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case_images: (A) CTU shows the right duplex kidney was accompanied by severe upper group hydronephrosis with minimal contrast uptake. (B) High density shadow in the operation area was considered as hematoma. Perinephric and retroperitoneal soft tissue shadow, extensive lymphadenopathy. (C) Bilateral pleural effusion with atelectasis, particularly on the right side. (D) Hematoxylin-eosin staining revealed a high-grade invasive urothelial carcinoma with extensive necrosis. (E, F) Trends in this patient's WBC count and body temperature during hospitalization.
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case_images: Figure 1A ). Following surgery, a right retroperitoneal drainage tube was placed, and on April 20, 2020, the patient presented to our hospital with dark red fluid in the perirenal drainage, accompanied by poor appetite and right flank pain, but without fever. Subsequent computed tomography scans revealed a high-density shadow in the operative area, indicative of hematoma ( Figure 1B ). April 24, 2020, the patient underwent right renal exploration and hematoma evacuation, after which he developed tachypnea and elevated WBC count. A follow-up CT scan revealed bilateral pleural effusion with lung tissue atelectasis, along with extensive perirenal and retroperitoneal lymphadenopathy on the right side, as well as abdominal and pelvic effusion ( Figure 1C ). Histopathological examination revealed a high-grade invasive urothelial carcinoma with extensive necrosis ( Figure 1D ). As indicated in  Figures 1E, F , the patient initially presented with normal body temperature upon hospital admission.
case_images: PMC10800997_02
case_images: (A) kub showed multiple stones in the left kidney and ureter. A left renal drainage tube was seen. (B, C) The CTU scan showed an unclear boundary between the left kidney and the adjacent psoas major muscle, with both structures displaying uneven enhancement. Additionally, there was evidence of malrotation in the right kidney. (D) The hematoxylin and eosin staining revealed high-grade invasive urothelial carcinoma with extensive necrosis and focal sarcomatoid differentiation. (E, F) Trends in WBC count and body temperature of the patient.
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case_images: Subsequent outpatient examination revealed multiple stones in the left kidney and ureter ( Figure 2A ). CTU revealed an indistinct demarcation between the left renal and adjacent psoas major muscle, with the identification of a left-sided psoas abscess ( Figures 2B, C ). Subsequently, the patient underwent left nephrectomy and psoas abscess resection, and histopathological examination revealed a high-grade invasive urothelial carcinoma with extensive necrosis and local sarcomatoid differentiation ( Figure 2D ). This observation is shown in  Figures 2E, F .
case_images: PMC10800997_03
case_images: (A) kub showed multiple stones in both kidneys. (B, C) The right kidney had a mixed density mass involving the right psoas major muscle and retroperitoneal space, with multiple small blood vessels passing through it. (D) Hematoxylin-eosin staining showed high-grade invasive urothelial carcinoma with glandular and squamous differentiation. (E, F) Trends in this patient's WBC count and body temperature during hospitalization.
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case_images: Bilateral renal calculi were found on outpatient examination ( Figure 3A ). CTU revealed a mixed-density mass in the right kidney along with bilateral pyelectasis, hydronephrosis, and multiple stones in both kidneys ( Figure 3B ). Figure 3C ). Furthermore, an ECT examination revealed a total GFR of 51.06 ml/min, with 41.08 ml/min contributed by the left kidney and 9.98 ml/min from the right kidney. Open right RNU was performed on March 21, 2023, and subsequent histopathological examination revealed a high-grade invasive urothelial carcinoma with glandular and squamous differentiation ( Figure 3D ). Similar to the other two cases, this patient exhibited a markedly elevated WBC count, whereas his temperature remained normal ( Figures 3E, F ).