A surgical case of high-grade urothelial carcinoma of the renal pelvis complicated with giant hydronephrosis, giving rise to diagnostic difficulties on a cytological examination

Abstract

Background We report a surgical case of urothelial carcinoma of the renal pelvis, resulting in diagnostic difficulties on cytological examination. Case presentation A man in his late 70s underwent nephrectomy for giant hydronephrosis and renal cysts after nephrostomy and renal cyst puncture and drainage. On all cytological examinations performed before surgery, including nephrostomy urine, renal cyst fluid, catheterized bladder urine, and bladder washings, we were unable to make any conclusive diagnosis of malignancy. The pathological diagnosis of the surgical specimen concluded that this was a case of high-grade urothelial carcinoma of the renal pelvis with focal squamous differentiation (pT4). Liver and lung metastases were identified 3 months after surgery, and the patient died 2 months later. Conclusion It was very difficult to make a conclusive diagnosis using cytological specimens because of the presence of a small number of atypical cells with severe degenerative changes. Since clinicians cannot predict the potential for malignancy on preoperative imaging findings, it is critical to consider the difficulties in clinically making a correct diagnosis of urothelial carcinoma of the upper urinary tract, especially in cases complicated with giant hydronephrosis.

Giant right hydronephrosis with underlying double malignancy: a case report

“…Giant hydronephrosis can lead to gradual progression and comorbidities such as hypertension, rupture of affected kidneys, renal impairment, and malignant transformation in some cases [ 2 ]. Giant hydronephrosis with concurrent malignancy is less common clinically and is easily misdiagnosed [ 3 , 4 ]. Here, we report a case of a giant hydronephrosis of the right kidney with incidentally detected pleomorphic rhabdomyosarcoma on histopathology of the renal specimen and ureteral low-grade papillary urothelial carcinoma.…”