Upper tract transitional cell carcinoma clinically mimicking inflammatory renal pathology: A report of three cases

Abstract

Upper tract urothelial carcinoma (UTUC) of the renal pelvis and the ureter is incidentally detected in a small proportion of cases. However, the majority of UTUC cases present with hematuria, flank pain, and clot colic. Typical imaging features include hydronephrosis of the kidney (s) due to obstruction by the mass with a soft-tissue lesion that typically shows low-grade enhancement with or without a filling defect. Rarely, such a tumor may present with signs and symptoms mimicking an inflammatory or infective pathology of the kidney and is diagnosed only on biopsy or on nephrectomy. We present three such patients and cite another similar case we have published earlier. All three of these patients presented with signs and symptoms of an obstructed infected kidney with long-standing renal calculi and a forgotten DJ stent in one instance. Nephrectomy for the presumed infected kidney in all three cases revealed high-grade UTUC. In patients presenting with equivocal findings on cross-sectional imaging with a history of renal calculi or foreign bodies, we should have a high index of suspicion for malignancy.

Atypical presentations of UTUC: a case report of three patients

“…UTUC is prone to misdiagnosis of inflammatory kidney diseases such as xanthogranulomatous pyelonephritis ( 19 , 20 ). This was demonstrated in a case reported by Ordones et al., in which a patient presented with symptoms of flank pain, collapse, and fever, and was initially diagnosed with xanthogranulomatous pyelonephritis ( 20 ).…”

“…Jena et al. reported three cases of UTUC who presented with a low-grade fever and persistent leukocytosis ( 19 ). None of these patients had any hematuria and they were diagnosed only on biopsy or on nephrectomy.…”

Focus on Upper Urinary Tract Stones Combined With Parenchymal Infiltrative Renal Pelvis Cancer

“…Preoperative abdominal CT was performed on some patients with upper urinary tract stones; however, the doctors were only interested in finding the stones themselves and disregarded any tissue abnormalities [4,7]. Two individuals with upper urinary tract stones in whom renal pelvic carcinoma was overlooked were described by Jena et al [3]. On preoperative enhanced CT scans, both patients had localized hypoenhancement of the renal parenchyma, which was consistent with the 2 patients in our group but was similarly misinterpreted as a local infection of the kidney.…”

“…This implies the critical role played by CT scans and the precise interpretation of their results in the evaluation of patients' situations. Malignancy should be strongly suspected in individuals with renal stones or pelvic foreign bodies who have abnormal CT alterations in the renal parenchyma [3]. Puncture biopsy is possible to clarify the diagnosis for individuals with aberrant preoperative imaging findings but unclear findings, and several biopsies can be carried out if necessary.…”

“…Although studies have shown that upper urinary tract stones and pelvic cancer are relatively uncommon, they do occur more frequently than the average case of pelvic cancer alone during the same time period, and they occur more frequently in patients who have had stones for at least 10 years [1, 2]. According to a review of the literature, individuals with pelvic cancer and stones frequently receive the incorrect diagnosis of yellow granulomatous nephritis and they have a long history of stones or foreign bodies in the renal pelvis [3, 14].…”