Urothelial carcinoma of renal pelvis

Urothelial carcinoma of renal pelvis 

Updated: 10/27/2022

© Jun Wang, MD, PhD

General features
  • Commonly multifocal, probably through drop metastases
  • May coexist with lower urinary tract urothelial carcinoma
  • More common in male, mean age 67
  • Likely non-invasive if low grade
Risk factors
  • Tobacco use
  • Phenacetin
  • Industrial carcinogen exposure (coal, asphalt, petrochemicals, tar)
  • Thorium containing radiologic contrast material
  • Balkan endemic nephropathy
Clinical features
  • Hematuria
  • Flank pain
Pathological features
Markers
  • Positive for p63, uroplakin, CK7, CK20, PAX8
Genetic abnormality
  • Microsatellite instability
  • Complex karyotype if high grade
Diagnosis
  • Radiologic studies
  • Ureteropyeloscopy with cystoscopy
  • Biopsy
  • Urine cytology with molecular technologies such as FISH (Urovysion): only for high grade
Treatment
  • Surgery
  • Chemotherapy
Poor prognostic indicator
  • High stage
  • High tumor grade
  • Vascular invasion
  • Older age, metastasis
  • Extensive tumor necrosis


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