Anatomical Pathology Interesting Case Conference

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