Renal Cancer

A 42-year-old woman came to the emergency department because of hematuria for 1 day, a low-grade fever, and weight loss over the past 2 months. She denied having any abdominal pain or urinary problems. Pallor was the only noteworthy physical finding.

A 68-year-old man presented with a sudden-onset, 2.5 × 2-cm, rock-hard, erythematous, nontender nodule on the right side of the chest. A dense mat of telangiectases surrounded the solitary lesion. The remainder of the cutaneous examination was unremarkable.

A 45-year-old man complained of blood in his urine. The patient had a 7-year history of chronic renal failure secondary to hypertension; he had undergone hemodialysis for the past 5 years.

Vague abdominal pain, malaise, anorexia,and the loss of 10 lb in 2months prompted a 65-year-old manto seek medical evaluation. A yearearlier he had undergone surgery forstage III carcinoma of the sigmoidcolon. Because metastases to thelymph nodes were found in the resectedcolon, the patient was given postoperativechemotherapy. Histologicexamination revealed poorly differentiatedadenocarcinoma.

An 85-year-old man was admitted to the hospital with acough and shortness of breath of 1 week’s duration anda fever and increased sputum production for 2 days. Hishistory included renal cell carcinoma and metastatic renalcancer for 2 years. The patient had smoked cigarettesfor 30 years. He had lost 30 lb during the last few months.A chest film revealed pneumonia of the right lowerlobe. Metastatic nodules were noted on the scalp; extensivelung, bone, and brain metastases also were found.

A 40-year-old man was concerned about an enlarging painlessmass on the right side of his neck that had been presentfor 6 months (A). The patient reported no other healthproblems; his medical history was unremarkable, and hewas taking no medications.There was no family or personal history of thyroiddisease or of exposure to radiation. Thyroid function testresults were within normal limits. A chest film revealed nopathology.

A 43-year-old woman was admitted to the hospital withleft flank pain. The physical examination revealed a left abdominalmass. Laboratory test results identified normochromic-normocytic anemia (hematocrit, 33%; hemoglobin,10.8 g/dL; and mean corpuscular volume, 88 fL) andmicroscopic hematuria (10 red blood cells per high-powerfield).