Case Study: Incidental low grade invasive transitional cell carcinoma of minor calyx in a hydronephrotic kidney with renal stones

Summary

Incidental carcinoma of the renal pelvis is a rather common radiological finding with hydronephrotic kidneys or kidneys with renal stones; but it is extremely rare to detect carcinoma of the renal pelvis in such cases. I have recently reported one such case. So clinicians, radiologists, and pathologists should be aware of the fact that incidental carcinoma in a hydronephrotic kidney not only involves the renal pelvis but also the calyxes, and they should take measures accordingly!

Background

The majority of the hydronephrotic kidneys are examined for tumors around the pelvis and the ureters, and meticulous examination of whole pelvi-calyceal system is not done; thus we might have missed possible tumors. Here we shall discuss the diagnostic possibility of infiltrative urothelial carcinoma when a large, nonfunctioning, hydronephrotic kidney is present.

Case Presentation

A 43-year-old female patient presented with recurrent urinary tract infections, hematuria, edema and renal colic. Imaging (ultrasonography and CT-scan) detected the hydronephrosis (sac-like dilatation) of the left kidney. Surgical removal of the non-functioning kidney was performed. Gross finding was a sac-like dilated kidney with 4 small (2-3 mm) blackish stones in the minor calyceal system and a grayish-white exophytic growth measuring 3 x 2 x 2 cm. Histopathological examination confirmed the infiltrative low grade urothelial cancer. The patient recovered fully 15 days after the operation without any complications.

Investigations

• Urine chemical and microscopic examination
• Urine microbiology
• USG and CT-scan
• Blood test for urea and creatinine
• Serology and pre-anesthetic check-up

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