BACKGROUND
A 74-year-old man presents to the hospital with on-and-off abdominal pain for the past month. The man has a history of kidney stones, hypertension, and 2 strokes. He states that the pain is not related to food intake, movement, or exertion. He denies any weight loss, difficulty swallowing, diarrhea, hematochezia, or hematuria.
Two weeks ago, urinalysis showed mild urinary tract infection (UTI). The patient was treated with a 1-week course of antibiotics. Urine cytologic findings were negative.
Physical examination reveals no hepatosplenomegaly and no palpable mass. He has mild anemia, his serum creatinine is 1.4 mg/dL, his lactate dehydrogenase (LDH) level is 295 IU, and serum protein and immunofixation electrophoresis reveals a mild spike (0.43) in the alpha-1 region. CT and biopsy are performed.
What is the diagnosis?
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Hint
This is an unusual cause of a kidney mass.
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Author:
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Winston W. Tan, MD, FACP, Assistant Professor, Department of Hematology Oncology, Mayo Clinic Jacksonville, and David Pinkstaff, MD, Staff Physician, Department of Urology; Michael Wehle, MD, Consulting Staff, Department of Urology, Mayo Clinic Jacksonville
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eMedicine Editor:
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Sat Sharma, MD
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Associate Professor, University of Manitoba, Department of Medicine, Division of Pulmonary Medicine
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eMedicine Case
