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An 83-year-old man presented to hospital with gross hematuria. His medical history was remarkable for remote open left pyelolithotomy, chronic inflammatory demyelinating peripheral neuropathy, benign prostatic hyperplasia, and cerebrovascular accident for which he took aspirin-dipyridamole. Urine cytology was negative for malignant cells. Renal ultrasound showed a lobulated, hypoechoic lesion centered in an echogenic hilum of the upper pole of the left kidney. Preoperative CT urogram showed a large, round, heterogeneously-enhancing soft tissue filling defect, measuring 3.6cmx4.0cmx3.3cm, casting the major calyx of the upper pole of the left kidney (Figure-1). It showed definitive heterogeneous enhancement after contrast administration. On the delayed urographic phase, contrast was noted outlining the filling defect. The findings were typical for urothelial carcinoma, with invasion of the subjacent parenchyma of the upper pole of the left kidney. In addition, an irregular, exophytic 1.4cmx1.4cm nodule was found arising from the posterolateral cortex of the left kidney, in the vicinity of the renal parenchymal invasion by the urothelial carcinoma. The nodule was homogeneously hyper-enhancing and appeared contiguous with the less enhancing urothelial carcinoma (Figures 2A and B). The nodule was thought to be either urothelial carcinoma invasion or a synchronous renal cell carcinoma. There was no local regional lymphadenopathy. He underwent laparoscopic nephroureterectomy without complication. Pathologic examination confirmed urothelial carcinoma

international braz j urol

Chromophobe renal cell carcinoma mimicking cortical invasion by synchronous invasive urothelial carcinoma of the intra-renal collecting system on CT urography