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.

Early diagnosis of renal pelvis villous adenoma:A case report

BACKGROUND Villous adenoma is a rare tumor in the urinary system that usually occurs in the bladder.It is extremely uncommon in the renal pelvis.Most of the previously reported cases have been diagnosed with severe hydronephrosis associated with renal parenchyma atrophy prior to surgery.Because of its rarity,available information on the pathogenesis,diagnosis,treatment and prognosis of the disease is limited.We reported a case of kidney stones with hydronephrosis.During percutaneous nephroscopic lithotripsy,a renal pelvis tumor was found.Biopsy confirmed that the tumor was a villous adenoma of the renal pelvis.CASE SUMMARY A 68-year-old female was admitted to the hospital due to right kidney stones with right hydronephrosis.After admission,a urinary system plain computed tomography scan was performed,which revealed right kidney stones with right hydronephrosis and right upper ureteral dilatation.Multiple new cauliflower-like papillary masses were then discovered in the renal pelvis and calyces during right percutaneous nephroscopic lithotripsy.Biopsy results indicated villous adenoma with high-grade glandular intraepithelial neoplasia.The patient underwent laparoscopic radical resection of the right kidney and ureter.Based on histopathological and immunohistochemical examination,the patient was diagnosed with villous adenoma without adenocarcinoma.CONCLUSION Villous adenoma is rare in the urinary system.We reported a case of renal pelvis villous adenoma,which may provide useful information for the early diagnosis and treatment of this tumor.

Renal pelvis sarcomatoid carcinoma with renal vein tumor thrombus:A case report and literature review

BACKGROUND Renal pelvis sarcomatoid carcinoma(RPSC)is a rare and aggressive malignancy whose diagnosis is difficult because radiological imaging results can lead to misclassification as a more common type of renal tumor.In addition,clinical management of patients with RPSC is difficult because of the limited efficacy of available treatments.In this study,we present a comprehensive description of a patient who presented with RPSC and a simultaneous renal vein tumor thrombus.CASE SUMMARY During April,2020,a 64-year-old female presented with an isolated episode of hematuria accompanied by abdominal pain.Computed tomography(CT)and magnetic resonance imaging(MRI)showed a lesion in the right renal pelvis.We therefore performed a radical nephrectomy of the right kidney.The subsequent histopathological and immunological results verified the diagnosis of RPSC.Despite administration of 6 cycles of a gemcitabine-cisplatin regimen,the patient's condition progressively deteriorated,and she died about 15 mo after the nephrectomy.CONCLUSION We performed a comprehensive analysis of a patient with RPSC that included CT,MRI,immunohistochemistry,and genetic testing.The insights from our detailed analysis of this patient and our concomitant review of the literature may assist clinicians in their diagnosis and treatment of RPSC.

A Case Report: High-Grade Urothelial Carcinoma in the Renal Pelvis with Complete Kidney and Ureter Duplication Featuring Heterologous Differentiation

This report describes a considerably rare case of high-grade urothelial carcinoma of the renal pelvis and ureter,presenting with heterologous differentiation,in a patient with bilateral duplicated kidneys.A 73-year-old male experienced intermittent gross hematuria for 5 months,accompanied by lower back and abdominal pain.Ultrasound and computed tomography scans revealed bilateral renal and ureteral duplication with multiple tumors in the left renal pelvis.A total nephroterectomy and bladder cuff resection were performed on the left two nephrons.Multiple space-occupying lesions were identified in the left renal pelvis and ureter.Histopathological examination showed poorly differentiated and diverse tumor cells,manifesting as sarcomatoid carcinoma,papillary adenocarcinoma,and infiltrating high-grade urothelial carcinoma.The tumor infiltrated the subcutaneous fibrous connective tissue of the renal pelvis and the full thickness of the ureter.Given the rarity of recurrent renal urothelial carcinoma with heterogeneous differentiation,comprehensive imaging and pathological assessments are vital to delineate the nature of the lesion and the direction of tissue pathological heterologous differentiation.These evaluations guide early radical surgical interventions,improving survival rates.

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.

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.

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.

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.

Amyloidosis of the Unilateral Renal Pelvis,Ureter and Urinary Bladder:a Case Report

AMYLOIDOSIS of more than two urinary organs happened in one person is very rare.Here we reported a patient with amyloidosis of the left renal pelvis, ipsilateral ureter as well as urinary bladder occurring successively.

