[Concurrent tumors in a patient with giant hydronephrosis]

Area of Science:

• Urology
• Nephrology
• Oncology

Background:

• Giant hydronephrosis is defined as >1000 ml urinary collector system fluid.
• It presents a diagnostic challenge due to its varied clinical manifestations.

Observation:

• A 66-year-old male presented with cachexia, abdominal mass, and anemia, initially suspected as a digestive tumor.
• Radiological imaging revealed massive right hydronephrosis due to ureteropelvic junction obstruction.
• Nephrectomy evacuated 7800 ml fluid; histology showed transitional and renal cell carcinoma.

Findings:

• Giant hydronephrosis can present asymptomatically or mimic abdominal tumors, ascites, or retroperitoneal lesions.
• Simple nephrectomy is often the treatment of choice for advanced renal deterioration.
• Percutaneous drainage may be necessary for hemodynamically unstable patients.

Implications:

• This case underscores the importance of considering giant hydronephrosis in patients with unexplained abdominal masses and constitutional symptoms.
• Early diagnosis and appropriate management, including surgical intervention or drainage, are crucial.
• The association with renal and transitional cell carcinoma highlights the need for thorough oncological evaluation.