A 49 years old male with 35 pack years presented with painless mass in left scrotal sac and microscopic hematuria. On laboratory investigation, Alphafetoprotein and lactate dehydrogenase was negative. What is the most probable diagnosis?
Epididymitis
Seminoma
Renal cell carcinoma
Carcinoma lung
Answer- C (Renal cell carcinoma)MC type of RCC, mainly sporadica.Spread:Characteristic feature of RCC is tendency to invade renal vein. Fuher extension produces a continuous cord of tumor in IVC and even in right side of hea.MC route is hematogenousMC sites of distant metastasis are lungs (cannon ball deposits and pulsating secondaries) Q> bone> liver> brain.Lymphatic spread occurs when tumor extends beyond renal capsule.Response to biological response modifiers (IL-2 and lFN-alpha)MC and consistent presentation is hematuriaClassical triad of gross hematuria, abdominal mass and pain is seen in 10% cases