcome; D005834:Genital Neoplasms, Male / Q000175:diagnosis* / Q000556:secondary* / Q000628:therapy; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D006848:Testicular Hydrocele / Q000175:diagnosis* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D013521:Urologic Surgical Procedures, Male