[Concurrent tumors in a patient with giant hydronephrosis].
OBJECTIVE
Giant hydronephrosis, defined as the presence of a liquid volume over 1000 ml within the urinary collector system, is a rare clinical entity, the diagnosis of which is an excellent exercise because it lacks of a defined clinical presentation.


RESULTS
We report the case of a 66-year-old male under study for a suspicious digestive tumor due to a long lasting clinical picture with severe cachexia, asthenia, anemia, constipation, and abdominal mass. Radiological tests showed a great right hydronephrosis secondary to a culculus in the ureteral-pelvic junction. Simple nephrectomy was performed, evacuating 7800 ml of serous-hematic liquid from the pyelocalicial system. A histological diagnosis revealed the presence of multiple foci of transitional cell carcinoma and renal cell carcinoma associated. We review the diagnostic and therapeutic features in the literature.


CONCLUSIONS
Giant hydronephrosis represents a diagnostic dilemma. It may present as an asymptomatic process, with clinical features of abdominal organs compression (bowel or urinary obstruction) or simulate abdominal tumors, massive ascites, or cystic retroperitoneal lesions. Simple nephrectomy is the treatment of choice in most cases, due to the advanced deterioration of the renal unit. Nevertheless, in some cases, in compromised patients, percutaneous drainage may be necessary as previous or definitive treatment to avoid changes in the hemodynamic balance secondary to the sudden abdominal decompression.
Pereira Arias
José Gregorio
JG
Servicio de Urología, Sección de Antomía Patológica, Hospital de San Eloy, Baracaldo, Vizcaya, España. urologia.saneloy@hsel.osakidetza.net
Ullate Jaime
Vicente
V
Gutiérrez Díez
José Maria
JM
Ateca Díaz-Obregón
Ricardo
R
Ramírez Rodríguez
María Mar
MM
Pereda Martínez
Esther
E
Berreteaga Gallastegui
José Ramón
JR
D000368:Aged; D002292:Carcinoma, Renal Cell / Q000150:complications*; D002295:Carcinoma, Transitional Cell / Q000150:complications*; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology* / Q000473:pathology; D007680:Kidney Neoplasms / Q000150:complications*; D008297:Male; D009378:Neoplasms, Multiple Primary / Q000150:complications*