Presentation
Hematuria.
Patient Data
In the pelvis, artefact from the left hip prosthesis obscures the urinary trigone. There is mild distension of the left renal pelvis which contains enhancing soft tissue consistent with transitional cell carcinoma. No parenchymal invasion is identified. There is minimal contrast hold up. No ureteral lesion is identified. A few tiny calculi are present within the calyces of the left. The urinary bladder is properly distended and shows no mural thickening. Liver is normal size with no focal lesion. Spleen, pancreas, adrenal glands and right kidney are unremarkable. No retroperitoneal lymphadenopathy. Small saccular infrarenal abdominal aortic aneurysm measuring less than 3 cm in size. Extensive diverticular disease with no evidence of acute inflammation. No destructive lesion in the bones. In the lungs, there is consolidation in the right lower lobe that may be related to aspiration.
One month later, ultrasound demonstrates a moderate left hydronephrosis and irregular thickening of the renal pelvis wall consistent with tumoral involvement.
Case Discussion
This case was confirmed to be a transitional cell carcinoma. Urine cytology:
MACROSCOPIC DESCRIPTION: 50ml clear straw colored fluid.
MICROSCOPIC DESCRIPTION: The smears contain malignant urothelial cells, with benign transitional cells, renal tubular epithelial cells, squamous cells, necrotic cellular debris, crystal and red blood cells.
DIAGNOSIS: Urothelial cell carcinoma.
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