Multidisciplinary consultation on difficult cases in Urology of the Guangdong Medical Association (Phase 14): Malignant tumor of the left renal pelvis and massive hydronephrosis of the left kidney

doi:10.3877/cma.j.issn.1674-3253.2024.03.018

Abstract

Abstract:

This article reports a case of diagnosed left renal pelvis malignant tumor due to the discovery of massive fluid accumulation in the left kidney. The patient was admitted to the Third Affiliated Hospital of Guangzhou Medical University for treatment due to dizziness and memory loss for more than 3 months, left lower back pain, and difficulty urinating for 2 days. CT scan showed huge hydronephrosis in the left kidney. Symptoms improved after left kidney puncture and fistula, and the patient was discharged. Later, a PET-CT scan was performed in an external hospital, revealing two nodular metabolic hyperintensities in the renal calyx area of the upper left kidney, indicating a tendency towards urothelial carcinoma. Upon re admission to the Urology department of our hospital, atypical cells were observed in the liquid based cytology of the left renal fistula drainage fluid, suggesting high-grade urothelial carcinoma. Considering that the patient is older and has multiple underlying diseases, after communicating with the patient, immunotherapy has been decided. The patient underwent 5 rounds of immunotherapy with Tirizizumab in our hospital. After treatment, the patient's tumor shrank, the color of the drainage fluid and urine became clear, and there was no visible hematuria. After multidisciplinary consultations on difficult cases in the urology department of Guangdong Medical Association, experts suggest that the patient undergo radical surgery again, and immunotherapy is an optional option. After communicating with the patient, they consider continuing immunotherapy. After continuing immunotherapy three times, the urine based cytology test was negative. During the treatment process, the patient had no significant adverse reactions. Therefore, for elderly patients with upper urinary tract urothelial carcinoma who have multiple underlying diseases and generally poor conditions, immune monotherapy is an optional treatment option in addition to curative surgery.

Key words: Tumor of renal pelvis, Immunotherapy, Urine liquid-based cytology, Urothelial careinoma

Nan Deng, Ping Liu. Multidisciplinary consultation on difficult cases in Urology of the Guangdong Medical Association (Phase 14): Malignant tumor of the left renal pelvis and massive hydronephrosis of the left kidney[J]. Chinese Journal of Endourology(Electronic Edition), 2024, 18(03): 296-299.

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