This is a 57-year-old patient with a history of ductal carcinoma of the left breast diagnosed in 1999 and ductal carcinoma in situ of the right breast in 2002, with no data of recurrence since then, working as a hospital worker.
The patient has never smoked, but both have a floor of 65 meters square with her husband, a smoker of 30 cigarettes per day also smokers (black age), with whom she has lived for 35 years, her son and daughter,
The child is a smoker of 20 cigarettes a day, with whom he has lived 31 years; and the daughter is a smoker of 10 cigarettes a day, with whom he has lived 25 years.
They all smoked on the floor, none went to the verandah to smoke.
He consulted for frank hematuria related to mechanical low back pain.
The physical examination did not show relevant data, and there was no mass in the renal fossae.
Urocultive examination, ultrasound and laboratory tests were performed.
Blood tests were normal except for proteinuria, and the urine culture was negative.
Ultrasound was reported as "no significant changes except mild ectasia in the upper right quadrant".
We decided that in case of hematuria with positive proteinuria (confirmed in 24-hour urine), we sent him to the Nephrology service to complete study and follow-up.
A second ultrasound was performed, resulting in the same conclusion as the first (performed 6 months apart), as well as an intravenous urography where right foot and ureteral dilation are visualized.
Computed Tomography (CT) showed the same findings, with no obstructive cause justifying this dilation.
In the third ultrasound (months later) echogenic content is visualized in the footlocalization system producing right intrafusal kidney. For this reason a TC was again requested, where an image with a density of the superior renal soft tissues was found.
The lesion captures and is compatible with transitional cell carcinoma in the right collecting system, upper infundibulum and part of the renal pelvis.
Urine cytology was positive.
The patient underwent right laparoscopic nephrectomy and nephrectomy.
1.
Pathology confirmed transitional cell carcinoma of the renal pelvis, with foci of mucinous carcinoma that affects the pelvis, parenchyma and respects ureteral borders, theoretical stage pT3.
Almost two years later, chest CT confirmed space occupying lesions in the liver compatible with liver and bone metastases.
