Case with renal pelvic carcinoma with giant hydronephrosis

: A 62-year-old man consulted us for further examination of left giant hydronephrosis which was accidentally found by abdominal ultrasonography. The patient chose observation instead of left nephrectomy. One year later, he re-visited us with a complaint of sudden abdominal pain. Computed tomography (CT) revealed left giant hydronephrosis containing high-density fluid which was suspected of hemorrhage in the renal pelvis. Percutaneous nephrostomy yielded discharge of 7000 ml of hemorrhagic fluid and urine cytology revealed class V. Systemic examination by CT and magnetic resonance imaging (MRI) showed renal pelvic tumors in the left kidney as well as multiple metastatic lesions in the lung, liver and bone. Pathological examination of the left renal pelvic tumors obtained by biopsy showed high-grade urothelial carcinoma. Although systemic and intra-arterial chemotherapy showed partial response in the metastatic lesions, he died of cancer 1 year and 3 months after the first diagnosis.