– Presenting with hematuria
What is the most likely diagnosis?
Enhancing mass in the left renal pelvis, most likely TCC
What is the treatment?
Left total nephroureterectomy and bladder cuff excision
Microscopy result: Transitional Cell Carcinoma of 2,5 cm in the renal pelvis, low grade.
TNM classification Pyelum-Ureter (8th edition UICC): pTa.
– The vast majority of renal pelvis and ureter tumours are transitional cell carcinoma (> 90%), the remainder of tumours are squamous cell carcinoma (< 10%) and adenocarcinoma (< 1%) Transitional cell carcinoma much more commonly occurs in the bladder than in the renal pelvis or ureter - Synchronous and metachronous tumours are frequent because TCC is caused by toxic exposure through for example cigarette smoking - TCC of the renal pelvis can spread to the kidney and intraluminal seeding to more caudal parts of the ureter and to the bladder is common => always look for other space occupying lesions
– For these reasons, an excretory phase is always useful when a kidney mass is suspected, as TCC’s represent 10 to 15% of renal tumours
– CT scan protocol: non enhanced CT, enhanced CT (70-90 sec), delayed phase (10-15 mins)