Acute scrotal pain and priapism: an early sign of progression in metastatic renal cell carcinoma?

Abstract

A 43 -year-old man was treated with pazopanib for metastatic renal cell carcinoma (RCC) with imaging studies suggesting a partial response to treatment. However, the patient presented numerous times with severe testicular pain and gradually increasing priapism. He underwent an inguinal orchidectomy for symptom control. Histopathology confirmed invasion of the cord and tunica vaginalis with metastatic RCC. Further CT of the abdomen and pelvis suggested non-progression of the disease. The patient continued to develop priapism for several weeks before imaging studies confirmed disease progression; a month later the patient died. Genital involvement in metastatic RCC is unusual but should alert clinicians to the possibility of disease progression.

Figure 1

Coronal reconstruction of CT: low attenuation lesions in the liver (black arrows), known to be metastatic renal cell carcinoma.

Figure 2

Axial CT showing right-sided renal tumour (black arrow).

Figure 3

T2-weighted axial MRI demonstrating reduced signal throughout the corpora, consistent with tumour infiltration (white arrows). Under normal conditions, the corpora return a high signal on T2-weighted MRI.

Figure 4

Axial CT through liver demonstrating increase in the size of the liver metastases (black arrows) due to disease progression.