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Presented by Peter Illei, M.D. and prepared by Joseph J. Maleszewski, M.D.
Case 6: 43-year-old retired housewife who reports approximately 5-month history of right flank, right CVA pain.
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1. Question
Week 368: Case 6
43-year-old retired housewife who reports approximately 5- month history of right flank, right CVA pain. This pain is now shifted and she now has intermittent periods of radiation down her back with accompanying numbness. She recently noted gross hematuria in 03/08 that and was given antibiotics for urinary tract infection. The hematuria resolved; however, the pain persisted. This prompted evaluation with the CT scan that demonstrated a kidney mass with involvement of the inferior vena cava.images/jjm101308/case6a.jpg
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images/jjm101308/case6e.jpgCorrect
Answer: High grade urothelial carcinoma
Histology: Sections show a high grade urothelial carcinoma that infiltrates the renal parenchyma, involves the ureter and renal pelvis, and infiltrates through
the parenchyma into perinephric and renal sinus fat. Tumor is present in the lumen of the renal vein margin (tumor is seen surrounded by organized thrombus that fills the lumen but not in the wall of the vein margin). Sections of the renal pelvis show foci of high grade papillary urothelial carcinoma and areas suspicious for carcinoma in situ.Discussion: High grade urothelial carcinoma of the renal pelvis is an aggressive neoplasm with poor prognosis. Appropriate T-staging of upper urinary tract tumors is usually performed after radical surgery; however, endoscopic tumor resection with imaging studies is sometimes performed for low grade tumors. Simultaneous bladder cancer also needs to be excluded.
Incorrect
Answer: High grade urothelial carcinoma
Histology: Sections show a high grade urothelial carcinoma that infiltrates the renal parenchyma, involves the ureter and renal pelvis, and infiltrates through
the parenchyma into perinephric and renal sinus fat. Tumor is present in the lumen of the renal vein margin (tumor is seen surrounded by organized thrombus that fills the lumen but not in the wall of the vein margin). Sections of the renal pelvis show foci of high grade papillary urothelial carcinoma and areas suspicious for carcinoma in situ.Discussion: High grade urothelial carcinoma of the renal pelvis is an aggressive neoplasm with poor prognosis. Appropriate T-staging of upper urinary tract tumors is usually performed after radical surgery; however, endoscopic tumor resection with imaging studies is sometimes performed for low grade tumors. Simultaneous bladder cancer also needs to be excluded.
