Focus on Upper Urinary Tract Stones Combined with Parenchymal Infiltrative Renal Pelvis Cancer

• Published in: Kidney & blood pressure research 2024-01, Vol.49 (1), p.228-238
• Main Authors: Zhang, Yue, Ke, Ying, Qiu, Ai-Xin, Yang, Bo, Shen, Chen, Wen, Li-Jie, Xu, Xiao-Long, Yu, Yang, Wang, Wei
• Format: Article
• Language: English
• Subjects: Abdomen; Abscesses; Aged; Back pain; Biopsy; Blood clots; Cancer therapies; Case Report; Creatinine; differential diagnosis; Female; Fever; Hematuria; Humans; Hydronephrosis; Infections; Kidney Calculi - complications; Kidney Neoplasms - complications; Kidney Neoplasms - pathology; Kidney Pelvis - diagnostic imaging; Kidney Pelvis - pathology; Kidney stones; Kidneys; Lithotripsy; Male; Middle Aged; Nephrology; Pathology; Pelvis; renal pelvis cancer; Surgery; Tomography, X-Ray Computed; upper urinary tract stones; ureteral soft lithotripsy; Urinary tract; Urine; Urogenital system; Urology
• ISSN: 1420-4096; 1423-0143
• DOI: 10.1159/000538280

Abstract Introduction: Upper urinary tract stones combined with parenchymal infiltrative renal pelvic cancer are challenging to detect on imaging and to evaluate the differential diagnosis. Case Presentation: The symptoms and diagnoses in three cases of parenchymal infiltrative renal pelvic cancer and upper urinary tract stones that occurred between June 2019 and June 2022 were reviewed. Primary symptoms of lumbar discomfort and hematuria were evident in all 3 patients. Preoperative computed tomography (CT) abdominal imaging revealed that all three cases had hydronephrosis along with renal stones, while the other two cases only had localized hypoenhancement of the renal parenchyma, which was only thought to be limited inflammatory changes in the renal cortex as a result of the combination of renal pelvis infection. After percutaneous nephrolithotomy or ureteroscopic lithotripsy, a combined renal pelvis tumor was discovered in all of these instances. Radical tumor surgery was later performed. One patient who had several tumor metastases passed away 6 months after surgery. A case with multiple metastases was discovered 15 months after surgery and survived with the help of the current chemotherapy. A case with a bladder tumor recurrence was discovered 16 months after surgery and had transurethral bladder tumor electrosurgery and routine bladder perfusion chemotherapy. Conclusion: Upper urinary tract stones and parenchymal infiltrative pyel carcinoma have atypical imaging, easily confused with infectious diseases. CT or computed tomography urography (CTU) must be considered by urologists. Patients who have a CT with local renal parenchyma density should be suspected of having parenchymal invasive renal pelvis carcinoma; a needle biopsy ought to be performed; and repeat biopsies may be performed if necessary. High-risk individuals need multiple, sufficient biopsies as needed and a comprehensive intraoperative assessment of the renal pelvic mucosa.