A case of localized amyloidosis of the bladder manifesting post-renal failure

We report a case of primary localized amyloidosis of the bladder which manifested post-renal failure. A 79-year-old woman with diabetes mellitus complained of anorexia and oliguria. Computed tomographic (CT) scan showed bilateral hydronephrosis. Cystoscopic examination revealed a broad-based nonpapillary tumor in the trigonum of the bladder and CT scan demonstrated thickening of the posterior wall of the bladder. Pathological examination of the transurethral biopsy specimen revealed amyloid deposits in the submucosa, but no malignant changes were found. Cytodiagnosis of washing fluid of the bladder revealed amyloid deposits around the exfoliative cells. Serum electrophoresis showed a normal pattern. Urinary Bence-Jones protein was not detected. Amyloid deposits were not found in rectal mucosa. Systemic or secondary amyloidosis was ruled out from these findings, and primary localized amyloidosis of the bladder was diagnosed. The mass of the bladder was transurethrally resected and pig-tail stents were indwelt. These procedures gave a satisfactory result.     

Primary malignant lymphoma of the urinary bladder: a case report

We report a case of primary malignant lymphoma of the urinary bladder. A 72-year old woman complaining of low abdominal pain was admitted to the Tone Central Hospital in February, 2001. Macrohematuria appeared, and the submucosal tumor was observed by cystoscopy, and A Transurethral bladder biopsy led to a histopathological diagnosis of non-Hodgkin's malignant lymphoma (diffuse lymphoma, large-sized cell type, B-cell type). Clinical stage was IE, but as soon, she was get bilateral hydronephrosis and bladder-ileum fistula. The administration of 6-course CHOP chemotherapy had an excellent effect of disappearing the tumor, bilateral hydronephrosis, and bladder-ileum fistula. She remained free of disease until now.     

A model of orthotopic transplantation in mice using MBT-2

We attempted to produce a malignant urinary bladder carcinoma in mice by transplanting MBT-2 cells. MBT-2 carcinoma about 3.0 x 10(3) cells/0.02 ml were successfully transplanted into the bladder wall with an incidence of 80% (20/25) after three experimental weeks. Inoculated tumor cells grew expansively into the bladder cavity from the bladder submucosa, and invaded the muscle layer. We observed that tumors caused gross hematuria and bilateral hydronephrosis. This malignant tumor model in which a tumor is implanted into its original organs seems to be useful for predicting clinical effectiveness in experimental cancer therapy.     

Malignant hemangiopericytoma of the pelvis. Report of a case with urological implications and immunohistochemical analysis.

A case of a malignant hemangiopericytoma located in the pelvic fossa of a 50-year old man is reported. The tumor displaced the urinary bladder and caused bilateral hydronephrosis. Light microscopic diagnosis was followed by immunohistochemistry. After surgery the patient was successfully treated by chemotherapy and irradiation. This paper reviews clinicopathological features in respect of prognosis and a possible treatment.     

A case of proliferative cystitis forming ureterovesical junction obstruction

We report a case of proliferative cystitis forming ureterovesical junction obstruction. A 28-year-old man presented with a complaint of gross hematuria. Abdominal ultrasonography revealed left hydronephrosis and bladder tumor. Drip infusion pyelography (DIP) demonstrated left ureterovesical junction obstruction and cystoscopic findings appeared papillary sessile tumor around the bladder neck, trigone, and bilateral ureteral orifice. Transurethral resection of the bladder tumor (TURBT) was performed. The pathological diagnosis of the tumor was proliferative cystitis and confirmed that left ureterovesical junction obstruction was derived from proliferative cystitis. The tumor was not responsive to medical treatment. After the 4th TURBT, the tumor was completely resected, and left hydronephrosis and ureterovesical junction obstruction were improved. One year after the last operation, there is no evidence of recurrence of the tumor. Tumor formation arising from proliferative cystitis is relatively rare. Pathogenesis and management of this rare condition are discussed.     

Sjogren's syndrome with bilateral hydronephrosis caused by pseudolymphoma of bilateral renal pelves: a case report

We report a case of bilateral hydronephrosis caused by pseudolymphoma of bilateral renal pelves. A 52-year-old woman with Sjogren's syndrome and bronchial asthma was found to have bilateral hydronephrosis. Abdominal plain computerized tomography showed an irregular thickening of the bilateral renal pelves with moderate hydronephrosis. The gallium scintigraphy revealed intense tracer uptake in bilateral renal pelves. Open biopsy of the right renal pelvis was performed under the diagnosis of malignant lymphoma. The pathologic diagnosis was pseudolymphoma of the renal pelvis. Steroid therapy dramatically improved pseudolymphoma and hydronephrosis within a month. There were no signs of recurrence.     

