Urothelial Cancer of the Renal Pelvis in Percutaneous Nephrolithotomy Patients

Abstract

Introduction: The association between staghorn calculus of the kidney long-standing and urothelial tumors of the renal pelvis is well documented. We describe 3 patients with urothelial cancer in a kidney who underwent percutaneous nephrolithotomy (PCNL). Patients and Methods: Retrospective analysis of our series of more than 500 PCNLs revealed 3 patients in whom urothelial cancer of the renal pelvis was diagnosed during or following percutaneous stone removal. Preoperative assessment included IVP, renal sonography and renal scan using DTPA in all 3 patients, and CT in 2 patients. Imaging did not raise the suspicion of a neoplastic lesion. Results: All patients had a long history of urolithiasis and urinary infections. No patient was diagnosed preoperatively. One patient was diagnosed postoperatively, when a CT demonstrated a renal lesion. The second patient underwent simple nephrectomy due to a non-functioning kidney, and the tumor was found on pathological analysis. In the third patient, biopsies were taken from a suspicious-looking tissue in the renal pelvis during the PCNL session. All patients had transitional cell carcinoma: 1 associated with sarcomatoid features and 1 with squamous carcinoma. They all died from metastatic disease 2–19 months after the diagnosis of urothelial cancer. Conclusions: The preoperative diagnosis of urothelial cancer in patients with staghorn stones is difficult due to the existing stone and inflammation. Since the prognosis of urothelial cancer is extremely poor, biopsies of the renal pelvis, obtained directly through the nephroscope during the PCNL session, may be the only key for early diagnosis and treatment. A high index of suspicion should be raised when patients suffering from infected staghorn calculi are encountered, and such intraoperative biopsies should be considered.

Urothelial Carcinoma Concomitant With Malakoplakia In Non-Functioning Nephrolithic Kidneys

“…In addition, studies in the relevant literature report that malakoplakia, which is a chronic inflammatory disease of unknown etiology, may be accompanied by malignant tumors. [1][2][3] plasms can develop in longstanding non-functioning nephrolithic kidneys and clinical approach should be applied accordingly.…”

“…Kidneys in this condition fail to function properly and there is also a high risk of developing urothelial neoplasm. [1][2][3] We report on a case of concurrent urothelial carcinoma and malakoplakia in a non-functioning nephrolithic kidney.…”

Transitional cell carcinoma recurrence in the nephrostomy tract after percutaneous nephrolithotomy

“…Th e association of TCC, small cell carcinoma, adenocarcinoma and sarcomatoid carcinoma with renal stone disease has been documented in the literature [18][19][20] . Urothelial cancer of the renal pelvis in patients undergoing PCNL was studied previously.…”

Incidental Diagnosis of Transitional Cell Carcinoma during Percutaneous Nephrolithotomy

“…To the best of our knowledge, only one study related to the incidental diagnosis of urothelial malignancy during PCNL has been published -a study based on the records of 500 patients who underwent PCNL for renal stones [18] . In that study, 1 patient was diagnosed postoperatively after CT revealed a renal lesion, 1 patient underwent simple nephrectomy due to a non-functioning kidney and the tumor was found due to pathological analysis, and 1 patient had suspicious findings in the renal pelvis during PCNL and subsequent pathological examination of the renal pelvis biopsies revealed TCC with sarcomatoid features.…”