Primary squamous cell carcinoma of the renal pelvis masquerading as pyonephrosis: a case report

Squamous cell carcinoma of the renal pelvis is a rare tumor, which is usually associated with nephrolithiasis. It is rarely associated with pyonephrosis. We report the case of a 69-year-old man who presented with features of pyonephrosis and underwent nephrectomy. The postoperative histological evaluation revealed an unsuspected squamous cell carcinoma of renal pelvis with a concomitant pyonephrosis. The rarity of this tumor in the absence of renal calculi and its association with pyonephrosis is highlighted.     

Intraluminal renal metastasis from a rectal adenocarcinoma: an unusual site

Primary adenocarcinoma of the urinary tract are uncommon. But secondary involvement of pyelocalyceal system by metastasis of colorectal origin is rare. We report a case of late rectal metastasis with renal pelvis growth presenting as a pyonephrosis. This study emphasizes the relevance of cytokeratin 7 and 20 immunostaining in such differential diagnosis.     

Successful treatment of fungus balls due to fluconazole-resistant Candida sake obstructing ureter stents in a renal transplant patient

Reported here is the case of a 72-year-old renal transplant recipient with stenosis of the neo-ureter requiring stents, who was admitted to hospital with pyonephrosis caused by fungus balls. Fluconazole-resistant Candida sake was grown. Treatment with external drainage of the renal pelvis and intravenous and local administration of caspofungin resulted in relief of the obstruction. Eradication of the infection was achieved by surgical removal of the ureter with all stents and construction of a cysto-pyelostomy.     

A problem in diagnostic imaging

Many pathological processes can present as a swelling in the groin. We present a case of complex, ruptured pyonephrosis causing a psoas collection, which in turn presented clinically as an apparent right "incarcerated inguinal hernia." The patient was successfully treated with antibiotics and ultrasound-guided drainage of the abscess. The anatomical basis of the inguinal presentation of this complex pyonephrosis can be understood in the arrangement of the renal (Gerota's) fascia.     

Pregnancy complicated by emphysematous pyonephrosis

Emphysematous pyonephrosis is a rare, rapidly progressive infection characterized by the presence of exudative material and fermentative gases within a dilated renal collecting system. This unusual clinical entity is noted almost exclusively in diabetic patients, often in conjunction with chronic urinary tract infection and obstruction. In most instances, E. coli is the etiologic agent; however other enterobacteriaceae may be isolated. High fever, leukocytosis, renal parenchymal necrosis and the accumulation of gases in the kidney and perinephric tissues are the hallmark of this condition. Surgical resection of the involved tissue and systemic antibiotic administration are among the primary mainstays of therapy. We present a unique case of a pregnant patient with fulminant emphysematous pyonephrosis and the successful treatment rendered.     

Primary adenocarcinoma of the renal pelvis. Report of two cases and brief review of literature

Two cases of primary adenocarcinoma of the renal pelvis are described. One patient was a 64-year-old female who had multiple papillary tumors in the right ureter and renal pelvis. The other was a 57-year-old male who had diffuse infiltrating carcinoma in the left renal pelvis with calculi. In both cases, the lining of the renal pelvis underwent columnar cell metaplasia and the tumor cells showed mucin production. Forty-six cases reported previously are reviewed briefly. The histogenesis of primary adenocarcinoma of the renal pelvis seems to be closely related to metaplasia of transitional epithelium induced by longstanding chronic inflammation or renal calculi in many cases.     

PRIMARY ADENOCARCINOMA OF THE RENAL PELVIS

Two cases of primary adenocarcinoma of the renal pevlis are described. One patient was a 64-year-old female who had multiple papillary tumors in the right ureter and renal pelvis. The other was a 57-year-old male who had diffuse infiltrating carcinoma in the left renal pelvis with calculi. In both cases, the lining of the renal pelvis underwent columnar cell metaplasia and the tumor cells showed mucin production. Forty-six cases repored previously are reviewed briefly. The histogenesis of primary adenocarcinoma of the renal pelvis seems to be closely related to metaplasia of transitional epithelium induced by longstanding chronic inflammation or renal calculi in many cases.     

Renal pelvis urothelial carcinoma of the upper moiety in complete right renal duplex: a case report

Urothelial carcinoma (UC) originated from renal pelvis is the common tumor of the urinary system, however, neoplasia of the renal pelvis in duplex kidneys is extremely rare, especially in the complete renal and ureteral duplex cases. We present the first case of renal pelvis UC of the upper moiety in a complete right renal duplex. This male patient has bilateral complete renal and ureteral duplex. To the best of our knowledge, this is the first reported case of renal pelvis UC in a complete renal duplex system. After this experience we feel that the diagnosis of renal pelvis UC in duplex kidneys is not so easy, and once the diagnosis is determined, the whole renal duplex units and bladder cuff or ectopic orifice should be excised radically.     