A case of bladder tumor producing granulocyte colony-stimulating factor

A 75-year-old male was admitted with high grade fever, general fatigue, and appetite loss. The laboratory examinations revealed leukocytosis of 31,700/mm3 (neutrophils: 88%) in the peripheral blood. Cystoscopy demonstrated multiple bladder tumor. Computed tomography revealed bilateral hydronephrosis due to bladder tumor. Bilateral nephrostomy and transurethral resection bladder tumor were performed. Histological diagnosis was squamous cell carcinoma and immunohistochemical staining of the resected tumor using antihuman granulocyte colony-stimulating factor (G-CSF) antibody showed positive staining in the cytoplasm of the tumor cells. Serum analysis revealed a high level of G-CSF 126 pg/ml (normal: less than 18.1 pg/ml). Total cystectomy and bilateral cutaneous ureterostomy were performed. He died of cancer 3.5 months after admission. This is the 48th case in Japanese literature.     

Bilateral upper tract urothelial carcinoma eight years after total cystectomy and Indiana pouch urinary diversion for bladder cancer : a case report

A 46-year-old man underwent total cystectomy and Indiana pouch urinary diversion for bladder cancer in 2001. Pathological examination revealed an urothelial carcinoma of the bladder (pT2N0M0). He was referred to our hospital for bilateral hydronephrosis in June 2009. Cytological examination of the urine was negative. Percutaneous nephrostomy was performed, and we suspected bilateral ureteral tumors from pyelo-ureterography. Percutaneous ureteroscopy revealed a papillary tumor in the right ureter. Since there appeared to be a papillary tumor in the left ureter, we decided to perform ureterectomy for bilateral ureteral tumors, and to keep the bilateral nephrostomy tube for urinary diversion. Pathological examination revealed urothelial carcinoma in bilateral ureters. There has been no sign of recurrence at 17 months after the operation.     

A case of malignant aortico-pulmonary paraganglioma

A 64-year-old male was admitted to our hospital suffering from dysphagia and dyspnea. The chest X-ray films and chest CT films revealed huge tumor in his upper-anterior mediastinum. The filling defect at lower rim of the left brachiocephalic vein on venography indicated malignant potential of the tumor. There was no abnormal value in blood and urine examinations except CA 19-9 which was 31.8 U/ml. The tumor was resected with bilateral pleura, pericardium and left brachiocephalic vein. Macroscopically the specimen accompanied with a lot of bleeding spots was soft and yellow and has no capsule. The size of tumor was 15 X 13 X 8 cm and its weight was 865 gm. No tumor recurrence was found until present time: two years after surgical therapy followed by adjuvant radiation therapy (60 Gray). Though histological findings of anterior part of the tumor were consisted of "Zellballen" cells and bleedings, the posterior part had cell atypia and invasion into vessels. These cells were slightly positive on Keratin stain and on NSE stain. Typical findings of paraganglioma were also indicated by electron microscopy: those findings were more chief cells, fewer sustentacular cells, abundant mitochondria and few dense-cored granules which are thought to secrete hormonal substances. Judging from these clinical and pathological results, this tumor was diagnosed nonfunctional aortico-pulmonary paraganglioma. Mediastinal paraganglioma is a very rare tumor. There is no report of malignant aortico-pulmonary paraganglioma in Japan after Glenner and Grimelys' study concerning extra-adrenal paraganglion system.     

Primary choriocarcinoma of the urinary bladder

A 72-year-old woman with asymptomatic macrohematuria was referred to our hospital. Cystoscopy revealed a 7 cm sessile tumor on the left lateral wall of the bladder. Subsequently an intravenous pyelography revealed left hydronephrosis. We performed transurethral biopsy and resection of the bladder tumor under the diagnosis of ordinary malignant bladder tumor. Histopathologically, the lesion was shown to be an undiffentiated urothelial carcinoma, G3, > or = pT2, containing syncytiotrophoblastic giant cells. The level of serum human chorionic gonadotropin-beta (hCG-beta) level was slightly elevated (0.3 ng/ml; normal value: < 0.1). Because a further examination revealed an invasion into the surrounding fat tissue of the bladder and left ureter, a total cystohysterectomy with an ileal conduit were performed. The final histopathological classification was choriocarcinoma of the urinary bladder, pT3a, pN1, pMx. An adjuvant combination chemotherapy was carried out using methotrexate, vinblastine, adriamycin and cisplatin (MVAC). After two courses of chemotherapy, the serum hCG-beta levels returned to normal. Eleven months postoperatively, however, there was evidence of multiple lung metastases. The patient died 12 months after the surgery as a result of complications caused by widespread metastases.     

