Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (234 page)

Suggested Readings

Olgac S, Mazumdar M, Dalbagni G, et al. Urothelial carcinoma of the renal pelvis: a clinicopathologic study of 130 cases.
Am J Surg Pathol.
2004;28:1545–1552.

Paonessa J, Beck H, Cook S. Squamous cell carcinoma of the renal pelvis associated with kidney stones: a case report.
Med Oncol.
2011;28(Suppl 1):S392–S394.

LEUKOPLAKIA OF THE RENAL PELVIS

   Definition

   Leukoplakia of the renal pelvis is a visualized grayish patch observed on the mucosal surface epithelium of the renal pelvis (part of the kidney urothelium) and represents metaplastic squamous plaque (squamous metaplasia and keratinization).

   Who Should Be Suspected?

   Candidates are typically middle-aged individuals with recurrent episodes of renal or ureteric colic. In 90% of cases, the lesion is unilateral.

   Laboratory Findings

   Urine cytology (cell block or Pap smear): The finding of sheets of desquamated keratinized epithelial cells in urine during an attack of renal colic is pathognomonic.

   Flow cytometry (DNA): High-grade (aneuploid) tumors can be detected in >90% of cases.

Suggested Readings

Hertle L, Androulakakis P. Keratinizing desquamative squamous metaplasia of the upper urinary tract: leukoplakia—cholesteatoma.
J Urol.
1982;127:631–635.

Smith BA Jr, Webb EA, Price WE. Renal leukoplakia: observations of behavior.
J Urol.
1962;87:279–287.

Terry TR, Shearer RJ. Conservative surgical management of leukoplakia of upper urinary tract.
J R Soc Med.
1986;79:544–545.

DISORDERS

BENIGN PROSTATIC HYPERPLASIA (BPH)

   Definition

   BPH is enlargement of the prostate resulting from hyperplasia of prostatic stromal and epithelial cells, compressing the periurethral region of the prostate and causing partial or complete obstruction of the urethra.

   Who Should Be Suspected?

   Candidates are men, generally older than 30 years, with moderate to severe lower urinary tract symptoms (frequency, nocturia, hesitancy, urgency, weak stream) that gradually progress with time.