| Purpose:We retrospectively analyzed the characteristics of 22 cases of renal pelvis carcinoma misdiagnosed as renal cell carcinoma or other renal diseases before operation,so as to raise awareness of atypical renal pelvis carcinoma,improve the accuracy of preoperative diagnosis,and avoid misdiagnosis and delayed diagnosis and treatment.Materials and methods:We collected 22 patients misdiagnosised as renal cell carcinoma or other kidney disease from the first hospital of Jilin University from Jan.2011 to Dec.2017.They had biopsy or postoperative pathology confirmed as malignant tumor of the renal pelvis.retrospective summary analysis their medical history,auxiliary examination,pathological diagnosis were collected.Results:1.A total of 22 patients in this group were aged 45-80 years old and the average age was 62.4±10.34 years old.Among them,patients aged 60-70 were the most common,accounting for 63%,including 14 males and 8 females.The lesions were located in 10 cases on the left side of the kidney,11 cases on the right side,and 1 case on both sides.2.In this group of 22 patients,20 were misdiagnosed as renal cancer before surgery,1 was misdiagnosed as xanthogranulomatous pyelonephritis,and 1 was misdiagnosed as renal tuberculosis.3.The clinical manifestations of low back pain in 14 cases,11 cases of painless gross hematuria,routine physical examination found that there were 2 cases of kidney urination,fever,weight loss in 1 case each.Twenty-two patients in this group underwent CT examination.Among them,10 were performed with urinary color Doppler ultrasonography,2 with nuclear magnetic examination,1 with renal cystography,1 with retrograde urography,2 with contrast-enhanced ultrasound,8 with cystoscopy,and urine Cytological examinations were performed in 7 cases and biopsy in 4 cases.4.CT showed that the tumor located in the upper pole of the kidney in 11 cases,located in the middle of the renal parenchyma and in the renal sinus in 5 cases,located in the middle and lower part of the kidney in 2 cases.The renal loss of normal morphology showed severe renal hydronephrosis in 3 cases.There were multiple cases of multiple kidneys.The maximum volume of the tumor is 8 x 5 x 4 cm and the minimum volume is 3.6 x 3 cm.5.In this 22 patients,received surgical treatment in 19 cases.17 cases had preoperative diagnosis of renal cell carcinoma and 1 case had preoperative diagnosis of renal tuberculosis.Therefore,all patients underwent radical nephrectomy;1 patient underwent bilateral renal biopsy before operation.Correct the clinical diagnosis of bilateral renal pelvis cancer and perform a radical resection of the left renal pelvic cancer.Three patients did not receive surgical treatment.One patient had urine exfoliated cytology to find cancer cells and corrected clinical diagnosis of renal pelvis cancer.However,considering multiple metastases in both lungs,systemic chemotherapy was recommended;the remaining 2 renal biopsies corrected the clinical diagnosis of renal pelvis Cancer,1 case of chemotherapy was recommended,and 1 case was given up.6.Postoperative pathological reversion of pyelonephritis infiltrating papillary urothelial carcinoma,high-grade 16 cases,pyelonephrine-renal sarcomatoid carcinoma in 3 cases,renal pelvis;pathological TNM staging was T3-T4,There were 14 cases of T3 and 5 cases of T4.Conclusion:1.Imaging and clinical manifestations of atypical T3-T4 parenchymal infiltrating renal pelvis cancer,easy to identify with kidney cancer and other renal parenchymal diseases,can easily lead to misdiagnosis.2.Detailed questioning of patient history,careful examination and improvement of the necessary related auxiliary examinations are conducive to differential diagnosis.3.Although the positive rate of urine exfoliation cytology is low,but the specificity is high,but it should be used as an effective screening diagnosis of renal pelvic cancer,can reduce the misdiagnosis and missed diagnosis of renal pelvis cancer.4.Retrograde renal pelvis secretography can show the development of renal pelvis,clarify the relationship between tumor and renal pelvis,and increase the detection rate of parenchyma infiltrating renal pelvis.5.Renal biopsy is currently considered safe,and it is not clear that the nature and type of the tumor can be diagnosed with a needle biopsy to avoid misdiagnosis. |
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