Inflammatory pseudotumor of the renal pelvis. A report of 2 cases with clinicopathologic and immunohistochemical study

We describe 2 cases of inflammatory pseudotumor of the renal pelvis. Case 1, the male patient, was 37 years old, and case 2, the female patient, was 54 years old. Both patients presented with macroscopic hematuria and flank pain. Computed tomographic (CT) scan and ureterocystoscopy revealed in case 1 a mass in the left renal pelvis and the calyces. In case 2, urography showed a lacuna of the renal pelvis, and CT scan showed an irregular thickening of the renal pelvis. In both cases, the preoperative clinical diagnosis was urothelial carcinoma, and both patients underwent nephrectomy. Microscopic examination revealed in case 1 a tumor of the renal pelvis composed of spindle cells with eosinophilic cytoplasm in a myxoid and vascular stroma with abundant inflammatory infiltrate. In case 2, the tumor was composed of densely basophilic spindle cells in a fascicular pattern intermingled with lymphocytes and plasma cells and involving the lamina propria of the renal pelvis. The spindle cells reacted strongly with antibody to vimentin and focally with antibodies to smooth muscle actin and muscle-specific actin. In the urogenital tract inflammatory pseudotumor involves preferentially the urinary bladder. Rare cases have been reported in the kidney. The 2 cases presented here are unusual due to the location in the renal pelvis, mimicking urothelial carcinoma.     

Squamous cell carcinoma in a duplicated renal pelvis

We report an extremely rare case of squamous cell carcinoma (SCC) of the renal pelvis associated with an incompletely duplicated renal pelvis and ureter. A 71-year-old woman presented with left lower back pain and gross hematuria. Urinary cytology showed atypical squamous cells. Computed tomography, magnetic resonance imaging and retrograde pyelography revealed left incompletely duplicated renal pelvis and ureter and a mass in the left upper renal pelvis. A clinical diagnosis of left renal pelvic cancer was made and the patient underwent total nephroureterectomy. Histological examination of the resected specimen revealed SCC with marked keratinization in the upper renal pelvis. The tumor had invaded the renal parenchyma and perinephric fat. There was no urothelial carcinoma component. The pathological stage was pT4 N0. There was no evidence of recurrence 6 months postoperatively. Because the prognosis of SCC of the upper urinary tract is poor, urologists and pathologists should be aware that SCC may develop in duplicated urinary systems.     

Leiomyosarcoma arising from the blind end of a bifid renal pelvis

Sarcoma of the kidney is a rare condition. Leiomyosarcoma is the most common of the kidney sarcomas. Renal leiomyosarcoma usually originates from the smooth muscle layers of the kidney, for example, the renal capsule and renal vessels. Renal pelvis neoplasms, however, are primarily transitional cell carcinomas, and renal pelvis leiomyosarcomas are extremely uncommon. Renal pelvis leiomyosarcoma has never been reported in Korea. Moreover, no more than 10 cases have been reported internationally. However, none of these were associated with kidney abnormalities. Here we describe a case of leiomyosarcoma that originated from the blind end of a bifid renal pelvis.     

Primary carcinoma of renal calyx

Renal calyx carcinoma (RCXC) may mimic collecting duct carcinoma (CDC) or urothelial carcinoma (UC) of the renal pelvis. RCXC is distinguished from CDC and UC of the renal pelvis as having the tumor epicenter in the renal calyx, with limited involvement of the surrounding renal pelvis surface urothelium. In this study, we summarize our experience with this entity.     

Carcinoid tumor of the renal pelvis: consideration on the histogenesis

Carcinoid tumor of the renal pelvis is an extremely rare neoplasm and only two cases have been previously reported in the English-language literature. Reported herein is a third case of carcinoid tumor arising in the renal pelvis. The tumor extending from the left renal pelvis into the left kidney was incidentally found in a 55-year-old Japanese woman. Macroscopically, the tumor was predominantly located in the dilated renal pelvis and was grayish-white on cut surface. Microscopically, neoplastic cells proliferated with a ribbon-like, trabecular, tubular and solid pattern. Furthermore, the tumor focally invaded the kidney parenchyma. No precursor lesion of neuroendocrine tumor was observed in the peripheral urothelial epithelium. Neither urothelial carcinoma nor teratoma component was observed within the tumorous mass. The cytoplasm of neoplastic cells was focally positive for Grimelius stain and focally positive for chromogranin A and synaptophysin. However, no neoplastic cells reacted with cytokeratins 7 and 20. Ultrastructurally, neoplastic cells contained dense core granules in the cytoplasm. Urologists and pathologists should recognize that carcinoid tumor may arise from the renal pelvis.     

Renal excretory sectors

One thousand and ninety-four normal human kidneys and 18 abnormal (with duplication of the ureter) were studied by the corrosion method and pyelography followed by topometric and mathematics analyses. It was found that the renal pelvis is a calicopelvic complex built up of renal calices, urine ducts and renal pelvis. Before opening into the renal pelvis, renal calices join together forming urine ducts (superior and inferior; or superior, middle and inferior; or superior, middle anterior, middle posterior and inferior) which transport urine to the container, the renal pelvis. It can be seen that groups of renal calices with pyramids and their surrounding cortical substance form the renal excretory sectors of the kidneys where the processes of uropoiesis and transportation of urine through elements of the nephron and calicopelvic complex take place. These are two (superior and inferior), three (superior, middle and inferior) or four (superior, middle anterior, middle posterior and inferior) renal excretory sectors. The existence of renal excretory sectors is proved by congenital anomalies of the calicopelvic complex such as duplication of the ureter, where urine ducts of the superior and inferior renal excretory sectors do not form a renal pelvis but run separately to the urinary bladder. On the basis of anatomical data obtained, renal excretory sectors may be distinguished, analogous to bronchopulmonary segments in lungs. These data about renal excretory sectors will contribute to further improvement in the operative technique of renal partial resections as well as to anatomical nomenclature.     