Peritoneal mesothelioma presented with bilateral hydronephrosis: a case report

We report a case of peritoneal mesothelioma presenting with bilateral hydronephrosis, which was difficult to be diagnosed. A 43-year-old woman was admitted to our hospital with acute renal failure. Ultrasonography revealed bilateral hydronephrosis. Retrograde pyelography revealed the stenosis of bilateral lower ureter. Pelvic magnetic resonance imaging demonstrated only a small mass lesion around the bilateral ureter. Other examinations showed no findings of malignancy. Under the diagnosis of retroperitoneal fibrosis, steroid therapy was performed. After 3 months, computed tomography (CT) revealed multiple abdominal masses. Percutaneous needle biopsy of tumor was performed. Pathological diagnosis was peritoneal mesothelioma. Chemotherapy based on the pleural mesothelioma was done but not effective, she died 9 months after the first medical examination.     

A case of bladder tumor producing granulocyte colony-stimulating factor

A case of bladder tumor producing granulocyte colony-stimulating factor (G-CSF) is reported. A 78-year-old male presented with macroscopic hematuria. Cystoscopy demonstrated a large bladder tumor. Drip infusion pyelography and computerized tomography of the chest, abdomen and pelvis revealed right hydronephrosis, but did not reveal any metastasis. Total cystectomy and construction of bilateral cutaneous ureterostomy was performed. Histologically, the tumor consisted of sarcomatoid carcinoma with foci of transitional cell carcinoma (G3 > G2), showing marked infiltration of polymorphonuclear leukocytes. Immunohistochemical examination revealed a high concentration of G-CSF in the tumor specimen. Preoperatively, the white blood cell, count in the peripheral blood and serum G-CSF concentration were elevated, 45,400/mm3 and 73.4 pg/ml, respectively. After surgery these values became normal. This is the 19th reported case of G-CSF producing bladder tumor in Japan. The prognosis of the reported cases of G-CSF producing bladder tumor has been very poor. Fourteen of the reported 19 cases died within one year. This patient should be carefully followed up.     

Metastatic bladder tumor from gastric carcinoma: a case report]

A 63-year-old man with a two-month history of nocturia and dysuria consulted his family doctor. As renal dysfunction and bilateral hydronephrosis were indicated, he was admitted to our hospital on November 28, 1988. Cystoscopy revealed a non-papillary and flat tumor from the ureteral orifice to the back wall of the bladder. A biopsy of the bladder wall revealed signet-ring cell carcinoma. A metastatic bladder tumor was suspected and laboratory tests of tumor markers showed a carcinoembryonic antigen value (CEA) of 1,000 ng/ml and CA19-9 of 12,210 U/ml. Upper gastrointestinal examination revealed carcinomatosis involving the stomach. A biopsy specimen of the stomach revealed the same pathological finding as the bladder wall. A metastatic bladder tumor was confirmed. The patient died of pulmonary emboli on December 11, 1988.     

Megacystis microcolon intestinal hypoperistalsis syndrome: bladder distension and pyelectasis in the fetus without anatomic outflow obstruction

We report a case of a 46,XY male infant with a history of normal amniotic fluid levels who was delivered by elective cesarean section at 38.5 weeks' gestation because of progressive bladder distension, hydroureteronephrosis, and what was thought to be a dilated posterior urethra. The child died at 19 days of age of cardiovascular complications. The autopsy revealed megacystis, bilateral megaureters and pyelocaliectasis, congenital absence of ganglion cells in the bladder wall, renal dysplasia, and a microcolon. No dilation or anatomic obstruction of the posterior urethra was found. These findings strongly suggest the diagnosis of megacystis microcolon intestinal hypoperistalsis syndrome. We discuss the ultrasound findings of in utero bladder distension with hydronephrosis and one of its rare etiologies.     

Invasive bladder cancer recurrenced 5 years after complete response status by chemotherapy and radiotherapy: a case report

A 72-year-old man had undergone trasucethral resection of bladder tumor (TUR-Bt) three times from 1990 to 1991 and he had been lost to follow with no recurrence from 1996, came to our hospital complaining of asymptomatic macrohematuria in May 1999. A bladder tumor existed around the right ureteral orifice with right hydronephrosis. MRI and TUR-Bt revealed that the cancer was transitional cell carcinoma (TCC) > small cell carcinoma, G3, pT3b. Because the patient insisted on bladder preservation, intra arterial chemotherapy with cisplatinum (CDDP) and epirubicin (EPI-adr) followed by radiotherapy with CDDP was performed. The treatment resulted in a clinical complete response (CR), and the bladder was preserved. In January 2004, an invasive bladder cancer recurred at the left lateral wall. This time, neoadjuvant intra-arterial chemotherapy with CDDP and EPI-adr, followed by radical cystectomy was performed. Histologically, the recurrent bladder cancer was TCC, G3, pT3b.     

