0022-5347 /79/1221-0097$02. 00/0 Vol. 122, July Printed in U.S.A.
THE JOURNAL OF UROLOGY
Copyright © 1979 by The Williams & Wilkins Co.
CASE REPORT: TRANSITIONAL CELL CARCINOMA OF THE RENAL PELVIS PRESENTING WITH VASCULAR OBSTRUCTION REYNOLD F. X. NORONHA From the Section of Urology, St. Louis University School of Medicine, St. Louis, Missouri
ABSTRACT
A case of transitional cell carcinoma of the pelvis, which presented with vascular occlusion, is reported. wall was irregular. Renal angiography showed a normal vasculature to the right kidney, a tortuous aorta and normal celiac and mesenteric arteries. The left renal artery was visualized to be about 3 cm. beyond its origin, at which point it appeared to be obstructed completely (fig. 1). Through a flank incision the kidney was found to be extremely adherent and moderately hydronephrotic with preservation of about half of the renal cortical thickness. The obstruction of the renal artery was confirmed and nephroure-
A rather unusual presentation of a patient with transitional cell carcinoma of the renal pelvis with renal artery obstruction is described herein. CASE REPORT
A 69-year-old man complained of severe flank pain of sudden onset 2 weeks before hospitalization. He denied any hematuria but did admit to mild pain on the left side for many years. Except for some minimal left flank tenderness there
Fm. 1. Aortogram shows obstructed left renal artery
terectomy was done. When the renal pelvis was opened there was a large soft papillary mass mixed with blood clot. The lumen of the renal artery in the specimen was occupied by thrombus (fig. 2, A). The tumor was grade IV transitional cell carcinoma arising from the pelvis and invading the cortex of the kidney, the ureter, the hilus of the kidney and the perinephric fat (fig. 2, B). Transitional cell carcinoma of the renal pelvis most commonly presents with hematuria or hydronephrosis or as a nonfunctioning kidney secondary to ureteral obstruction. However, non-function of the kidney with transitional cell carci-
was no other significant abnormality on physical examination. Urinalysis showed 5 red blood cells per high power field. Hemoglobin and blood urea nitrogen were normal. High dose excretory urography demonstrated the right kidney to be of normal size and shape with a normal collecting system. The left kidney was not visualized. A technetium scan demonstrated no perfusion of the left kidney. A retrograde bulb ureterogram was attempted but contrast material could not be passed beyond the middle of the left ureter. The ureteral Accepted for publication September 22, 1978. 97
98
NORONHA
Fm. 2. A, thrombosed renal artery with transitional carcinoma infiltrating adventitial tissue. B, transitional cell carcinoma of renal pelvis invading wall of pelvis.
noma secondary to vascular occlusion is extremely rare. This case was unusual in that the patient did not have gross hematuria, despite the presence of a large papillary tumor in the renal pelvis. The symptoms of mild flank pain may have been owing to episodes of intermittent ureteral obstruction of
the left kidney. It is likely that there was extrinsic compression of the renal artery by the tumor, which led to thrombosis of the renal artery. Since the tumor was high grade with invasion of perinephric fat the prognosis for this patient remains poor.
THE JOURNAL OF UROLOGY
Copyright © 1979 by The Williams & Wilkins Co.
CASE REPORT: TRANSITIONAL CELL CARCINOMA OF THE RENAL PELVIS PRESENTING WITH VASCULAR OBSTRUCTION REYNOLD F. X. NORONHA From the Section of Urology, St. Louis University School of Medicine, St. Louis, Missouri
ABSTRACT
A case of transitional cell carcinoma of the pelvis, which presented with vascular occlusion, is reported. wall was irregular. Renal angiography showed a normal vasculature to the right kidney, a tortuous aorta and normal celiac and mesenteric arteries. The left renal artery was visualized to be about 3 cm. beyond its origin, at which point it appeared to be obstructed completely (fig. 1). Through a flank incision the kidney was found to be extremely adherent and moderately hydronephrotic with preservation of about half of the renal cortical thickness. The obstruction of the renal artery was confirmed and nephroure-
A rather unusual presentation of a patient with transitional cell carcinoma of the renal pelvis with renal artery obstruction is described herein. CASE REPORT
A 69-year-old man complained of severe flank pain of sudden onset 2 weeks before hospitalization. He denied any hematuria but did admit to mild pain on the left side for many years. Except for some minimal left flank tenderness there
Fm. 1. Aortogram shows obstructed left renal artery
terectomy was done. When the renal pelvis was opened there was a large soft papillary mass mixed with blood clot. The lumen of the renal artery in the specimen was occupied by thrombus (fig. 2, A). The tumor was grade IV transitional cell carcinoma arising from the pelvis and invading the cortex of the kidney, the ureter, the hilus of the kidney and the perinephric fat (fig. 2, B). Transitional cell carcinoma of the renal pelvis most commonly presents with hematuria or hydronephrosis or as a nonfunctioning kidney secondary to ureteral obstruction. However, non-function of the kidney with transitional cell carci-
was no other significant abnormality on physical examination. Urinalysis showed 5 red blood cells per high power field. Hemoglobin and blood urea nitrogen were normal. High dose excretory urography demonstrated the right kidney to be of normal size and shape with a normal collecting system. The left kidney was not visualized. A technetium scan demonstrated no perfusion of the left kidney. A retrograde bulb ureterogram was attempted but contrast material could not be passed beyond the middle of the left ureter. The ureteral Accepted for publication September 22, 1978. 97
98
NORONHA
Fm. 2. A, thrombosed renal artery with transitional carcinoma infiltrating adventitial tissue. B, transitional cell carcinoma of renal pelvis invading wall of pelvis.
noma secondary to vascular occlusion is extremely rare. This case was unusual in that the patient did not have gross hematuria, despite the presence of a large papillary tumor in the renal pelvis. The symptoms of mild flank pain may have been owing to episodes of intermittent ureteral obstruction of
the left kidney. It is likely that there was extrinsic compression of the renal artery by the tumor, which led to thrombosis of the renal artery. Since the tumor was high grade with invasion of perinephric fat the prognosis for this patient remains poor.
