Presentation
Per rectal bleeding. CT performed for staging of rectal tumor.
Patient Data
Filling defect of higher attenuation than urine in the right renal pelvis - this was an incidental finding. Distal rectal tumor and synchronous sigmoid tumor.
CT-IVU peformed for further assessment at a later point.
After a 5 day interval and appropriate other non-imaging investigations, the patient returned for a dedicated CT-IVU.
The right renal pelvis filling defect persists - better elucidated as now a clear filling defect in the contrast filled pelvis. It appears adherent to the urothelium.
Case Discussion
The CT was performed for staging of a endoscopically diagnosed rectal tumor. Two further tumors were identified:
- Synchronous sigmoid tumor
- Right renal pelvis TCC (this was confirmed on ureteroscopy and biopsy)
This case demonstrates the radiological error of "satisfaction of search" if the latter two pathologies were not discovered after finding the first tumor.
Histology
- Rectum: Infiltrating malignant tumor composed of complex glands lined by columnar cells with pleomorphic vesicular nuclei with prominent nucleoli and abundant cytoplasm. A moderately differentiated adenocarcinoma.
- Renal pelvis mass: malignant tumor composed of round to elongated cells arranged in diffuse sheets. Appearances are of a transitional cell carcinoma.
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