Two cases of heterotopic bone formation in the kidney and clinico-pathological study of 36 cases reported in Japan

We report two cases of heterotopic bone formation in the kidney. One patient was a 54-year-old man who consulted his family physician with the complaint of fever-up and nocturia. X-ray examination revealed a calcification in the left kidney and location of the pelvis for outside. Therefore, abdominal CT scan and selective renal angiography were performed. As a malignant renal tumor with hypovascularity could not be neglected, left nephrectomy was performed on August 18, 1980. Grossly, the resected kidney was 230 g in weight and had a 8 X 3 cm mass with a white cut surface and bone-like tendency. Histopathologically, a well-developed bone with erythropoietic bone marrow was found outside of the renal capsule. The other patient was a 52-year-old man with the complaint of painful swelling of left scrotum and lumbago. X-ray examination revealed bilateral renal stones and left ureteral stone. Bilateral nephrolithotomy and left ureterolithotomy were performed, and some stones and a part of bilateral renal pelvis which was bony hard and white in color were resected. Histopathologically, there were well-developed bone formation and infiltration of inflammatory cells in renal pelvic membrane. Among 36 reported cases in Japan, 16 cases were in male and 20 cases in female patients. Our second case was the first cases of bilateral renal heterotopic bone formation complicated with bilateral renal stones in 5 reported cases with renal stones. Including our first case, 5 cases which had heterotopic bone formation in renal capsule have been reported.     

A case of renal cell carcinoma with heterotopic bone formation

We report a case of renal cell carcinoma with heterotopic bone formation in a 28-year old woman. The patient was referred to our hospital with a complaint of left lumbargo. Laboratory data were within normal limits. Radiography (KUB) suggested a calcification in the left kidney and abdominal computed tomographic (CT) scan confirmed the presence of a renal mass which contained a calcification. Selective renal angiography revealed a hypervascular (microaneurysm-like change) tumor at the lower part of the kidney. Left nephrectomy was performed. Histopathological diagnosis was renal cell carcinoma with heterotopic bone formation (clear cell carcinoma, G1 > G2, pT1b). There has been neither metastasis nor any recurrence during the 7 months since her operation.     

A case of synchronous ipsilateral renal cell carcinoma and transitional cell carcinoma]

A case of synchronous ipsilateral renal cell carcinoma with renal pelvic and ureteral transitional cell carcinoma is reported. A 80-year-old man, who had had transurethral resection of bladder tumor three times, was admitted on August, 1989 for recurrence of bladder tumor. Excretory pyelography revealed a filling defect of left renal pelvis. Findings of retrograde pyelography and computed tomography were in accord with those of the excretory urograms. Under a diagnosis of the left renal pelvic and ureteral tumor associated with the bladder tumor, left nephroureterectomy with bladder cuff resection was performed. Pathological diagnosis was renal pelvic and ureteral transitional cell carcinoma with renal cell carcinoma, which existed incidentally in the same kidney. Double unrelated primary carcinoma in urinary tract, especially, double dissimilar primary carcinoma in the same kidney, is rare. To our knowledge, this case is the 20th double cancer in upper urinary tract reported in Japan.     

A case of renal pelvic tumor due to phenacetin abuse

An 80-year-old female had been taking phenacetin-containing analgesics due to severe pain in her legs and headache caused by SMON since 1957. The total accumulated dose of phenacetin that she had taken was about 2.3 kg. She visited the department of urology in our hospital complaining of gross hematuria in May, 1987. DIP showed that bilateral kidney were atrophic and her left pyelogram was non-visualized. A solid mass was located in her renal pelvis on the CT scan. Under the diagnosis of a left renal pelvic tumor, nephrectomy was performed on her left kidney in January, 1988. Histological diagnosis was interpreted as a transitional cell carcinoma, at a grade 1 greater than 2 and interstitial nephritis was detected. She died 8 months after the operation because of lung and bone metastasis. In autopsy, interstitial nephritis of the right kidney was also recognized. Our case is the fourth report of renal pelvic tumor due to phenacetin abuse in Japan.     

A case of heterotopic bone formation in the kidney

A case of heterotopic bone formation in the right kidney is presented. The case was a 58-year-old woman who complained of right flank pain. Excretory pyelography revealed that the kidney was nonfunctioning and had a few calcification shadows. The right kidney was removed. By histological examination of the surgical specimen, the heterotopic bone formation with bone marrow was found beneath the renal pelvic mucous membrane.     

