Invasive urothelial carcinoma

Case contributed by Dr Michael P Hartung

Presentation

Hematuria.

Patient Data

Age: 60 years
Gender: Male

Enhancing soft tissue filling the left renal pelvis and proximal ureter. Infiltrative strandy soft tissue about the renal pelvis, proximal ureter, and vascular pedicle resulting in vascular narrowing. Dilated calyces, worse in the upper pole.

Case Discussion

This case highlights an unusual appearance of a more invasive and infiltrative urothelial carcinoma involving the renal pelvis, resulting in obstruction of the upper pole calyces. The final pathology confirmed “invasive high-grade urothelial carcinoma with positive arterial margin involving the adventitia”. It is important to take the clinical picture into consideration here - the urine was not infected and there is no fever. Additionally, the infiltrative nature in the renal pelvis is unexpected and when you look carefully, it is enhancing and narrowing the vasculature, indicating a neoplastic or infiltrative process rather than infection. 

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