RENAL PELVIC TUMOUR, MASQUERADING AS PELVI-URETERIC JUNCTION OBSTRUCTION A CASE REPORT

Abstract

Urothelial tumour of the renal pelvis presenting
as large hydronephrosis is uncommon.
Clinical suspicion of urothelial
carcinoma does not arise in the absence
of haematuria. This case highlights the
pitfalls of standard investigations, which
might miss the diagnosis. 67-year-old
man presented with mass and dull aching
pain over right upper abdomen.
Laboratory investigations were within
normal limits. Ultrasound showed dilated
renal pelvis with a stone. IVU showed
non visualisation of right kidney with a
stone in the pelvis. CECT showed nonfunctioning
right kidney with gross hydronephrosis
and a stone of size 2.1x1.8
cm in the renal pelvis. Right PCN was
done and initially 1.2 litre of brown coloured
urine drained, which progressively
decreased to less than 30 mL per day.
Right nephrectomy was done. Specimen
revealed a stone along with a growth in
the renal pelvis. HPE report of the growth
was Infiltrating urothelial carcinoma with
glandular differentiation.
During the postoperative period, cystoscopy
was done to exclude urothelial tumour
of the bladder. Subsequently remaining
right ureter along with a cuff of bladder
was removed. Specimen showed growth
involving the lower part of ureter. HPE of
the ureter showed infiltrating urothelial carcinoma.
Patient currently is on followup. In
this case a preoperative diagnosis of pelvic
urothelial tumour was neither suspected
nor confirmed by investigations. This case
is presented for its rarity and to emphasise
the need for high degree of suspicion to
further investigate non-functioning kidneys
to detect underlying urothelial carcinoma.