A 49 yr old male with a 35-pack-year history of smoking presents with a painless left scrotal mass. Examination revealed microscopic hematuria, absence of AFP and LDH. The most probable cause of the scrotal mass is:

Ans is 'b' i.e. Renal cell ca History of smoking suggests either Ca lung or Renal cell ca. Microscopic hematuria ors RCC. The painless left scrotal mass can be metastasis from RCC to the scrotum (which is rare but several cases have been repoed) or the mass could be varicocele. A secondary varicocele can be caused by compression of the testicular vein by the renal mass (infact RCC is the most common cause of secondary varicocele). Ca lung has no relationship with microscopic hematuria or a scrotal mass (though in extremely rare circumstances may (t) metastasize to scrotum). Seminoma and epididymitis have no relationship to smoking or microscopic hematuria. .