Benign fibroepithelial polyps of the renal pelvis.

Benign fibroepithelial polyps of the renal pelvis are rare. Although many ureteral fibroepithelial polyps have been reported, there are, to our knowledge, only 20+ reported cases in the renal pelvis. We report herein the clinical and pathologic features of fibroepithelial polyp of the renal pelvis and provide a detailed review of the literature.     

Carcinoid tumor associated with adjacent dysplastic columnar epithelium in the renal pelvis: A case report and literature review

Carcinoid tumors are well documented in the pulmonary and gastrointestinal systems, but very rare in the urinary tract, especially in the renal pelvis. We report on a 60‐year‐old female patient who presented with left flank pain and fever. Abdominal computed tomography demonstrated a heterogeneously enhancing mass in the left renal pelvis and a stone at the left proximal ureter. Multiple parenchymal lesions were also observed, which were identified as uneven caliectasis displaying air‐fluid levels and renal parenchymal atrophy. The patient underwent simple nephro‐ureterectomy. Macroscopically, a polypoid mass was observed in the renal pelvis. Microscopically, the tumor revealed acinar, tubular, and solid pattern and was composed of small, monotonous and hyperchromatic cells. Lining epithelia in renal pelvis and ureter revealed columnar epithelia with dysplastic change. The tumor cells were positive for chromogranin A, synaptophysin, CD56, and focally positive for cytokeratin. Immunohistochemical staining of synaptophysin and chromogranin A highlighted the neuroendocrine cells in the columnar epithelium. Ki‐67 (1:50; MIB‐1) labeling index was less than 1% in the area with highest uptake. We report here a case of carcinoid tumor of the renal pelvis that was associated with adjacent dysplastic columnar epithelium.     

Sarcomatoid carcinoma of the renal pelvis: a case report

A case of sarcomatoid carcinoma of the renal pelvis is reported. A 72-year-old male was admitted with a chief complaint of right flank pain. Clinical imaging studies revealed marked dilation of the right renal pelvis caused by a tumor at the pyeloureteric region. Right nephrectomy was performed in June 1999. The 8.4 x 6.5 cm tumor was grossly polypoid in appearance and protruded into the renal pelvis. Histologically, sarcomatoid spindle cells predominated over the carcinomatous component (mainly transitional cell carcinoma, partly associated with squamous cell and adenocarcinoma components). Osteoclast-like CD68-positive multinucleated giant cells were scattered. The sarcomatoid component was immunoreactive for both cytokeratin and vimentin. Sarcomatoid cells negative for cytokeratin were also noted. In both the sarcomatoid and carcinomatous components, nuclear overexpression of p53 oncoprotein was confirmed. The histogenesis of sarcomatoid carcinoma of the renal pelvis is discussed.     

A case of renal transitional cell carcinoma associated with synchronous contralateral renal cell carcinoma

We report a case of simultaneous contralateral renal transitional cell carcinoma and renal cell carcinoma. A 63-yr-old male presented with hematuria. He was diagnosed with left renal pelvis tumor and contralateral renal cell carcinoma. Subsequently, the patient received left nephrectomy and paraaortic lymphadenectomy (transitional cell carcinoma, pT3N2M0). Post-operatively, chemotherapy of renal pelvis tumor and angioinfarction of contralateral renal cell carcinoma are being considered. We believe that management planning should be individualized in such cases.     

Squamous cell carcinoma of the renal pelvis

Primary squamous cell carcinoma (SCC) of the renal pelvis is rare because SCC represents only 0.5% to 0.8% of malignant renal tumors. Chronic irritation, inflammation, and infection induce squamous metaplasia of the renal collecting system, which may progress to dysplasia and carcinoma in most of affected individuals. Nephrolithiasis, especially formation of staghorn calculi, is the most common risk factor for SCC, which usually occurs in older adults (age 50-70 years) with no sex predilection. Clinical features include flank or abdominal mass, weight loss, hematuria, or paraneoplastic syndromes, such as hypercalcemia. Radiologically, SCC of the renal pelvis may appear as a solid mass, hydronephrosis, or calcifications. The radiologic differential diagnosis includes primary and secondary renal neoplasms and xanthogranulomatous pyelonephritis. Squamous cell carcinomas of the renal pelvis are usually large, necrotic, and ulcerated, with gross invasion of the renal parenchyma and perinephric soft tissue. Most SCCs of the renal pelvis are moderately or poorly differentiated and typically present at an advanced stage. Surgical resection and adjuvant chemoradiotherapy are rarely curative. The prognosis is dismal with a 5-year survival rate of less than 10%.     

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 cnf1 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.