Presentation
Painless hematuria.
Patient Data
Enhancing right renal pelvis mass extending to the right upper pole calyces. Results in a filling defect on the excretory phase images. No lymphadenopathy.
Histopathology
MACROSCOPIC DESCRIPTION: The specimen comprises kidney 90x45x40 mm, the renal cortex is 7mm thick and the renal medulla is 20mm thick. Ureter is 230x5 mm. Perirenal fat is 40mm wide occupying the lower pole aspect. Within the upper pole of the kidney and occupying the renal pelvis is a soft cream colored friable tumor measuring 45x30x25 mm. No macroscopic involvement of renal sinuses or renal veins. The capsule is intact and the tumor is 7mm from the capsule. No adrenal tissue is identified. The tumor appears to arise from the renal pelvis. The remaining renal parenchyma is unremarkable.
MICROSCOPIC DESCRIPTION: The sections of renal pelvis show a non-invasive papillary urothelial carcinoma, high grade. The tumor is consisting of delicate fibrovascular cores covered by thickened atypical urothelium. The atypical cells has high N:C ratio, round to oval hyperchromatic nuclei, prominent nucleoli, scant eosinophilic cytoplasm and frequent mitoses. The tumor is expanding the renal pelvis and pushing the surrounding renal parenchyma, but there is no invasion. No lymphovascular or perineural invasion is seen. The ureter and vascular margins are clear of tumor. The remaining renal parenchyma show mild non-specific chronic inflammation.
DIAGNOSIS: Non-invasive papillary urothelial carcinoma, high grade.
Case Discussion
Urothelial / transitional cell carcinomas uncommonly occur in the renal pelvis, with the bladder being the most common site. Metachronous bladder urothelial carcinomas are common, occurring in up to 40% of patients.