Transitional cell carcinoma obstructing a calyceal diverticulum: unusual presentation as a peripheral cystic mass.

Abstract

Transitional cell carcinoma, while being the most common tumor of the urinary tract overall, is a relatively uncommon tumor when the upper urinary tract is considered separately. In the kidney, adenocarcinoma occurs more often than transitional cell carcinoma by a ratio of 4:1 to 5:1. 1 When transitional cell carcinomas occur in the upper urinary tract, they are usually located in the proximal ureter or the renal pelvis. 2 The typical presentation of transitional cell carcinoma on excretory urograms and CT scans is a filling defect produced by a central, solid tumor that does not distort the renal outline. 1 We report a transitional cell carcinoma obstructing a calyceal diverticulum that appeared as a peripheral complex cystic mass projecting laterally and distorting the upper pole of the kidney. The possibility that a peripheral cystic upper urinary tract lesion might be a transitional cell carcinoma, rather than a renal adenocarcinoma, has important implications for both the clinician and surgeon. CASE REPORTA 67 year old white man had acute onset of left flank pain. He denied hematuria and other urinary symptoms. He reported some decrease in energy but was otherwise in good health. His past medical and surgical history was unremarkable. He had stopped smoking 30 years ago, after a prior smoking history of 22 pack years. On physical examination he was found to have a benign abdomen without costovertebral angle tenderness.Excretory urography was performed, which revealed a 9 cm mass projecting laterally from the upper third of the left kidney. The mass had a thick wall medially and inferiorly and was of low density centrally. The left collecting system was not well visualized. Ultrasonographic examination showed a fluid-filled mass containing amorphous, turbid debris (Fig. 1). Some central areas were hyperechoic and were thought to represent hemorrhage into the substance of the mass.By CT examination, the mass appeared to arise from the lateral aspect of the left kidney. It was cystic but had a 2 cm

Transitional cell carcinoma arising in a calyceal cyst mimicking a cystic renal tumour

“…9 Roberts and colleagues also performed nephroureterectomy of the rest of the ureter when TCC was identified in a frozen section tissue biopsy conducted during surgery. 10 In the present case, the patient's condition was diagnosed as cystic RCC, on the basis of pre-surgical CT scans. Since preoperative renal biopsy is not mandatory for tumours in the kidney, a renal biopsy was not performed.…”

The imaging appearances of calyceal diverticula complicated by uroliathasis

“…Other common presenting features include ipsilateral flank pain and haematuria [2][3][4][5]. Isolated reports exist of transitional cell carcinoma occurring within a calyceal diverticulum [6] and calyceal diverticular rupture [7]; however, such cases are rare. Auge et al [8] analysed a group of patients with symptomatic calyceal diverticular stones and found them to have at least one metabolic abnormality predisposing to stone formation; the authors recommended that these patients undergo the same cohort of investigations as other stoneforming patients.…”