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.     

Squamous cell carcinoma of the renal pelvis after intrarenal bacillus Calmette-Guerin therapy for carcinoma in situ of upper urinary tract: a case report

A 73-year-old man was admitted with high fever. Histopathologically, he was diagnosed with transitional cell carcinoma in situ (CIS) of bilateral upper urinary tracts and urinary bladder in April, 1995. Double J shape ureteral catheter was placed in the left ureter to induce vesicoureteral reflux and Bacillus Calmette-Guerin (BCG) was instilled intravesically every week. Then, the same procedure was performed on the other side. Unfortunately, the treatments could not be completed due to severe complications (high fever and renal dysfunction). Follow-up studies revealed that the left kidney had lost function and right upper urinary tract still had CIS. Therefore, right nephroureterectomy was performed for right renal pelvic cancer (TCC, G3, pT1) followed by permanent hemodialysis in September, 1996. Invasive bladder cancer arose in the abandoned bladder and cystourethrectomy and left ureterocutaneostomy was performed in September, 1999. In April 2000, imaging studies revealed a renal pelvic tumor in his left kidney and left nephroureterectomy was performed. Histopathological diagnosis was squamous cell carcinoma of the left renal pelvis.     

肾移植术后并发双侧自体肾盂和输尿管移行细胞癌16例

目的 总结肾移植术后发生双侧自体肾盂、输尿管移行细胞癌的诊治经验.方法 回顾性分析16例肾移植术后发生双侧自体肾盂、输尿管移行细胞癌患者的资料.首次发现上尿路肿瘤的时间为移植后(56.2±33.0)个月.2例同时发现双侧上尿路肿瘤,其余14例双侧上尿路肿瘤先后发现的时间间隔为(8.6±6.7)个月.临床症状和检查阳性结果以血尿和自体肾积水为主.均行自体上尿路根治性切除术,术后行膀胱灌注化疗.结果 16例手术均成功.32次自体肾、输尿管的病理检查结果均为移行细胞癌,包括单纯肾盂肿瘤4次,单纯输尿管肿瘤9次,合并肾盂、输尿管肿瘤19次.23次肾盂肿瘤的分级为1级8例,2级11例,3级4例;28次输尿管肿瘤的分级为1级6例,2级10例,3级12例.术后随访(26.8±25.1)个月,1例出现肺部转移后死亡;1例发生腰背部软组织转移性移行细胞癌,局部切除;其他患者未发现肿瘤复发及转移.结论 肾移植后自体上尿路移行细胞癌的常见表现为血尿合并自体肾积水,该肿瘤侵袭性较强,对于膀胱及一侧自体上尿路同时存在移行细胞癌者,应行对侧自体肾上尿路预防性切除术.

Abstract：

Objective To investigate the clinical features of bilateral native pelvic and ureteral transitional cell carcinoma (TCC) in renal transplant patients. Methods A retrospective analysis was carried out on 16 patients with bilateral native pelvic and ureteral TCC after kidney transplantation.The mean time between transplantation and diagnosis of upper urinary TCC was 56. 2 ± 33. 0 months.Two patients were suffered from bilateral upper urinary TCC at the same time. The mean interval between 2 upper urinary tract operations of the remaining 14 cases was 8. 6 ± 6. 7 months. Hematuria and hydronephrosis of native kidneys were the main symptoms and targets in checkup. Intravesical chemotherapy was postoperatively given. Results All operations were performed successfully. All specimens obtained from the operations were pathologically diagnosed as TCC. The TCC location involved pure native pelvis (n = 4), pure native ureter (n = 9), and pelvis combined with ureter (n = 19). Pelvic TCC pathological grades included grade 1 in 8 cases, grade 2 in 11 cases, and grade 3 in 4 cases; Ureteral TCC grades included grade 1 in 6 cases, grade 2 in 10 cases, and grade 3 in 12 cases.Patients were followed up for 26. 8 ± 25. 1 months. One patient died of lung metastasis. (One case of lumbar soft tissue transfer was given local excision. The remaining patients had no recurrence and metastasis. Conclusion Renal transplant patients with hematuria and native renal hydronephrosis should be highly vigilant of the occurrence of upper urinary tract TCC. TCC after renal transplantation is invasive. Prophylactic contralateral nephroureterectomy should be performed on the recipients having TCC at the bladder and one side of native upper urinary tract.     

Simultaneous occurrence of renal cell and transitional cell carcinoma in the same kidney and ureter. A case report

An unusual case of 2 concurrent primary renal tumors within the same kidney is reported. A 70-year-old woman presented with gross hematuria when she was in the hospital for cerebral infarction. Excretory urography revealed a marked expansion of the right kidney with no renal function. CT scan showed a mass arising from the right kidney, the hydronephrotic right renal pelvis, and a mass in the lower right ureter. Selective renal angiogram showed marked neovascularity of the mass. There was an encasement of the intrarenal artery to the lower pole. Angiographic findings were highly suggestive of a renal cell carcinoma with a second neoplasm in the renal pelvis. Subsequently, the patient underwent right radical nephroureterectomy and partial cystectomy. Section of the removed specimen revealed a 4.0 X 3.8 cm solid tumor confined to the kidney in the upper pole and a transitional cell carcinoma arising from the renal pelvis. In addition, transitional cell carcinoma was present in the distal ureter.     

