Mildly enhancing lobulated right renal parenchymal lesion with extension into the pelvicalyceal system, highly suggestive of a malignant process like renal cell carcinoma (RCC). However, due to the extension of the lesion into the pelvicalyceal system, a possible differential diagnosis of transitional cell carcinoma (TCC) was also raised. This preoperative distinction between the RCC and TCC was of paramount importance for the urologist due to a striking difference in the surgical management of these entities, i.e. RCC is usually managed with the partial or radical nephrectomy whereas the renal TCC is managed with nephroureterectomy.

The patient underwent cystoureterorenoscopy for biopsy of the renal lesion and after confirmation of a diagnosis of the papillary RCC, he later on underwent a radical nephrectomy.