Three cancers in the renal pelvis,bladder,and colon:A case report

BACKGROUND Multiple primary cancers are rare occurrences that can involve either metachronous or synchronous development.It is particularly rare for an individual to have more than two primary cancers.In this report,we present a case study of an elderly man who was diagnosed with three heterochronous cancers in the renal pelvis,bladder,and colon.CASE SUMMARY On December 30,2014,a 51-year-old Chinese man was admitted to our hospital with complaints of intermittent painless gross hematuria for the preceding week.A computed tomography(CT)scan revealed wall thickening in the left ureter’s upper segment,while a CT urography revealed a left renal pelvis tumor.A successful laparoscopic radical resection of the left renal pelvis tumor was subsequently performed at Shanghai Zhongshan Hospital in January 2015.The pathological findings after the surgery revealed a low-grade papillary urothelial carcinoma of the renal pelvis.The final pathological tumor stage was pT1N0M0.After surgery,this patient received 6 cycles of intravenous chemotherapy with gemcitabine and carboplatin,as well as bladder infusion therapy with gemcitabine.On December 18,2017,the patient was admitted once again to our hospital with a one-day history of painless gross hematuria.A CT scan showed the presence of a space-occupying lesion on the posterior wall of bladder.Cystoscopic examination revealed multiple tumors in the bladder and right cutaneous ureterostomy was performed under general anesthesia on December 29,2017.The postoperative pathological findings disclosed multifocal papillary urothelial carcinoma of the bladder(maximum size 3.7 cm×2.6 cm).The bladder cancer was considered a metastasis of the renal pelvis cancer after surgery.The pathological tumor stage was pT1N0M1.The patient refused chemotherapy after surgery.After another six years,the patient returned on February 28,2023,complaining of periumbilical pain that had lasted six days.This time,a CT scan of the abdomen showed a tumor in the ascending colon,but a subsequent colonoscopy examination indicated a tumor in the descending colon.On March 12,2023,a subtotal colectomy and an ileosigmoidal anastomosis were carried out under general anesthesia.Postoperative pathological findings revealed that all three tumors were adenocarcinomas.The final pathological tumor stage was pT3N0M0.The patient had an uneventful postoperative recovery and was discharged without complications.CONCLUSION The case of this elderly man presents a rare occurrence of metachronous primary cancers in the renal pelvis and colon.Bladder cancer is considered a metastasis of renal pelvis cancer after surgery.Optimal treatment can be implemented by evaluating the patient’s histological features,clinical history,and tumor distribution correctly.

Ileo-colonic intussusception secondary to small-bowel lipomatosis:A case report

Intestinal lipomatosis is a rare disease with an incidence at autopsy ranging from 0.04% to 4.5%.Because the lipomas are diffusely distributed in the intestine,most patients are symptom-free,and invasive intervention is not advised by most doctors.Here,we describe a case with intussusception due to small-bowel lipomatosis.Partial small bowel resection and anastomosis were performed because the intestinal wall was on the verge of perforation.This case indicates that regular followup is necessary and endoscopic treatment should be considered to avoid surgical procedures if the lipoma is large enough to cause intestinal obstruction.

Synovial lipomatosis: A rare cause of knee pain in an adolescent female

Synovial lipomatosis is a benign proliferative disease of the subsynovial adipose which can lead to a variety of presentations. Cases of synovial lipomatosis in children or adolescents are rare. This case report describes an adolescent patient with a rare bilateral presentation of synovial lipomatosis. She had been treated for years prior to her presentation for juvenile idiopathic arthritis. She presented with chronic bilateral knee pain, swelling, and mechanical symptoms. Bilateral MR imaging demonstrated effusions, hypertrophy of the synovium, and polyp-like projections of tissue with the same signal intensity as fat which is pathognomonic for synovial lipomatosis. Arthroscopic synovectomy and extensive debridement of polyp like fat projections of the right knee was performed. Histopathology was consistent with the synovial lipomatosis diagnosis. Postoperatively, the patient was satisfied with her outcome with improved pain relief and function in her right knee.

