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Practice Interactive case report

70 year old man with scrotal swelling, abdominal aortic aneurysm, and renal lesions: case report

BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7546.899 (Published 13 April 2006) Cite this as: BMJ 2006;332:899

Re: neoplastic disease needs to be excluded.

Since Renal cell Carcinoma is most common in the age group 50-70,also
the clinical picture strongly suggests of a somewhat sinister origin,so
the exclusion of a Carcinoma should be the foremost obligation.The
probability of Polycystic kidney can also be considered,however a detailed
history supportive of this is first essential.The left renal cyst
certainly points to malignant lesion.The most important consideration is
are these lesions primary or secondary?A detailed series of tests and
imaging is required before we can jump to any conclusion.

The presence of a varicocoele,is again a strong indicator of
compression on the renal vein by an outgrowth originating near it.It is a
common sign seen in men presenting with renal cell carcinoma.The hyrocoele
on left side could again be a result of metastasis.

The abdominal aortic aneurysm also needs to be investigated,and
symptoms should be queried in detail if they are hampering the daily
routine.

Since these tumours are mostly hormone producing so relevant symptoms
should be taken into account.

The following investigations should be carried out as soon as
possible.

1.Complete Blood Count.

2.Urine tests.

3.Serum Calcium.

4.Serum Glutamate Pyruvate Transaminase and Alkaline Phosphate levels.

5.Urine Cytology.

6.Liver Function tests.

7.U-S Scan of the Abdomen.

8.IVP.

9.Renal Arterigraphy.

10.Tumour Markers like Alpha Feto protein,Carcinoembryonic antigen-
125,Prostate Specific antigen,should all be measured.

11.Bone scan.

12.Chest x-ray for metastasis.

In case the diagnosis is still unclear should proceed with
biopsy.However,uneccessary invasive procedures may cause undue discomfort
for the patient.

References

1.Das et al.70 year old man with scrotal swelling,abdominal aortic
aneurysm,and renal lesions:case report.BMJ.2006;332:899

2.Macloed,J.(Ed.)Davidson's Principals and Practise of
Medicine,14:407

Competing interests:
None declared

Competing interests: No competing interests

21 April 2006
Noor-ul-Ain Mughal
Doctor(Summariser)
Parkside Medical Centre,Bletchley,MiltonKeynes MK3 6EN