A 73-year-old man was admitted to our clinic with flank pain and gross macroscopic hematuria. Radiologic examination revealed a solid mass in the left kidney and additionally another mass in the ureteropelvic junction of the same kidney with severe hydronephrosis. Left nephroureterectomy with bladder cuff removel was performed, and histopathological evolution showed a Fuhrman grade 3 clear cell type RCC with low-grade TCC of the pelvis.
Simultaneous occurrence of renal cell carcinoma (RCC) and transitional cell carcinoma (TCC) in the ipsilateral kidney is a rare entity. There are only about 50 cases reported in the literature to date [
Herein, we reported a 73-year-old man who admitted to our clinic with simultaneous RCC and TCC of the left kidney.
A 73-year-old man who he had suffered from with left flank pain and hematuria was admitted to our clinic. Physical examination and laboratory findings were normal. Patient has a history of ischemic heart disease and 1 pack of cigarette smoking for 40 years. The USG showed grade 4 hydronephrosis and a solid mass with 5 cm diameter in the left kidney. Computed tomography revealed several hydronephrosis and a solid mass with 52 × 41 mm diameters in the middle part of the left kidney. Additionally, a 50 × 45 × 38 mm solid mass was detected at the ureteropelvic junction (UPJ) of the same kidney with normal contralateral kidney (Figures
CT image of the solid renal parenchymal mass in the left kidney.
CT image of the solid mass in the left ureteropelvic junction with severe hydronephrosis.
Macroscopic view of RCC (small arrow) and TCC (large arrow) with severe hydronephrosis.
Microscopic overview of the RCC (H-E, ×30).
Papillary urothelial carcinoma (H-E, ×30).
RCC is the commonest solid lesion of the kidney and accounts for approximately 90% of all kidney malignancies [
Several possible aetiological factors have been implicated for primary renal pelvic neoplasms. Although the etiology of coexistence of different type renal neoplasms is still unclear, chronic irritation, hydronephrosis, and urinary calculi have been the most commonly discussed etiologic factors [
The symptoms of the synchronous RCC and TCC are similar to the solitary RCC or TCC of the kidney. The most common symptom at presentation was haematuria which was seen in 90% of the cases [
Although synchronous RCC and TCC of the same kidney are a rare condition and there is no certain opinion about the treatment, radical nephroureterectomy with bladder cuff removal may be curative, especially in low-grade tumors.