Patterns of peritoneal spread of tumor in the abdomen and pelvis

The spread of tumor in the peritoneum can be understood, although it is a complex organ. A study of its embryology, anatomy and function is of clear benefit. It is formed from a network of folds, reflections, and potential spaces produced by the visceral and parietal peritoneum. These folds and reflections begin as a dorsal and ventral mesentery, supporting the primitive gut in early embryologic development. The dorsal mesentery connects the stomach and other organs to the posterior abdominal wall, while the ventral mesentery connects the stomach to the ventral abdominal wall. As the embryo develops, there is further organ growth, elongation, cavitation and rotation. The dorsal and ventral mesentery also develops along with the viscera, forming ligaments, mesenteries, omenta and potential spaces from the resulting reflections and folds. These ligaments, mesenteries, and omenta, support and nurture the organs of the peritoneum, providing a highway for arteries, veins, nerves and lymphatics. The potential spaces created from these folds and reflections of the visceral and parietal peritoneum are also important to realize. For example, the transverse mesocolon divides the peritoneal cavity into a supramesocolic and inframesocolic space in the abdomen and paravesicular spaces within the pelvis. The falciform ligament is well known in the supramesocolic space, dividing it further into a left and right compartment. Knowledge of the peritoneal vascular anatomy is beneficial in locating the spaces and ligaments about the peritoneum. For example, identifying the left gastric artery or vein will lead to the gastrohepatic ligament, which is part of the supramesocolic space. Besides serving a life sustaining role, the multiple compartments, ligaments, mesenteries and omenta within the peritoneum can also facilitate the spread of disease. Tumors can spread directly from one organ to another, seed metastatic deposits in the peritoneal cavity, and travel through the lymphatic or hematogenous route to invade other organs in the peritoneum.

Spontaneous rupture of the renal pelvis presenting as an urinoma in locally advanced rectal cancer

A 29-year-old gentleman underwent a transverse colostomy for intestinal obstruction caused by advanced rectal carcinoma. On the 5th postoperative day, the patient developed a painful swelling on the right side of the abdomen. The contrast enhanced computed tomography of the abdomen revealed a right sided hydronephrosis, a large rent in the renal pelvis, and a large retroperitoneal fluid collection on the right side. Percutaneous nephrostomy and pigtail catheter drainage of the urinoma led to resolution of abdominal swelling. Development of a urinoma as a consequence of rectal carcinoma is highly unusual. Prompt imaging for confirmation of diagnosis, decompression of the renal pelvicalyceal system, and drainage of the urinoma limits morbidity.

Pelvic lipomatosis with cystitis glandularis managed with cyclooxygenase-2 inhibitor:A case report

BACKGROUND Pelvic lipomatosis(PL)is a rare benign condition with characteristic overgrowth of histologically benign fat and invasion and compression of pelvic organs,often leading to non-specific lower urinary tract symptoms(LUTS).Approximately 40%of patients with PL have cystitis glandularis(CG).The cause of PL combined with CG is poorly understood,and there is currently no effective treatment.Refractory CG with upper urinary tract obstruction even requires partial or radical bladder resection.CASE SUMMARY In this case,a patient suffering from PL with CG was treated by transurethral resection of bladder tumour(TUR-BT)and oral administration of celecoxib,a selective cyclooxygenase-2(COX-2)inhibitor.The LUTS were alleviated,and the cystoscopy results improved significantly.Immunohistochemistry showed upregulated COX-2 expression in the epithelium of TUR-BT samples,suggesting that COX-2 may participate in the pathophysiological process of PL combined with CG.CONCLUSION We report for the first time that celecoxib may be an effective treatment strategy for PL combined with refractory CG.

Benign symmetric lipomatosis of the knees

Benign symmetric lipomatosis（BSL） is a rare disease characterized by the presence of multiple, symmetric and nonencapsulated fat masses in the face. neck and other areas. It is commonly seen in middle-aged Caucasian Mediterranean males, while its etiology is still not clear. The majority of the patients with BSL have a history of alcohol abuse and hepatopathy. BSL of the limbs is very rare. This article reports a unique case of a 60-year-old Chinese woman with involvement of the knees confirmed by the results of magnetic resonance imaging（MR1） and histopathology, which was not described previously in published literatures.

