ACUTE VARICOCELE REVEALING RENAL CANCER

Issue Applied in Ecuador

Varicoceles most commonly present as unilateral dilatation of the pampiniform plexus of veins above the left testis.

Left-sided varicoceles are present in approximately 10% to 20% of men and are believed to be secondary to the venous anatomy of the left testis.

Right-sided varicoceles usually occur as bilateral processes and are apparent in 10% of clinical cases and in as many as 50% of subclinical cases

Diagnosis

The left-sided varicoceles secondary to the venous anatomy of the left testis are very common. Enlargement of the left testicle can be associated with blockage of the left testicular vein by tumoral invasion of the left renal vein and should be evaluated for the presence of retroperitoneal malignancy as well.

The most common retroperitoneal malignancy causing this presentation is right-sided renal cells carcinoma.

Scrotal ultrasound is the initial diagnostic test of choice, it mays help to distinguish intrinsic from extrinsic testicular lesions

Pros

• Its association with renal cancer is so frequent that such a development should be regarded as sufficient cause for pyelography or other appropriate studies.
• This acute varicocele, similar to the benign varicocele which usually appears in youth, is almost always on the left side. Possibly because of its acute development, it is more often symptomatic than is benign varicocele.
• The mechanism for this might be combined tubular and vascular obstruction by the tumour resulting in impaired drainage of urine and devitalization of tissue in an area of kidney adjacent to the tumour.

Conclussion

Acute kidney injury can occur as a result of a mass effect or as a result of thrombosis of renal vessels. But, the cause of varicocele is usually the obtruccion of the inferior vena caval and is characterized by an acute onset , it is presented in the right testicle usually

Physicians should perform a complete abdominal examination in every patient with varicocele or testicular pain, because the large tumors can cause abdominal pain as a late manifestation.

Catholic University

Medical English

Acute Varicocele Revealing Renal Cancer

Presented by: Luissana Intriago

IV Ciclo C.

Lcdo. John Moscoso BA

Tw: @LuIntriagoL

Fb: Luissana Intriago Lino

Email: lu_intriago10@hotmail.com

Cons

• Tumours causing varicocele tend to be large. Other retroperitoneal tumours and a variety of non-neoplastic conditions may be responsible for the development of varicocele later in life.
• Tumours causing varicocele tend to be large.
• The most important mode of spread is by invasión of the renal venous system, that occur quite regularly when the tumour reaches a certain size.
• The thrombosis may extend for a varying distance along the renal vein and sometimes propagates to the vena cava. Occasionally caval occlusion occurs, with edema of the legs and evidence of collateral venous circulation.

Definition

A varicocele is a dilatation of the pampiniform plexus of the spermatic cord; this network of veins is dependent on the spermatic vein. Varicocele occurs more commonly on the left side because the spermatic vein opens at a sharp angle into the left renal vein, where as the right spermatic vein opens into the larger inferior vena cava.

An acute nontraumatic varicocele, especially on the left side, may indicate the presence of a retroperitoneal mass.

Applications in Medicine

• A 65-year-old man with no notable medical history presented to the urology clinic with swelling in the area of the left testicle that had started 4 weeks earlier. Examination of the scrotum revealed an enlarged varicose vein along the left spermatic cord and abdominal palpation revealed a mass in the right flank.
• Computed tomography of the abdomen and pelvis revealed multiple bilateral renal tumors with the largest tumor located in the left kidney.
• Open radical nephrectomy of the left kidney was performed, and the results confirmed the diagnosis of renal-cell carcinoma. One week later, the varicocele disappeared.

ACUTE VARICOCELE REVEALING RENAL CANCER