Biomedicine

Abstract

Urothelial cancers of the renal pelvis and collecting system are rare malignancies that constitute less than 10% of all renal tumors. More than 90% of such malignancies are of transitional cell origin. Most patients present with hematuria, loin pain, or acute renal colic. While most of the presentations follow a specific clinical or radiological pattern, sometimes, atypical presentations do occur. The purpose of this manuscript is to highlight this fact it is imperative for the clinicians and the radiologists to be familiar with both the usual and the unusual radiologic presentations of these diseases. A 65-year-old male presented with dull aching left loin pain, storage urinary symptoms and hematuria. A radiological diagnosis of pelviureteric junction (PJU) calculus obstruction with gross hydronephrosis and multiple secondary calculi was made. Hematuria was attributed to either secondary infection of hydronephrotic kidney or anti-platelet effect or due to prostatomegaly. After initial transurethral resection of the prostate, he underwent per cutaneous nephrolithotomy for kidney stones. As the patient had persistent pus discharge from the nephrostomy site, he underwent nephrectomy. The biopsy report was suggestive of high-grade papillary urothelial carcinoma with squamous differentiation. A combination of urothelial malignancy with renal stones and gross hydronephrosis is a rare finding. The objective of this report is to reiterate the importance of bearing in mind such peculiar associations. The purpose of this manuscript is also to highlight the rarity of this condition and stress upon the need for a thorough knowledge of these unusual radiologic features of urothelial cancer of the renal pelvi-caliceal system will facilitate making the correct diagnosis and also in planning appropriate treatment strategies.