An obese 63-year-old man comes to the physician because of 3 episodes of red urine over the past week. He has also had recurrent headaches and intermittent blurry vision during the past month. He has benign prostatic hyperplasia. He works as an attendant at a gas station. The patient has smoked one pack of cigarettes daily for the last 40 years. He does not drink alcohol. Current medications include tamsulosin. His temperature is 37.4°C (99.4°F), pulse is 90/min, and blood pressure is 152/95 mm Hg. Examination shows a flushed face. Serum calcium is 12.3 mg/dL. Urinalysis shows 30-40 red blood cells/hpf, negative protein, and no casts. A CT scan of the abdomen is shown below. Which of the following is the most likely diagnosis?

Question

An obese 63-year-old man comes to the physician because of 3 episodes of red urine over the past week. He has also had recurrent headaches and intermittent blurry vision during the past month. He has benign prostatic hyperplasia. He works as an attendant at a gas station. The patient has smoked one pack of cigarettes daily for the last 40 years. He does not drink alcohol. Current medications include tamsulosin. His temperature is 37.4°C (99.4°F), pulse is 90/min, and blood pressure is 152/95 mm Hg. Examination shows a flushed face. Serum calcium is 12.3 mg/dL.  Urinalysis shows 30-40 red blood cells/hpf, negative protein, and no casts.  A CT scan of the abdomen is shown below.  Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

Eductional Objective: Classic signs and symptoms of renal cell carcinoma (RCC) include hematuria, an abdominal mass, flank pain, and weight loss.  Hypercalcemia and erythrocytosis are common paraneoplastic syndromes associated with RCC.

An Obese 63-Year-Old Man Comes to the Physician Because of 3