Carcinomas of the renal pelvis and ureter:a clinicopathological study of 63 cases with a review of literature

Objective： The aim of this study was to summarize the clinicopathological characteristics of patients with renal pelvis and ureteral carcinomas, and analyze the recurrence in the remaining urinary tract and metastasis outside the urinary tract after surgical treatment. Methods： The patients＇ characteristics, tumor stage and grade, recurrence and metastasis distribution were summarized by tables, respectively. Spearman rank test, Log-rank test, Kaplan-Meier survival curve, and Cox proportional hazards regression model were used to make statistical analysis. Results： A total of 63 patients with 30 men, 33 women, 30 renal pelvic tumors and 33 ureteral tumors was found. Seven had muttifocal lesions. Fifty-four underwent surgical operation, which contained 49 cases of pathologically confirmed transitional cell carcinoma, 4 transitional cell carcinoma with squamous differentiation, and 1 squamous cell carcinoma. Tumor stage and grade had positive correlation. Among the 34 followed-up cases, 21 had no metastasis, 10 had metastasis, in which stage T3-4 groups accounted for 90%, and 5 developed tumor recurrences. The metastasis-free survivals had no significant difference between renal pelvic carcinoma and ureteral carcinoma, but had significant difference between high, middle and low stage groups, and between high and low grade groups. Conclusion： The incidence rates of the renal pelvic carcinoma and ureteral carcinoma is similar and no gender difference. Multifocal lesions can be seen Jn any stage and grade, but this is not necessarily a symbol of poor prognosis. The bladder recurrences is often seen in the cases with initially multifocal lesions or lesions in the middle or lower portion of the ureter. The prognosis is good after resection of the recurrence lesion. The prognosis get worse with the increasing stages and grades. Stage is the main factor to influence the survival. Metastasis outside the urinary tract is often seen in patients with high stage tumors.

Primary follicular lymphoma in the renal pelvis:A rare case report

BACKGROUND Follicular lymphoma(FL)is more common in lymph nodes,while primary extranodal lymphomas are rare.Urinary tract lymphoid neoplasms are extremely rare,accounting for less than 5%of all extranodal lymphomas.Only one case of FL from the renal pelvis has previously been reported.CASE SUMMARY A 70-year-old male patient with a history of esophageal cancer visited our hospital for follow-up examination.Abdominal computed tomography revealed a malignant mass in the right renal pelvis.The whole-body positron emission tomography/computed tomography showed a significant increase in fluorodeoxyglucose uptake of this soft tissue mass and no abnormal fluorodeoxyglucose uptake in the esophageal wall.The patient underwent radical resection of a malignant tumor in the right kidney,which was confirmed by postoperative pathology to be FL.The patient received no radiation or chemotherapy after surgery,and no recurrence of lymphoma or other malignant tumors was found at the 1-year follow-up.CONCLUSION Extranodal FL is more common in the skin and gastrointestinal tract but rarely occurs in the urinary tract.This is the second report of primary renal FL.Localized extranodal FL is expected to have a favorable prognosis and can be cured by local resection.

Benign symmetric lipomatosis (Madelung’s disease) with concomitant incarcerated femoral hernia: A case report

