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A 76-year-old man with a long-standing history of low grade urothelial carcinoma reported gross hematuria. An upper tract study in the form of a computed tomography (CT) urogram demonstrates a filling defect in the right upper pole. Cystoscopy does not show any lower track pathology; however, ureteroscopy confirms a large papillary lesion in the right upper pole calyx.
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This case was prepared by Alexander Kutikov, MD, of Fox Chase Cancer Center in Philadelphia.
Reference
1. Brien JC, Shariat SF, Herman MP, et al. Preoperative hydronephrosis, ureteroscopic biopsy grade and urinary cytology can improve prediction of advanced upper tract urothelial carcinoma. J Urol 2010;184:69-73.
C. Positive cytology, hydronephrosis, and high grade biopsy are significant risk factors for high-risk upper tract urothelial carcinoma. For instance, in a multi-institutional cohort, 89% of patient who possessed all 3 risk factors exhibited muscularis propria invasion at nephroureterectomy, while no patients had T2 or greater disease if all 3 risk factors were absent.1 As such, risk stratification harnessing these variables can help guide decisions regarding radical surgery and neoadjuvant chemotherapy.
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