Ipsilateral synchronous renal pelvic transitional cell carcinoma and renal cell carcinoma: a case report and review of the literature

A case of ipsilateral transitional cell carcinoma of left renal pelvis and left-renal cell carcinoma is presented. A 75-year-old male consulted our hospital with the complaint of painless gross-hematuria which had persisted for four years. Excretory urography revealed left non-visualized kidney. Retrograde pyelography demonstrated the filling defect, which had an irregular border, in the left renal pelvis. The selective left renal arteriography revealed the hypervascular region in the left renal cortex. Intraarterial chemotherapy with CDDP, MTX and ADR was performed preoperatively. Then, total left nephroureterectomy and segmental resection of the bladder was done. The surgical specimen was pathologically diagnosed as transitional cell carcinoma of the renal pelvis and renal cell carcinoma of the left kidney. This case is the 23rd reported case of ipsilateral synchronous renal malignancy in Japan.     

Simultaneous bilateral renal pelvic tumors: a case report]

A case of simultaneous bilateral renal pelvic tumors is reported. A 64-year-old man with the chief complaint of gross hematuria and left flank pain was admitted. Clinical investigations revealed a tumor in the right pelvis and ureter, and another tumor in the left renal pelvis. The right ureteral tumor had invaded the bladder. Right nephroureterectomy, total cystectomy, left partial pyelectomy and ureterocutaneostomy were performed. By pathological examination, right renal pelvic and ureteral tumors were non-papillary transitional cell carcinoma, grade 3, pT4, and the left renal pelvic tumor was papillary transitional cell carcinoma, grade 2, pT1. To our knowledge, this is the 16th case of simultaneous bilateral urothelial tumors of the upper urinary tract in Japan.     

Simultaneously detected double malignancies on a duplicated kidney associated with atrophied counterpart: a case report]

A case of simultaneous double malignant tumor in the same kidney, associating renal cell carcinoma with renal pelvic transitional cell carcinoma, in a 70 year-old-male was reported. On January 6, 2000 he presented with macroscopic hematuria. There were no remarkable findings on cystoscopic examination. Drip infusion pyelography and multidetector-row computed tomography demonstrated a tumor mass on the upper pole of the left kidney and atrophic right kidney. Systemic chemotherapy with CDDP, MTX and ADR was performed preoperatively. Then, hemi-left nephrectomy underwent with the diagnosis of renal pelvic tumor and renal tumor. The surgical specimen was pathologically diagnosed as transitional cell carcinoma of the renal pelvis and renal cell carcinoma of its upper pole. This is the 32nd case of simultaneous occurrence of renal cell carcinoma and transitional cell carcinoma in the same kidney in the Japanese literature.     

肾透明细胞癌骨化一例报告并文献复习

目的 探讨肾癌钙化骨化的发病机理、病理特点、鉴别诊断及预后. 方法 患者,男,48岁.因体检发现右肾钙化性占位2周人院.CT示右肾外形不规则,肾上极町见一类圆形占位性病变,伴明显骨化.PET-CT检查示右肾上极类圆形肿块,明显钙化,不伴有高功能性,考虑良性病变.术前拟诊断为肾癌,取右侧腹直肌旁切口行右肾探查术. 结果 术中见右肾中上极7.5 cmX5.0cm肿块,质硬如石,肾门周围未见肿大淋巴结,行右肾部分切除,术中冰冻病理提示肾透明细胞癌伴明显骨化,即行根治性肾切除加肾门周围淋巴组织清扫.术后病理报告:肾透明细胞癌伴广泛骨化纤维化,输尿管残端、血管残端及肾周组织未见癌组织浸润,未见转移淋巴结.术后随访8个月未见复发转移. 结论 肾癌骨化较少见,肾实质性占位伴明显钙化骨化术前应按恶性肿瘤对待,肾癌骨化预后相对较好.     