BACKGROUND Benign symmetric lipomatosis(BSL)was first described by Brodie in 1846 and defined as Madelung’s disease by Madelung in 1888.At present,about 400 cases have been reported worldwide.Across these cases,surgical resection remains the recommended treatment.Here we report a case of neck BSL with concomitant thick fatty deposit in the inguinal region,which concealed the signs of a right incarcerated femoral hernia.CASE SUMMARY A 69-year-old male patient was admitted to our hospital with“abdominal pain,abdominal distension,nausea-vomiting and difficult defecation for half a month”.Moreover,he had a mass in the right inguinal region for more than 10 years.An egg-sized neck mass also developed 15 years ago and had developed into a full neck enlargement 1 year later.In addition,the patient had a history of heavy alcohol consumption for more than 40 years.With the aid of computerized tomography scan,the patient was diagnosed with BSL and a low intestinal mechanical obstruction caused by a right inguinal incarcerated hernia.Under general anesthesia,right inguinal incarcerated femoral hernia loosening and tension-free hernia repair was performed.However,this patient did not receive BSL resection.After a 1-year follow-up,no recurrence of the right inguinal femoral hernia was found.Moreover,no increase in fat accumulation was found in the neck or other areas.CONCLUSION Secretive intraperitoneal fat increase may be difficult to detect,but a conservative treatment strategy can be adopted as long as it does not significantly affect the quality-of-life.

Pelvic lipomatosis and renal transplantation:A case report

BACKGROUND Pelvic lipomatosis is a rare disease of unknown etiology,characterized by the overgrowth of pelvic adipose tissue that causes compression of the urinary tract including the bladder and ureters,rectum and blood vessels.The patient may progressively develop obstructive uropathy which could subsequently lead to renal failure.At present,there are no reports of renal transplantation due to uremia caused by pelvic lipomatosis.The ideal management of patients with pelvic lipomatosis after renal transplantation is not yet well-established due to the lack of literature and follow-up data.CASE SUMMARY We report a 37-year-old male patient with pelvic lipomatosis who received a successful living donor renal transplantation on July 22,2015.The operation was complicated as the iliac vessels and bladder were wrapped entirely in excessive abnormal fat.The external iliac artery and vein were located using ultrasonographic guidance.The adipose tissue around the right bladder was removed as far as possible,and the graft ureter was reimplanted into the bladder,using the Lich-Gregoir technique.At 22 mo after transplantation,graft percutaneous nephrostomy was performed under ultrasonographic guidance for urinary diversion due to hydronephrosis of the graft kidney.Follow-up at four years showed that the renal allograft function was stable.CONCLUSION When patients with pelvic lipomatosis develop renal failure,renal transplantation could be a feasible treatment strategy.

Gastric pseudolipomatosis, usual or unusual? Re-evaluation of 909 endoscopic gastric biopsies

Microvesicular pneumatosis intestinalis, also called 'pseudolipomatosis' for resembling fatty infiltration, is characterized by the presence of small gas voids in the gastrointestinal wall, especially in mucosa. These voids are not lined with epithelia. There are few reported cases about colon, duodenum and skin. Because there is only one case report about pseudolipomatosis in the stomach, we reevaluated 909 endoscopic biopsies taken from gastric corpus to check the presence of pseudolipomatosis. We determined pseudolipomatosis foci in 3 percent (n=27) of biopsies. In two cases there were pseudolipomatosis foci in endoscopic biopsies having otherwise normal histologic findings, while there were pseudolipomatosis foci in endoscopic biopsies of 25 patients with gastritis. H pylori was found in 85 % of biopsies having pseudolipomatosis foci. In this study, we presented some histopathologic characteristics of pseudolipomatosis seen in gastric mucosa.

Spectrum of mucin-producing neoplastic conditions of the abdomen and pelvis:Cross-sectional imaging evaluation

Various mucin-producing neoplasms originate in different abdominal and pelvic organs.Mucinous neoplasms differ from non-mucinous neoplasms because of the differences in clinical outcome and imaging appearance.Mucinous carcinoma,in which at least 50%of the tumor is composed of large pools of extracellular mucin and columns of malignant cells,is associated with a worse prognosis.Signet ring cell carcinoma is characterized by large intracytoplasmic mucin vacuoles that expand in the malignant cells with the nucleus displaced to the periphery.Its prognosis is also generally poor.In contrast,intraductal papillary mucinous neoplasm of the bile duct and pancreas,which is characterized by proliferation of ductal epithelium and variable mucin production,has a better prognosis than other malignancies in the pancreaticobiliary tree.Imaging modalities play a critical role in differentiating mucinous from non-mucinous neoplasms.Due to high water content,mucin has a similar appearance to water on ultrasound(US) ,computed tomography(CT) ,and magnetic resonance imaging,except when thick and proteinaceous,and then it tends to be hypoechoic with fine internal echoes or have complex echogenicity on US,hyperdense on CT,and hyperintense on T1and hypointense on T2-weighted images,compared to water.Therefore,knowledge of characteristic mucin imaging features is helpful to diagnose various mucinproducing neoplastic conditions and to facilitate appropriate treatment.

