Renal parenchymal involvement is unusual in ureteral urothelial carcinoma and may be difficult to interpret. We report a 78-year-old man with hematuria, right-sided hydronephrosis, and impaired renal function. Urinary cytology was suspicious for high-grade urothelial carcinoma, whereas ureteroscopic biopsy showed pT1 low-grade disease. Radical nephroureterectomy revealed high-grade pT3 ureteral urothelial carcinoma with lymphovascular invasion and unexpected ipsilateral renal parenchymal involvement without continuity with the collecting system. Pathological findings favored metastatic involvement, although the route of spread remained uncertain. The case also demonstrates the diagnostic challenge posed by discordant ureteroscopic biopsy, cytology, and final pathology.
Late scrotal involvement by urothelial carcinoma after radical cystoprostatectomy may coexist with necrotizing infection. We report a 61-year-old man presenting 68 months after cystoprostatectomy for high-grade pT1 bladder cancer with scrotal gangrene and septic shock. Emergency debridement revealed papillary tumor-like tissue protruding through a defect in the retained urethral wall. Scrotal skin and spermatic cord histology showed high-grade urothelial carcinoma with micropapillary differentiation, lymphovascular emboli, and perineural invasion. Urethral recurrence with local extension was suspected but unconfirmed without urethral biopsy. The patient died from persistent septic shock. Histopathology revealed coexisting malignancy.
Malignancies within a horseshoe kidney (HSK) are rare, with papillary renal cell carcinoma (PRCC) being exceptionally uncommon in young adults. We report a large, locally advanced 10-cm pT3a PRCC in a 28-year-old male. Contrast-enhanced CT revealed the right-moiety primary tumor alongside synchronous, hypovascular liver lesions mimicking benign cavernous hemangiomas. An open transperitoneal right radical nephrectomy and midline isthmectomy were successfully performed. This case highlights that open surgery remains a reliable strategy for large tumors distorting HSK anatomy. Furthermore, it emphasizes the importance of recognizing the hypovascular radiological behavior of PRCC metastases, which easily mimic benign hepatic lesions.
Prostatic solitary fibrous tumor (SFT) is exceptionally uncommon and can be mistaken for aggressive prostate cancer on imaging. A 59-year-old man presented with obstructive urinary symptoms and a normal serum PSA. Multiparametric MRI showed a PI-RADS 5 nodule breaching the prostatic capsule. Biopsy revealed bland spindle cells expressing STAT6, CD34, CD99, and BCL-2, with a Ki-67 index of 1%, establishing the diagnosis. After multidisciplinary review and counseling, he elected surveillance instead of resection; MRI at 12 months showed no progression. Tissue confirmation should precede radical treatment of such lesions.
Bladder leiomyoma is a rare benign tumor, predominantly affecting middle-aged women, presenting with hematuria, LUTS, or incidentally. We report a 51-year-old female with intermittent flank pain and LUTS, found to have a large pelvic mass causing severe hydroureteronephrosis. Cystoscopy showed a compressive mass with intact urothelium. Open excision revealed a detrusor-arising mass, completely removed via partial cystectomy; histopathology confirmed the diagnosis. This case was notable for its large size and upper urinary tract impact, exceeding smaller intravesical tumors managed by TURBT alone. Bladder leiomyoma warrants inclusion in the differential diagnosis of pelvic masses, emphasizing early radiologic detection to prevent complications.
