Retroperitoneal sarcoma presenting as a right-sided varicocele

Case contributed by Dr David Pryde

Presentation

Patient presented with 'lumpy' right testis for investigation.

Patient Data

Age: 69
Gender: Male

Scrotal ultrasound demonstrate a large right sided varicocele. Both testes were normal (not shown).

On scanning of the kidneys, a large mass with internal vascularity was found, in close contact with the right kidney. 

There is a large vascular mass related to the right kidney with a large tortuous draining vein, thought to be the renal capsular vein, passing infero-medial to the kidney and communicating with the gonadal vein causing reflux of the vein down to the scrotum as well as passing, as usual, up to the IVC.

 

A right radical nephrectomy was performed.

Pathology:

Attached to mid-portion of kidney there was a mass which did not infiltrate the renal parenchyma.

Histology showed a pleomorphic spindle cell sarcoma with smooth muscle differentiation.

Case Discussion

In this case, an ultrasound finding of a large right sided varicocele prompted further scanning of the abdomen, and this demonstrated a large retroperitoneal vascular tumour, later proven to be a sarcoma.  

Related to this was a large varicose draining vein passing to gonadal vein and rendering it incompetent - hence the varicocele.

Most right varicoceles are caused by a left sided varicocele with cross flow to the right side.

Left sided varicoceles are mostly caused by an incompetent gonadal vein, however, when seen for the first time on ultrasound the left kidney and left renal vein (into which the gonadal vein drains) are normally examined. Pathologies include renal masses, renal vein thrombosis and nutcracker syndrome.

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Case information

rID: 49173
Case created: 14th Nov 2016
Last edited: 5th Jun 2017
System: Urogenital
Inclusion in quiz mode: Included

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