Retroperitoneal laparoscopic partial resection of the renal pelvis for urothelial carcinoma:A case report

BACKGROUND The standard treatment of transitional cell carcinoma of the upper urinary tract consists of radical nephroureterectomy with bladder cuff removal,which can be performed either in open or laparoscopy or robot-assisted laparoscopy.Treatment of chronic renal insufficiency patients with upper urothelial tumor is in a dilemma.Urologists weigh and consider the balance between tumor control and effective renal function preservation.European Association of Urology guidelines recommend that select patients may benefit from endoscopic treatment,but laparoscopic treatment is rarely reported.CASE SUMMARY In this case report,we describe a case of 79-year-old female diagnosed with urothelial carcinoma of the renal pelvis and adrenal adenoma with chronic renal insufficiency.The patient was treated with retroperitoneal laparoscopic partial resection of the renal pelvis and adrenal adenoma resection simultaneously.CONCLUSION Retroperitoneal laparoscopic partial resection of the renal pelvis is an effective surgical procedure for the treatment of urothelial carcinoma of the renal pelvis.

Chylous ascites after whole pelvis suspension:case report and literature review

We report a case of Chylous ascites after whole pelvis suspension and to discuss the possible reasons. An 85-year-old female patient with anterior vaginal prolapse 1V （AVP IV）, vaginal vault proplapse IV and posterior vaginal prolapse IV （PVP IV）, developed Chylous ascites 2 weeks after she received whole pelvis suspension, The cause of chylous ascites in the present case was not associated with malignant tumor, hepatic cirrhosis, or inflammation. Therefore, surgical trauma may be considered the cause of disorder. X-ray lymphangioadenography should be performed to draw a final conclusion.

Pyonephrosis as a sign of sarcomatoid carcinoma of the renal pelvis

We report the case of an urgent nephrectomy because of a pyonephrosis and sepsis due to an unsuspected sarcomatoid transitional cell carcinoma, an infrequent subtype with a bad oncological prognosis. We present a 58-year-old man assessed by internal medicine for a general syndrome and weakness many months previously. A pyonephrotic kidney was observed at abdominal computed tomography in the context of septic shock, without suspecting the underlying cause. The pathology report described a sarcomatoid transitional cell carcinoma. Sarcomatoid transitional cell carcinoma is an invasive and infrequent subtype of urothelial tumors. The symptoms are often the same as other renal masses; however, in this case, sepsis and pyonephrosis were the rare initial symptoms.

Melanoma metastases in the abdomen and pelvis: Frequency and patterns of spread

AIM: To investigate the frequency, typical and atypical locations and patterns of melanoma metastases identifiable by computed tomography (CT) in the abdomen and pelvis. METHODS: We performed a retrospective review of index CT examinations of the abdomen and pelvis in patients with melanoma and recorded all findings suggestive of metastatic disease. RESULTS: Metastases were present on 36% (181/508) of the index examinations and most commonly involved the liver (47%) and pelvic lymph nodes (27%). Lower extremity primaries had the highest rate of metastasis (52%). Ocular and head and neck melanomas have a predilection to metastasize to the liver (hepatic involvement in 70% and 63%, respectively, of patients with metastatic disease) and metastases from lower extremity primaries most commonly involve pelvic lymph nodes (54% of patients with metastatic disease). Metastases to atypical locations were present in 14% of patients and most commonly occurred in the subcutaneous tissue and spleen. Primary tumors of the lower extremity, back and head and neck were most commonly associated with atypical metastases. Pelvic metastases are more common with lower extremity primaries (accounting for 70% of cases with pelvic metastases) but 5% of patients with supraumbilical primaries also had pelvic metastases. CONCLUSION: The distribution of metastatic melanoma in the abdomen and pelvis that we have defined should help guide the interpretation of CT exams in these patients.

