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The Role of Cytology in the Diagnosis of Pyelon Tumour - A Case Report

Tumours of the renal pelvis and ureter arising from epithelial and mesenchymal elements account for 8% of all urinary tract neoplasms and of these greater than 90% are urothelial carcinomas. Haematuria and lumbal pain are the major symptoms. In a 72-year-old woman hospitalized for acute myocardial infarction, mediastinal lymphadenopathy is detected incidentally as well as a left supraclavicular lymph node, approximately 1.5 cm in diameter, from which samples were taken for cytological analysis. The smears revealed a number of single, very large cells, with distinct anisonucleosis and eccentric nuclei, often with large nucleoli and tiny granules in a prominent cytoplasm. Immunocytochemical staining showed positivity for CK18, 20 and 7 and negativity for vimentin, HMB45, AFP, thyreoglobulin, synaptophysin and chromogranin. The findings indicate malignant epithelial cells, most probably of the transitional cell epithelium. Urine sediment analysis of 3 samples discovered cells identical to those found in the lymph node sample. Further diagnostic tests (abdominal ultrasound, MR, PET-CT, cystoscopy)confirmed the presence of a tumour in the pyelon of the right kidney, which had caused an obstruction and atrophy of the right kidney. The patient started to receive chemotherapy, however metastases have been detected (by scintigraphy and PET-CT) in the skelet and a lymph nodes. This work confirms the clinically valuable role of cytology (exfoliative and FNA) in the diagnosis of rare occurrences and localizations of malignant tumours. In this case, cytology detected the presence of malignant cells in the lymph node and in the urine much before the onset of clinical signs of the disease before other diagnostic methods.

Tumours of the renal pelvis; cytology

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