Massive renal urothelial carcinoma with renal vein tumor thrombus, pancreatic infiltration and adrenal metastasis: A case report

Abstract

Abstract.A 49-year-old female patient presented with a massive left renal tumor, recurrent left flank pain and gross hematuria. The tumor was accompanied by a renal vein tumor thrombus, pancreatic infiltration and a solitary adrenal metastasis. Radical nephrectomy, distal pancreatectomy, ipsilateral adrenalectomy and splenectomy were performed. Histopathological examination suggested high-grade urothelial carcinoma (UC); however, tumor recurrence and multiple metastases were detected only 3 months after the surgery, and the patient succumbed during follow-up 1 month later. To the best of our knowledge, this is the first case of renal UC of such advanced stage with renal vein tumor thrombus, pancreatic infiltration and a solitary adrenal metastasis.

Sarcomatoid variant of urothelial carcinoma of renal pelvis with direct invasion of the pancreas and descending colon

“…Several reports indicate incidental postoperative detection of SVUC. 3,6 Differential diagnosis of SVUC of the renal pelvis is difficult as imaging findings are similar to those of renal sarcomas and renal cell carcinomas. Furthermore, only a few cases of SVUC of the renal pelvis have been reported.…”

“…Cases in which the preoperative diagnosis was mistaken for renal cell carcinoma have been reported. 6,8 Apparently, SVUC tends to infiltrate leading to a suspected diagnosis of RCC. Consistent with previous reports, 2,8,9 preoperative diagnosis was challenging in our case.…”

“…Early diagnosis is rare because clinical symptoms, such as gross hematuria or back pain develop late during the disease course. Several reports indicate incidental postoperative detection of SVUC 3,6 . Differential diagnosis of SVUC of the renal pelvis is difficult as imaging findings are similar to those of renal sarcomas and renal cell carcinomas.…”

“…The diagnosis becomes increasingly complex in cases with local infiltration. Cases in which the preoperative diagnosis was mistaken for renal cell carcinoma have been reported 6,8 . Apparently, SVUC tends to infiltrate leading to a suspected diagnosis of RCC.…”