Urothelial Carcinoma of Renal Pelvis

Fragments of high-grade urothelial carcinoma in a biopsy from the renal pelvis. The patient presented with gross hematuria. Urine cytology showed high-grade urothelial carcinoma. Cystoscopy was negative for bladder lesions. This and the next 5 images are from the same case. Obtaining adequate biopsies from lesions in the renal pelvis and ureters is technically quite difficult. The specimens tend to be small and sometimes do not survive processing. They may contain predominantly blood, acellular debris, or show extensive cautery artifact. The biopsy may also not be representative of the tumor and consist of benign urothelium. Due to the treatment implications (nephroureterectomy), they are one of the most challenging specimens encountered by pathologists.