Upper tract urothelial carcinoma

Case contributed by Dr Andrew Ryan

Presentation

Extended history of haematuria with non-diagnostic urine/ureteric cytology and pyeloscopic biopsies. Most recent pyeloscopic biopsies showed atypical squamous epithelium. Persistent suspicious radiology prompted surgical treatment.

Patient Data

Age: 50
Gender: Male

Left kidney - Ultrasound

Modality: Ultrasound

Upper left kidney partly exophytic solid-appearing heterogeneous isoechoic mass demonstrating no cystic component or internal Doppler flow.  

Kidneys - contrast enhanced CT

Modality: CT

Ill-defined partly exophytic solid-appearing heterogeneous left upper renal mass demonstrating heterogeneous predominately peripheral irregular post contrast enhancement, no associated calcification.  The mass is less than 4cm diameter, no perinephric or Gerota's fascia extension, multiple small left para-aortic lymph nodes, no evidence of abdominal spread of disease.    

Left kidney - Pathology

Modality: Pathology

Macroscopic and microscopic findings of the left upper to middle pole renal mass.

Case Discussion

This lesion is a poorly differentiated urothelial carcinoma with extensive squamous differentiation.

Squamous differentiation is commonly seen in urothelial carcinoma, but rarely to the extent seen in this lesion (approximately 90% of the tumour showed squamous morphology). A thorough search for conventional urothelial carcinoma is required in these cases as primary squamous cell carcinoma of the kidney/urinary tract should only be diagnosed in the setting of a pure squamous lesion (1) 

Many thanks to Dr Vaughan Beckley for contributing the ultasound and CT component of the case

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Case Information

rID: 39704
Case created: 16th Sep 2015
Last edited: 15th Sep 2016
System: Urogenital
Inclusion in quiz mode: Included

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