A 66-year-old male presents with a history of loin pain
and passage of blood in his urine. He says he has been feeling unwell for some
time with weight loss, fever and night sweats.
On examination apart from an elevated blood pressure you
cannot find any clinical signs.
Investigations reveal an elevated ESR and hypercalcaemia.
In this patient what is the most likely diagnosis:
Renal cell carcinoma
Renal cell carcinoma commonly presents with loin pain,
haematuria and a palpable mass in the abdomen.
Systemic symptoms are common with weight loss, fever, hypertension,
hypercalcaemia, night sweats and malaise
Varicocele, usually left sided, may occur due to obstruction of the
Renal cell carcinoma is frequently associated with
paraneoplastic syndromes, including hypercalcaemia, erythrocytosis, hepatic
dysfunction (Stauffer syndrome). Polyneuromyopathy, amyloidosis, anaemia,
fever, cachexia, weight loss, dermatomyositis, increased erythrocyte
sedimentation rate, and hypertension may also occur
Cytokine release by the tumour (IL-6, erythropoietin,
nitric oxide) is the mechanism by which these paraneoplastic effects occur
Successful treatment of the primary metastatases may
result in resolution of symptoms or biochemical abnormalities