Solitary fibrous tumor of the renal pelvis:A case report

BACKGROUND Solitary fibrous tumor(SFT)is a rare mesenchymal neoplasm.SFT derived from the renal pelvis is an exceedingly rare entity.In this study,we report a case of renal pelvis SFT and review the relevant literature on this rare tumor.CASE SUMMARY A 76-year-old man was hospitalized due to right lumbar and abdominal pain.Abdominal computed tomography showed a hypervascular space-occupying renal lesion,sized 2.3 cm×1.8 cm.Based on the computed tomography findings,the patient was diagnosed with right renal pelvis tumor and underwent nephrectomy.Postoperative immunohistochemical results confirmed the diagnosis.As of the 3-year follow-up,there were no signs of recurrence,and the patient has recovered well.CONCLUSION We report a rare case of SFT derived from the renal pelvis and discuss the imaging and histopathological features that distinguish renal pelvis SFT from other renal pelvis tumors.

Clinical analysis of squamous cell carcinoma of renal pelvis

Objective To review the diagnosis and treatment of squamous cell carcinoma of renal pelvis. Methods The clinical data,from October 1991 to May 2009,of eight cases of squamous cell carcinoma of renal

Adherence of uropathogenic Escherichia coli to human primary epithelial cells of renal pelvis

Human primary epithelial cells of renal pelvis was established to investigate the adherence of uropathogenic Escherichia coli （UPEC） to this cell line, in which the primary cell culture was performed by using cultivation of the normal epithelium of renal pelvis in keratinocyte serum free medium （K-SFM） with epidermal growth factor （EGF） and bovine pituitary extract （BPE）. Both UPEC132 obtained from urine specimen of patients with pyelonephritis and the pilus-free representative strain E. coli K-12p678- 54 were used to study the adherence of these strains on human primary epithelial cells of renal pelvis. The UPEC adherence was performed with observation on the morphological changes of the adhered cells, while the adhesion rates and indices were calculated in different times of experiment. In addition, the virulence genes hly and cnfl of UPEC132 were detected by multiplex PCR assay. In this study, the human primary epithelial cells of renal pelvis was found to exhibit the character of the transitional epithelial cells. Compared with the control group, the adhesion rates and indices began to increase from 15 min of the experiment time and reached its peak in 120 min. The adhesion rate and index of UPEC132 to human primary epithelial cells of renal pelvis were 74.4% and 34.0 respectively. Many microscopic changes in the primary cells adhered with UPEC132 could be detected, such as rounding or irregularity in shape, unevenness in staining and the cytoplasmic and nuclear changes. It suggests that human primary epithelial cells of renal pelvis can be used for the experiment on UPEC adhesion, thus providing a basis for the further study on the pathogenesis of UPEC.

Images for diagnosis Sarcomatoid carcinoma of the renal pelvis in duplex kidney

Sarcomatoid transitional cell carcinoma of the renal pelvis is a rare neoplasm with only 14 well-illustrated examples reported previously. Duplex kidney is the most common congenital abnormality of the urinary tract, with an incidence of around 2%. Neoplasia of the renal pelvis in duplex kidney is rare. We reported a case whose sarcomatoid carcinoma originated from the upper portion of the duplicated renal pelvis with hydronephrosis, and total nephroureterectomy with bladder cuff excision surgery of both renal units was carried out. Because of the rare nature of renal pelvic sarcomatoid carcinoma and its apparent lack of response to adjuvant therapy, it is essential to do early diagnosis and early radical surgery to improve survival. It is important to stress the need for frequent and diligent monitoring or treating complex duplex kidney with hydronephrosis of either moiety in case of a risk of havina neoplasias.

Report of primary leiomyosarcoma of renal pelvis and literature review

Primary sarcomas of kidney are exceptionally rare tumors,accounting for only 1-2%of all malignant tumors of kidney.Leiomyosarcoma(LMS)is the most common histological subtype among all renal sarcomas.The authors describe here a case of primary leiomyosarcoma of renal pelvis in a 50-year-old lady,presenting with flank pain.Based on triple phase cardio-electroencephalographic covariance tracing abdomen,presumptive diagnosis of renal cell carcinoma/renal sarcoma/neurogenic tumor was made and patient underwent radical nephrectomy.Microscopy reflected spindle cell tumor which showed strong positivity for desmin and smooth muscle actin with negative epithelial markers,thereby confirming the diagnosis of renal LMS.Owing to aggressive nature and low survival rates of LMS patient received adjuvant treatment in form of chemotherapy and radiotherapy.Patient is doing well 1 year post treatment.

