History
Renal urothelial carcinoma (UC) is rarely reported as an incidental finding. Symptoms are significant enough to suggest the diagnosis in a relatively short time after disease development. A small percentage (1-2%) of patients are asymptomatic.
Gross hematuria is the most common presenting symptom, occurring in 75-95% of patients. Microscopic hematuria occurs in 3-11% of patients.
Approximately 14-37% of patients report pain. Pain is usually dull and is caused by the gradual obstruction of the collecting system. Renal colic also may occur with the passage of blood clots.
Physical Examination
The physical examination usually is not informative or specific, especially in patients with early-stage disease. A palpable flank mass may be noted in fewer than 20% of patients. The classic clinical triad of hematuria, pain, and mass is also rare (15%) and is usually an indicator of advanced disease.
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CT scan with contrast, vascular phase. Mass can be seen in left renal pelvis (black arrows). Patient underwent nephroureterectomy. Tumor was high-grade urothelial carcinoma invading subepithelial tissue (stage T1) and measuring 7.5 × 3.2 × 3 cm.
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CT scan, delayed phase. Enhancing mass can be visualized in left renal pelvis (white arrows).
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Retrograde pyelography. Filling defect can be seen in left renal pelvis and lower calyx (black arrows). Patient underwent left nephroureterectomy. Tumor was low-grade urothelial carcinoma measuring 2.5 × 2 × 1 cm.
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Right retrograde pyelogram demonstrates large filling defect in midureter due to transitional cell carcinoma (large arrow). Note characteristic appearance of radiographic contrast material just distal to obstruction (small arrow), which gives rise to so-called goblet sign. Contrast is also visible beyond partially obstructed segment of ureter in renal pelvis and collecting system.
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Pathology specimen shows urothelial tumor of renal pelvis (white arrows).
