More than Just a Stone: Staghorn Surprise with Ureteric Transitional Cell Carcinoma - A Rare Co-Incidence

Thiruvarul P V, Ezhil Sundar V, Chengalvarayan G, Mohamed Salmon M

Abstract: Upper tract urothelial carcinoma (UTUC) accounts for approximately 5-7.5% of all urologic malignancies. Its concurrent occurrence with an ipsilateral staghorn calculus is exceedingly rare, with only isolated case reports in the published literature. We present a 75-year-old male who reported a single episode of gross haematuria and right loin pain of two weeks duration. Plain computed tomography (CT) revealed a 3.7 ? 2.6 ? 0.9 cm staghorn calculus involving the right renal pelvis, upper and middle calyces. CT Urogram additionally demonstrated a homogenously enhancing soft tissue mass measuring 1.5 ? 1.7 ? 3.7 cm within the right mid-ureter with proximal ureteric and pelvicalyceal system dilatation. The right kidney showed hypo-enhancement compared to the left and absent excretion on delayed-phase imaging, indicating severely compromised function. The patient underwent laparoscopic right nephroureterectomy with bladder cuff excision. Post-operative histopathology confirmed high-grade invasive urothelial carcinoma of the mid-ureter with invasion into the muscularis propria (pT2N0Mx), with clear surgical margins. Immunohistochemistry demonstrated diffuse CK7 and Uroplakin positivity. This case highlights the critical importance of comprehensive radiological evaluation- including CT Urogram- in elderly patients presenting with haematuria and loin pain, even when a calculus appears to account for the symptoms, as a concurrent urothelial malignancy may be masked by coexisting stone disease.

Keywords: Staghorn calculus, ureteric transitional cell carcinoma, upper tract urothelial carcinoma, nephroureterectomy, haematuria, CT urogram.

How to Cite?: Thiruvarul P V, Ezhil Sundar V, Chengalvarayan G, Mohamed Salmon M, "More than Just a Stone: Staghorn Surprise with Ureteric Transitional Cell Carcinoma - A Rare Co-Incidence", Volume 15 Issue 6, June 2026, International Journal of Science and Research (IJSR), Pages: 1148-1150, https://www.ijsr.net/getabstract.php?paperid=SR26619194513, DOI: https://dx.doi.org/10.21275/SR26619194513

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