Urinary Tract Pathology Case Studies


CASE 6: Urothelial carcinoma of renal pelvis


Clinical History:

A 64-year-old man with a 50 pack/year history of smoking and who worked for many years in a printing shop noted that for the past week there was blood in his urine when he first urinated in the morning. He went to a urologist who did cystoscopy but did not see a lesion in the bladder. Biopsies and urine cytology specimens were sent to the laboratory. The biopsies of the bladder showed benign transitional epithelium, but the cytology specimens showed atypical cells present. The urologist then did another cystoscopy and took separate urine cytology samples from each ureter. The atypical cells were present on the left. An intravenous pyelogram showed a filling defect of the left renal pelvis. A left nephrectomy was performed.
  1. What is the diagnosis?

    2. This is a urothelial carcinoma of the renal pelvis.

  2. Where do these tumors occur?

    3. urothelial carcinomas occur anywhere in the urinary tract, but they are most common in the bladder.

  3. Are there any risk factors or environmental causes of this tumor?

    4. Smoking, exposure to analine or azo dyes, and napthylamine exposure are the best known associations with urothelial cancers.

  4. What must be remembered about the origin of these tumors?

    5. Urothelial tumors often have a multicentric origin. These patients need careful follow-up.