Cyclophosphamide-induced renal pelvic tumor--a case report

We report a case of transitional cell carcinoma in the left renal pelvis, which occurred in a 24-year-old man. He had been treated with cyclophosphamide (CPM) for a period of 27 months for retroperitoneal rhabdomyosarcoma diagnosed at the age of 10. At first 1.2 g CPM had been given twice intravenously for 3 months, followed by oral administration of 41 g CPM for 23 months. Drip infusion pyelography revealed a filling defect in the left renal pelvis. A left renal pelvic tumor was strongly suspected on computerized tomography and magnetic resonance imaging. Left nephroureterectomy was then performed. Histological diagnosis of the left renal pelvic tumor was transitional cell carcinoma, grade 2, pT1N0M0. No recurrence was defected 17 months later. This case seems to be the second case of cyclophosphamide-induced upper urothelial carcinoma reported in Japan.     

Squamous cell carcinoma in the renal pelvis of a horseshoe kidney

We report a rare case of squamous cell carcinoma in the renal pelvis of a horseshoe kidney. An 80-year-old woman was referred to the National Nagano Hospital for the examination of occult blood in her urine. Microscopic hematuria was found, but pyuria was not seen. Computed tomography and magnetic resonance imaging showed a mass in the left renal pelvis of the horseshoe kidney. No renal stone or hydronephrosis was found. Cytopathological examination in the voided urine specimen was positive. Left nephroureterectomy with the splitting of the isthmus of the horseshoe kidney was performed without renal pedicle clamping using a microwave tissue coagulator. No bleeding was encountered after separating the isthmus. A final pathological diagnosis of squamous cell carcinoma with a tumor thrombus was made. Lymph node metastasis had developed and rapidly progressed and the patient died of disseminated malignancy 4 months after the operation. We reviewed 24 cases of renal pelvic tumor in horseshoe kidneys previously reported in Japan. Seven cases (30%) included components of squamous cell carcinoma. The incidence is higher than that of renal pelvic tumors in the general population.     

A case of renal pelvic tumor due to phenacetin abuse

A 65-year-old female had been taking analgesics containing phenacetin, because of severe headaches since 1958. The total dose of phenacetin that she had taken was calculated to be 8.0 kg. She visited the department of urology in our hospital in August, 1999 complaining of gross hematuria. A solid mass was detected in her left renal pelvis on the abdominal computed tomographic (CT) scan. Under the diagnosis of a left renal pelvic tumor, nephrouretectomy was performed in September, 1999. Histopathological diagnosis was grade 2 transitional cell carcinoma. Interstitial nephritis was also observed. Our case is the twenty-second report of an urinary tract tumor associated with phenacetin abuse in Japan.     

Transitional cell carcinoma of the renal pelvis in a woman discovered at childbirth

We report a case of transitional cell carcinoma of a renal pelvis in a woman discovered after childbirth. A 38-year-old woman, who delivered an immature male infant in cesarean section 29 days prior to hospitalization, was admitted complaining of asymptomatic gross hematuria. Excretory urography and retrograde pyelography showed a filling defect of the right renal pelvis, Spontaneous urine cytology indicated class 5. Renal computed tomographic scan demonstrated a mass lesion in the right kidney. Right total nephroureterectomy and partial cystectomy was performed for diagnosis and treatment. Pathological diagnosis was papillary transitional cell carcinoma (grade 2). This is the first case of transitional cell carcinoma of the renal pelvis occurring in a childbearing woman in Japan.     

Synchronous ipsilateral renal cell carcinoma and transitional cell carcinoma: report of 2 cases

Two cases of synchronous ipsilateral renal cell carcinoma and renal pelvic transitional cell carcinoma are presented, one in a 70-year-old man and another in a 54-year-old man. These two cases were diagnosed preoperatively as synchronous ipsilateral renal tumor and pelvic tumor from urine cytology, retrograde pyelography, computed tomography and magnetic resonance imaging, and in both two cases, nephroureterectomy was performed. Pathological diagnosis was renal cell carcinoma and renal pelvic transitional cell carcinoma, which existed incidentally in the same kidney. To our knowledge, these cases are the 34th and 35th reported cases of synchronous ipsilateral renal cell carcinoma and renal pelvic transitional cell carcinoma in Japan.     

Transitional cell carcinoma in a pelvic kidney associated with recurrent lung cancer

We report a case of transitional cell carcinoma of the renal pelvis arising in a pelvic kidney two years after resection of bronchogenic carcinoma. Primary cancer in a pelvic kidney has been rarely described and this is the second reported case of transitional cell carcinoma originating in a pelvic kidney and the first associated with recurrent lung cancer.     

