Incidental diagnosis of transitional cell carcinoma during percutaneous nephrolithotomy.

Introduction: The aim of this study was to investigate the characteristics of patients who were incidentally diagnosed with transitional cell carcinoma (TCC) during percutaneous nephrolithotomy (PCNL) surgery.

Patients And Methods: We retrospectively analyzed the data of 1,406 patients who underwent PCNL for the removal of renal calculi. Tumoral lesions detected during diagnostic cystourethroscopy and nephroscopy were endoscopically resected and the resected specimens were sent to the pathology laboratory for definitive diagnosis.

Results: Tumoral lesions were detected with cystoscopic examination in 6 patients and with nephroscopy in 4. Pathological examination of the lesions in the kidneys revealed stage T1G1 TCC in 2 patients, T1G3 TCC with carcinoma in situ in 1, and high-grade TCC with sarcomatoid features in 1 patient. The patient with sarcomatoid features died 2 months after surgery and all the other patients survived with no evidence of disease at the end of 26.67 +/- 18.58 months of follow-up.

Conclusions: Since early diagnosis and management of urothelial lesions significantly improves the prognosis, a careful examination of urothelial mucosa during PCNL surgery is important. Instant diagnosis of a sarcomatoid component and imperative surgical intervention may be life-saving.