Comparison stone-free rate and effects on quality of life of percutaneous nephrolithotomy and retrograde intrarenal surgery for treatment of renal pelvis stone(2-4 cm):A prospective controlled study

Objectives:The aim of our study was to compare the effects on quality of life(QoL)and stone-free rate(SFR)of percutane nephrolithotomy(PNL)and retrograde intrarenal surgery(RIRS)in patients with renal stones 2-4 cm.Materials and methods:A total of 102 patients with renal pelvis stones were enrolled in this prospective controlled study,of which 52 were performed RIRS and 50 with PNL.The QoL was evaluated by using Short From-36 pre-and post-operatively.Also,the surgical data of all patients during and after the operations were compared between the 2 groups.Results:The mean age,body mass index,stone size and density of the patients in the 2 groups were statistically similar(p>0.05).The SFR of PNL and RIRS were found 94%(47/50)and 73%(38/52),respectively(p<0.01).There were no statistically differences between operation times,minor complication rates and Short From-36 scores of the 2 groups.Hospitalization times were 1.13±0.34days for RIRS and 2.9±5.7days for PNL(p<0.05).While the blood transfusion rate of PNL group was 8%(4/50),none patient was made blood transfusion in RIRS.Conclusions:The results of our study show that the blood transfusion rates and hospitalization times of RIRS group are significantly lower than PNL for management of renal pelvis stone 2-4 cm.Despite these advantages of RIRS,the SFR is significantly lower than PNL for these stones.The effects on QoL of the both interventions before and after surgery were similar.

Primary small cell carcinoma of kidney after renal transplantation:a case report and literature review

Extrapulmonary small cell carcinoma （EPSCC） is a rare neoplasm comprising 2.5％ to 5％ of small cell carcinomas （SCCs）.Bladder SCC is the most common site of genitourinary tract.Primary renal SCC is extremely rare.We report a case of primary SCC of the kidney which is rarely reported in the urinary tract and presents an aggressive clinical picture.A 59-year-old female visited a urologic clinic with complaint of persistent left flank soreness 10 years after undergoing renal transplantation.Abdominal computed tomography showed a left renal pelvis tumor.After the patient received left nephroureterectomy with bladder cuff resection,her pathology results showed SCC.After surgery,she received adjuvant systemic chemotherapy,and her recovery has been uneventful as of 8 months.Primary renal SCC presents with an advanced tumor stage and a short median survival period,therefore early intervention and close follow-up are recommended.

Renal Pelvic Carcinosarcoma: One Case Report and Literature Review

IntroductionRenal pelvic carcinosarcoma (RPCS) is rare in clinic,and difficultto make preoperative diagnosis.One patient diagnosed as RPCS wastreated in our hospital in August 2008.We made it as a case report asfollows.

Revisiting the morphology of pelvicalyceal system in human cadaveric kidneys with a systematic review of literature

Objective:Renal collecting system macroscopically consists of minor calyx,major calyx,renal pelvis and ureter.Stone in renal collecting system is a common presentation in everyday urological practice.The prevalence of renal calculi ranges from 4%to 20%in different geographical distribution.Anatomical variation in renal collecting system plays a significant role in formation of calculi in its parts.The large extra renal pelvis leads to stagnation of urine for longer durations and formation of stones.The stone free rate after percutaneous nephrolithotomy and extra corporeal shock wave lithotomy is significantly related to anatomical factors,particularly the type of renal pelvis and dimensions(length and width)of lower infundibulum.Previous authors described the morphology of pelvicalyceal system in a highly variable manner and the available anatomical description of pelvicalyceal system is contradictory and incomplete.Hence an attempt has been made to provide the precise anatomy of pelvicalyceal system in adult human kidneys.Methods:We studied 196 formalin embalmed kidneys to note the number of infundibulum,major and minor calyces.The location and shape of pelvis were also studied.Results:The intra-renal pelvis was narrow and had funnel shaped appearance in 95 of total 196(48.5%)specimens,and the extra-renal pelvis was dilated as balloon shaped in 43 of 196(21.9%)specimens.In 41(20.9%)specimens,the renal pelvis was having partially intra-and extra-renal in location.Bilateral symmetry was found in only 27.1%of 196 renal collecting systems.The length of lower infundibulum was more than 22 mm in 19(9.7%)of 196 cases which directly affects the stone clearance rate during open and endoscopic surgeries on pelvicalyceal system.Conclusion:This study provides the accurate morphological details of the shape and dimensions of renal pelvicalyceal system to help the urologists and nephrologists.