Planning Margins to CTV for Image-Guided Whole Pelvis Prostate Cancer Intensity-Modulated Radiotherapy

Purpose: We investigated the margin recipes with different alignment techniques in the image-guided intensity-modulated radiotherapy (IMRT) of whole pelvis prostate cancer patients. Materials and Methods: Forty-eight computed tomography (CT) scans of eight prostate cancer patients were investigated. Each patient had an initial planning CT scan and 5 consecutive serial CT scans during the course of treatment, all of which were acquired using 3 mm slice separation and 0.94 mm resolution in the axial plane at 120 kVp, on a PQ 5000 CT scanner. Three different whole pelvis planning margin recipes, ranging from 3 to 13 mm, were investigated. A unique IMRT plan was created with each PTV on the initial CT scan, and was then registered to the 5 serial CT scans, by bony alignment or by prostate gland-based alignment. The dose computed on each serial CT scans was accumulated back to the initial CT scan using deformable image registration for final dosimetric evaluation of the interplay of the margin selection and alignment methods. Results: Bony alignment and prostate gland-based alignment gave very similar result to the pelvic lymphatic nodes (PLNs), regardless of its margin around. The prostate gland-based alignment greatly enhanced the coverage to the prostate and SV, especially with small margins. Meanwhile, the soft-tissue alignment also raised the incidental dose to the rectum and reduces the dose to the bladder. With small to intermediate margins, only soft-tissue alignment gave acceptable mean coverage to SV. Margin of 13mm or more was needed for PLNs to maintain good target coverage. Conclusion: We commend prostate-based alignment along with margins less than or equal to 5mm around prostate and SV, and margins greater than or equal to 13 mm around the vascular spaces.

Diffuse Lipomatosis of Thyroid—Case Report

Diffuse lipomatosis of thyroid gland is very rare disease, characterized by diffuse proliferation of adipose tissue in the thyroid gland, the pathophysiology of adipose tissue infiltration in the thyroid gland remains unknown. We report a case of a 55-year-old female who presented 6 months ago a dysphonia, ultrasound of the neck revealed the presence diffuse goiter with heterogeneous echogenicity, her thyroid hormone levels were normal, thyroid isotope scanning showed heterogeneous uptake of radioactivity and coexistence of cold and hot nodules. The patient underwent total thyroidectomy. Histological study concluded to the diagnosis of diffuse lipomatosis of thyroid gland.

Renal Replacement Lipomatosis—A Rare Benign Condition

Introduction: Renal replacement lipomatosis is a rare condition that occurs at the end of the spectrum of renal tissue replacement by fat. It is usually unilateral and occurs as a result of severe renal atrophy or destruction usually due to chronic calculus disease, chronic pyelonephritis and renal tuberculosis. The most commonly used diagnostic investigation remains CECT (contrast enhanced computed tomography) scan. Herein we report our series of patients with total renal replacement lipomatosistreated by nephrectomy. Materials & Methods: We retrospectively reviewed our hospital data for cases of RRL, presented and treated during the period Jan. 2006-Dec. 2015. The age, gender, presenting symptoms, clinical and laboratory findings were noted. The indications for surgery, postoperative outcomes and complications were similarly noted and analyzed. Results: Five patients (three females and two males) with a mean age of 48.4 ± 3.2 years presented with symptoms of pain. Computed tomography (CT) in these patients showed the affected kidney to be completely distorted and replaced by ill-defined fatty attenuating lesion. Open nephrectomy was done in all these patients. Histo-pathological report (HPR) revealed features of RRL with renal calculi. Conclusions: Renal replacement lipomatosis is an uncommon entity, and one should have a high index of suspicion when dealing with suspicious lesions similar to xanthogranulomatous pyelonephritis. Specific imaging, operative, and pathological differences may provide clues for the differential diagnosis.