PMC6081520_01
(a) Plain computed tomography image, showing a stone in the right upper urinary tract, but with no indication of the soft protein matrix in the right renal pelvis and calyceal diverticulum, which is radiolucent. (b) Dynamic computed tomography image, showing a complicated cyst, classified as a Bosniak type IIF cyst, arising from the right side of the kidney.
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Noncontrast enhanced CT revealed a right renal stone and a complicated cyst in the upper pole of her right kidney, which was categorized as a Bosniak type IIF cyst on dynamic CT, with a maximum diameter of 58 mm (Figure 1).
Retrograde pyelogram image, showing a duplex collecting system in the right kidney and calyceal diverticulum connected to the upper renal calyx. Defect sign of retrograde pyelogram, caused by filling of the diverticulum by the soft protein matrix, is observable. A percutaneous nephrostomy tube in the diverticulum was placed prior to ECIRS to remove the contents completely.
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The calyceal diverticulum, which had been diagnosed preoperatively as a complicated cyst, was confirmed by ureteroscopy and retrograde pyelogram (Figure 2).
Percutaneous nephroscopic examination, showing papillary lesions in the calyceal diverticulum.
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After the soft protein matrix was completely removed, papillary lesions were observed on the surface of the diverticulum using percutaneous nephroscopy (Figure 3), and a biopsy was performed.
Histopathological examination. (a) An area of verrucous squamous cell carcinoma, connected to a high-grade squamous cell carcinoma, identified on the inner surface of the calyceal diverticulum. (b) Under magnification, the high-grade squamous cell carcinoma was shown to invade the renal parenchyma.
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Pathological analysis confirmed a high-grade squamous cell carcinoma with renal parenchymal invasion (pT3) (Figure 4).