British Journal of Urology (1998), 82, 922

CASE RE PORT

Metachronous metastasis from testicular cancermasquerading as a renal calculusR. SHARMA, M.S. SEKHON and P. LALDepartment of Surgery, Government Medical College and Hospital, Chandigarh, India

Case report

A 32-year-old man underwent left orchidectomy in aperipheral centre for seminoma of the left testis. Thepatient was subsequently lost to follow-up and remainedasymptomatic. He presented one year later with pain inthe left lumbar region and haematuria of 2 months’duration. The patient was investigated for left renalstone; urine examination showed red blood cells, but aplain abdominal and chest X-ray were normal.Ultrasonography showed a hyperechoic shadow in therenal pelvis with mild hydronephrosis. Intravenous urog-raphy showed a circular space-occupying lesion(2×2 cm) in the left renal pelvis and the patient wasprepared for left pyelolithotomy. At surgery, there wasa bright red papillary lesion in the left renal pelvis justabove the PUJ, occupying most of the pelvis andencroaching into the middle and lower major calyces(Fig. 1). There was no evidence of infiltration outside thepelvis or into the renal pedicle. A radical nephroureterec-tomy was carried out with a per-operative diagnosis ofmalignancy. The histopathology revealed the pelvic massto be metastatic seminoma. The patient made an

Fig. 1. Section of the kidney showing the vascular papillary tumouruneventful recovery and was administered cisplatin-(arrow) occupying the renal pelvis and extending into the calyces.based combination chemotherapy. He is asymptomatic

after 2 years of follow-up.References

1 Bredael JJ, Vugrin D, Whitmore WF. Autopsy findings inComment 154 patients with germ cell tumours of the testes. Cancer

1982; 50: 548–51Testicular cancer is known to metastasize to kidney and2 Kramer ZB, Smith BD. Symptomatic renal metastasis from

is frequently seen at autopsy in patients succumbing totesticular cancer. Cancer 1993; 71: 3879–80

disseminated disease [1]. These secondaries are generally 3 Conrad MR, Ballard J, Epstein R. Renal metastasis fromasymptomatic; symptomatic secondaries may present treated seminoma. J Can Assoc Radiol 1978; 27: 197–8along with the primary tumour (synchronous) [2] ormay present at any time subsequently (metachronous)

Authors[3]. The management strategy for such secondaries isR. Sharma, MS, Registrar.not well defined; the present patients was managedM.S. Sekhon, MS, Professor and Head.successfully by nephroureterectomy and chemotherapy.P. Lal, MS, FRCS(Edin), FRCS(Glasg), Senior Lecturer.Correspondence: Professor M.S. Sekhan, 1115, Sector 32B,Chandigarh 160047, India.

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