Date of Presentation:12/10/2021

Attending pathologist: Anil V. Parwani, MD, PhD, MBA

Presented by: Nermeen Chaudhry, BA

Prepared by: Nada Shaker, MD

Organ:Kidney

HISTORY:

Patient is a 63 year old female with 48 year history of smoking, stroke, TIA (transient ischemic attack), and neoplasm of right renal pelvis. Previous CT pelvis w/ contrast revealed a 5x8 mm filling defect in the right renal pelvis, with a linear filling defect extending from this area into the lower pole calyx. Cystourethroscopy w/ right urethral catheterization and right ureter stent insertion was performed. Excision of paracaval, hilar, interaortocaval lymph nodes, and right nephrectomy with total ureterectomy was performed on follow up.

GROSS:

The kidney is opened to reveal multifocal areas of papillary, granular tan tissue within the renal pelvis and major calyces.  These areas range in size from 0.2 x 0.2 cm to 2.0 x 1.0 cm. The peripelvic fat, renal hilar fat, perinephric fat, and kidney parenchyma are uninvolved

The remaining kidney parenchyma consists of a tan-white ill-defined area within the superior pole of the parenchyma that measures 0.5 x 0.3 x 0.3 cm.

The ureter is opened to reveal a granular and minimally edematous cut surface to tan-brown and depressed cut surface

No evidence of neoplasia found in lymph nodes

What is the most likely diagnosis?

  1. Renal cell carcinoma with tubular differentiation
  2. Ductal cell carcinoma
  3. Urothelial carcinoma with intratubular spread
  4. Nested variant of urothelial carcinoma
Urothelial carcinoma with intratubular spread