RENAL PELVIC TUMOUR, MASQUERADING AS PELVI-URETERIC JUNCTION OBSTRUCTION A CASE REPORT

Urothelial tumour of the renal pelvis presenting as large hydronephrosis is uncommon. Clinical suspicion of urothelial carcinoma does not arise in the absence of haematuria. This case highlights the pitfalls of standard investigations, which might miss the diagnosis. 67-year-old man presented with mass and dull aching pain over right upper abdomen. Laboratory investigations were within normal limits. Ultrasound showed dilated renal pelvis with a stone. IVU showed non visualisation of right kidney with a stone in the pelvis. CECT showed nonfunctioning right kidney with gross hydronephrosis and a stone of size 2.1x1.8 cm in the renal pelvis. Right PCN was done and initially 1.2 litre of brown coloured urine drained, which progressively decreased to less than 30 mL per day. Right nephrectomy was done. Specimen revealed a stone along with a growth in the renal pelvis. HPE report of the growth was Infiltrating urothelial carcinoma with glandular differentiation. During the postoperative period, cystoscopy was done to exclude urothelial tumour of the bladder. Subsequently remaining right ureter along with a cuff of bladder was removed. Specimen showed growth involving the lower part of ureter. HPE of the ureter showed infiltrating urothelial carcinoma. Patient currently is on followup. In this case a preoperative diagnosis of pelvic urothelial tumour was neither suspected nor confirmed by investigations. This case is presented for its rarity and to emphasise the need for high degree of suspicion to further investigate non-functioning kidneys to detect underlying urothelial carcinoma.