Renal cell carcinoma in a horseshoe kidney

A 65-year-old man with pyuria visited our hospital. Physical examination had revealed a mass in the left upper quadrant of the abdomen. Intravenous pyelogram, ultrasonogram, computerized tomography and selective renal arteriogram suggested a hypervascular renal cell carcinoma on the left side of the horseshoe kidney. A left radical nephrectomy with division of the isthmus was performed. The pathological diagnosis indicated renal cell carcinoma consisting of clear cell type without invasion of the capsule or renal pelvis. Treatment with alpha-interferon was started and has continued for six months with no evidence of recurrence. Only 35 cases of horseshoe kidney with a renal tumor have been reported in the Japanese literature. Among them, adenocarcinoma was present in 54.3% of the cases, renal pelvic tumor in 17.1%, and nephroblastoma in 14.3%. While adenocarcinoma in horseshoe kidney is seen less often than normal kidney, there is an increased incidence of both renal pelvic tumor and nephroblastoma.     

Renal cell carcinoma in a horseshoe kidney with abdominal aortic aneurysm: a case report

We herein report a case of renal cell carcinoma in a horseshoe kidney with an abdominal aortic aneurysm in a 69-year-old man. Radiological examinations showed a left renal tumor, horseshoe kidney and abdominal aortic aneurysm. We performed a left radical nephrectomy with the division of the isthmus and artificial graft through an abdominal transperitoneal approach. Histological findings revealed clear cell type renal cell carcinoma without invasion of the capsule or renal pelvis. Only 31 cases of renal cell carcinoma in a horseshoe kidney have been reported in Japan, and our case is the 32nd. No case with abdominal aortic aneurysm has been reported previously. We assume that abdominal aortic aneurysm was associated with renal cell carcinoma by chance in the horseshoe kidney in this case. The arterial and venous supplies vary from case to case. We emphasize that arteriography and venography are very important preoperative procedures.     

Is it transitional cell carcinoma or renal cell carcinoma on computed tomography image?

We report on a 58-year-old female patient with renal cell carcinoma simulating transitional cell carcinoma on computed tomography. The computed tomography scan showed an enhancing 2.5-cm left renal pelvic mass without renal parenchymal mass. Urinalysis revealed microscopic hematuria. Cystoscopy and urine cytology was negative for transitional cell carcinoma. Laparoscopic nephroureterectomy was done under the preoperative diagnosis of localized transitional cell carcinoma of the renal pelvis according to the computed tomography findings. The histologic result, however, was a clear cell renal cell carcinoma.     

Vaginal metastasis from transitional cell carcinoma of renal pelvis in horseshoe kidney

We describe a case of transitional cell carcinoma of the renal pelvis in a horseshoe kidney with vaginal tumor as the first manifestation of remote metastasis. While the occurrence of adenocarcinoma in a horseshoe kidney appears to be no higher than in nonfused kidneys, the incidence of transitional cell carcinoma among neoplasms in horseshoe kidneys is higher. Vaginal metastasis from transitional cell carcinoma of the renal pelvis is considered extremely rare. To our knowledge, this is the first case reported of transitional cell carcinoma of the renal pelvis in a horseshoe kidney with metastasis to the vagina. The patient was successfully treated with surgery, irradiation, and chemotherapy.     

Transitional cell carcinoma developed in association with renal stone and ureter catheter: report of two cases

Chronic irritation or infection may cause a neoplastic change in the uroepithelium. Our recent experience with two cases of transitional cell carcinoma associated with such stimuli is reported. A 58-year-old woman was found to have a staghorn stone in the left kidney and underwent nephrectomy because of an atrophic kidney. Transitional cell carcinoma was incidentally identified microscopically on the renal pelvis of the removed kidney. Subsequently surgery was elected to remove the residual ureter and the retroperitoneal lymph nodes, both of which turned out to be non-malignant. Then, she was treated by combination chemotherapy with CTX, ADR and CDDP. The second case was a 77-year-old woman who had had a 15-year history of an indwelling ureter catheter after gynecological surgery. Because of purulent discharge without any urine production, she underwent nephrectomy for a contracted kidney. Histology revealed transitional cell carcinoma on the pelviureteral junction. The postoperative courses were uneventful in both cases: they were followed up for 6 months and 9 months respectively without any recurrence of the disease. 90 cases of renal pelvic tumors associated with renal stones were collected from the Japanese literature and reviewed.