Abstract
1) A patient with renal cell carcinoma who visited our hospital due to varicocele alone is reported.
This 38-year-old man came to hospital with a chief complaint of indolent swelling in the left scrotum. Neither triad of symptoms (hematuria, pain and tumor) nor systemic symptoms were recognized. No abnormalities were found except the irregular values of total bilirubin (1.1mg/dl), GOT (38 units/ml) and GPT (63 units/ml). His illness was diagnosed as the renal cell carcinoma of the left kidney by excretory pyelography, nephrotomography and renal angiography, and so the nephrectomy was carried out.
The involvement of the tumor into the renal vein was not observed. The varicocele proved to have appeared, because the tumor which had generated in the lower pole of the kidney compressed the internal spermatic vein. After the nephrectomy, the varicocele disappeared.
2) Of 79 cases with renal cell carcinoma encountered for 22 years and 3 months from January 1953 to March 1975, 7 cases (8.9%) had varicocele. Of the 7 cases, 5 cases who had the left renal cell carcinoma developed varicocele in the left side and the remaining 2 cases who had the right renal cell carcinoma developed varicocele in the right side. The mechanisms of occurrence of varicocele were discussed from the findings in operations and from renal venograms, and it was proved that these renal cell carcinomas had been caused by the tumor thrombus of the renal vein in 2 cases and had been caused by the pressure of the tumor on the internal spermatic vein in 5 cases.
3) From the fact that 6 of the 7 cases were complicated by the hepatic dysfunction, it was considered that there is a common factor between the occurrence mechanisms of varicocele and that of the hepatic dysfunction.
4) In older man, when varicocele suddenly developed, when the varicocele doesn't disappear even at a supine position or when the varicocele appears in the right side, the varicocele may have the relation with renal cell carcinoma. These findings are considered to be very useful for diagnosis of renal cell carcinoma.