Carcinosarcoma of the bladder: a case report

Carcinosarcoma of the urinary bladder is a uncommon tumor with characteristic histopathologic and immunohistochemical findings; his histogenesis have still not been clear; the prognosis seems to be improved by radical cystectomy and adjuvants therapies. We report a case of 47 years old women suffering from suprapubic pains, dysuria and hematuria of five months duration and had a 10 cm suprapubic mass that was found on physical examination. Radiographically, the tumor invaded the dome of the urinary bladder and causes bilateral hydronephrosis. Microscopically it was an urinary bladder carcinosarcoma. Our objective is to discuss the histogenesis, the anatomoclinical and prognosis of these rare tumors.     

A case of emphysematous cystitis

A 60-year-old woman visited our clinic with a complaint of gross hematuria. She was under treatment for rheumatoid arthritis, amyloidosis and diabetes mellitus at the Departments of Orthopedic Surgery and Internal Medicine. The results of a urine analysis showed protein urine, glucose urine, hematopyuria and bacteriuria. The diagnosis of emphysematous cystitis was made from radiography, ultrasonogram and cystoscopic findings. Antibiotics were administered effectively. However, one month later, bilateral hydronephrosis was identified by a computed tomographic scan performed by the Department of Internal Medicine. The bilateral hydronephrosis was brought on by urinary retention caused by a neurogenic bladder disorder. Thus, an indwelling catheter followed by intermittent catheterization was performed and cholinergic medication prescribed successfully.     

A case of corpus cancer presenting with positive urine cytology

A 76-year-old woman was admitted with a chief complaint of gross hematuria. Although no abnormality was found on excretory pyelography, class IV transitional cell carcinoma was suspected based on urinary cytology. However, no malignancy was observed on cystoscopy or on biopsy of the mucosa of the urinary bladder. Thereafter, class IV or class V carcinoma was continuously found by urinary cytology, and cervical lymphadenopathy was also observed. Since computed tomography showed the uterus enhanced heterogenously, the possibility of a gynecological tumor was considered. Poorly differentiated endometrioid adenocarcinoma was found on histological examination of the endometrium, and similar adenocarcinoma was also found on biopsy of cervical lymph node. Furthermore, infiltration of adenocarcinoma into the proper lamina of urinary bladder was found. These findings suggested that this tumor originated in the uterine body, followed by lymph node metastasis and infiltration into the urinary bladder. Concerning the route of emergence of carcinoma cells in urine, joining in urine via vagina seemed most likely. When malignant cells are found in urine, tumors of the urinary system should primarily be suspected, but at the same time, the possibility of a gynecological tumor should be kept in mind.     

Leiomyoma of the bladder causing bilateral hydronephrosis: a case report

We report a case of bladder leiomyoma with marked bilateral hydronephrosis caused by chronic urinary retention. Surgical finding was that the mass was smooth, fist-sized and had a thin stalk connected to the bladder wall. The tumor was completely removed. Histopathological diagnosis was leiomyoma of the bladder and the post-operative course was uneventful.     

The predictive factors of hydronephrosis in patients with spina bifida: reports from China

Purpose

To identify the risk factors for hydronephrosis in patients with neurogenic bladder caused by spina bifida.

Methods

A retrospective analysis of 120 patients with hydronephrosis between January 2005 and 2012 was conducted. The patients were evaluated for the following factors: age, sex, voiding symptoms, experience of using clean intermittent catheterization, history of urinary tract infection (UTI), history of one or more tethered spinal cord release surgery, routine urine examination, serum creatinine, ultrasound for kidneys, ureters, bladder, and urodynamic findings by univariate and logistic regression analyses.

Results

Among the 120 patients, 45 (38 %) had unilateral or bilateral hydronephrosis. Univariate analysis indicated that detrusor hyperreflexia, poor compliance (PC), vesicoureteral reflux (VUR), urinary incontinence, high residual urine, and UTI were the significant factors in the incidence of hydronephrosis. Multivariate analysis indicated that PC, VUR, and UTI were the risk factors for hydronephrosis and that detrusor hyperreflexia and urinary incontinence were the protective factors. UTI was the most serious risk factor for hydronephrosis, with an odds ratio of 29.6. Hydronephrosis was not associated with the history of tethered spinal cord release surgery.

Conclusion

This study revealed the prognostic risk factors for hydronephrosis. The medical history of patients, imaging examination, and urodynamic parameters play key roles in identifying the risk factors for hydronephrosis.