Prognostic variables in patients with transitional cell carcinoma of the renal pelvis and proximal ureter

Recent technological advances in urological endoscopic surgery of the renal pelvis and proximal ureter via ureteroscopy or percutaneous nephroscopy have made it possible to consider parenchymal-sparing procedures in patients with transitional cell carcinoma. To define the role of these procedures in the management of renal pelvic or proximal ureteral transitional cell carcinoma we analyzed retrospectively 31 patients who underwent nephroureterectomy for transitional cell carcinoma of the renal pelvis and/or proximal ureter. High grade upper urinary tract transitional cell carcinoma and a history of metachronous or synchronous bladder transitional cell carcinoma were independent adverse prognostic factors. However, patients with low grade upper urinary tract transitional cell carcinoma and no evidence of a urothelial field change had a 100 per cent 5-year survival rate. It would appear that parenchymal-sparing endoscopic techniques should be regarded with caution in patients with either high grade transitional cell carcinoma of the renal pelvis and proximal ureter or a history of bladder cancer.     

上尿路移行细胞癌12例误诊分析

目的探讨上尿路移行细胞癌的误诊原因。方法回顾性分析12例上尿路移行细胞癌患者在诊治过程中的误诊情况。误诊为肾炎4例,上尿路结石3例,泌尿系感染3例,肾结核1例,前列腺增生1例。结果 12例患者均经手术治疗,术后病理证实肾盂移行细胞癌9例,输尿管移行细胞癌3例,伴膀胱移行细胞癌2例。通过B超、静脉尿路造影（IVU）、逆行肾盂造影、CT、输尿管镜及膀胱镜等检查均提示发现肿瘤病灶。8例患者随访6个月~15年,3例死于肿瘤进展,2例术后出现膀胱移行细胞癌。结论对长期血尿病史患者需进一步病因检查,B超、IVU、CT等影像学检查具有重要的诊断价值,同时应提高对检查结果的正确分析和判读能力。     

输尿管癌预后相关因素的临床研究

目的探讨影响输尿管癌患者预后的重要因素。方法回顾性分析2001年1月至2005年12月133例接受手术治疗的原发输尿管癌患者的临床资料。结果在133例输尿管癌患者中,分期为Ta～T1的表浅输尿管癌42例（31．6％）,分期为12-T4的浸润性输尿管癌91例（68．4％）,肿瘤位于输尿管下段63例（47．4％）。数据显示越靠近输尿管下段的肿瘤较易呈浸润性生长。输尿管下段癌的生存率明显低于上、中段癌。多因素Cox生存率分析结果表明肿瘤的分级、分期与生存率密切相关。结论输尿管癌在输尿管下段好发,与膀胱癌不同,更容易呈浸润性生长,而且越接近输尿管下段的肿瘤分期越高。多因素Cox生存率分析表明输尿管癌的分级和分期是判断预后最重要的因素。     

Ureter cancer of complete double renal pelvis and ureter: a case report

A 66-year-old man presented at our hospital with left back pain. Intravenous pyelography, computerized tomography and magnetic resonance imaging revealed ureteral tumors of the complete left double renal pelvis and the ureter. An endoscopic examination disclosed a papillary tumor from the left ureteral orifice of the lower pole of the kidney. A transurethral resection of the tumor was done, and the pathological features revealed transitional cell carcinoma (PTa, grade 2). A left nephroureterectomy and a partial cystectomy were also carried out; macroscopic examinations showed a non-papillary tumor on the middle portion of the left ureter originating from the upper pole of the kidney. Microscopic examinations revealed transitional cell carcinoma (PT3, grade 3, PL1, PV1). Adjuvant chemotherapy (M-VAC) was administered but discontinued because of severe side effects. Dispite recurrence with retro-peritoneal lymph node metastasis, the patient is alive and again undergoing M-VAC chemotherapy 22 months after the initial surgery. However, the evaluation of the chemotherapy was "no change".     

Laparoscopic management of a transitional cell carcinoma arising in a right ectopic ureter

Ectopic ureter is a rare abnormality, so presenting a transitional cell carcinoma (TCC) arising from an ectopic ureter is extremely rare. We report here a case of a man with an invasive transitional cell carcinoma arising from a right ectopic ureter and managed by laparoscopy. To our knowledge, this is the fourth case described in the literature, and the second case of a TCC arising in a right ectopic ureter.     

Circumcaval ureter with synchronous ipsilateral transitional cell carcinoma of the renal pelvis and the urinary bladder: Report of a case and review of the literature

We report a case of concomitant transitional cell carcinoma (TCC) in a circumcaval ureter and invasive bladder cancer. The diagnosis was based on the findings of excretory urography (IVU) and contrast-enhanced computed tomography (CT). IVU showed a typical J-shaped deformity in the dilated right proximal ureteric segment with moderate hydronephrosis and a filling defect in the renal pelvis, while abdominal CT with contrast showed right hydronephrosis with an intrapelvic tumor. The patient underwent radical cystoprostatectomy and nephroureterectomy. No recurrence was detected after 12 months of follow-up.     

Synchronous ipsilateral conventional renal cell and transitional cell carcinoma

Simultaneous occurrence of renal cell carcinoma (RCC) and transitional cell carcinoma (TCC) in the same kidney is unusual. We report a 61-year-old man with ipsilateral synchronous renal adenocarcinoma and renal pelvic TCC. He was referred to our department for gross hematuria and right flank pain. CT and MRI studies revealed a 57 × 50 mm irregular and infiltrative upper right kidney mass with necrotic components. A right radical nephrectomy was done. Pathological diagnosis was a high grade tumor originating from just beneath the intact urothelium of renal pelvis and infiltrating through the parenchyma showing solid and occasional tubular growth patterns. A second tumor in close proximity to the first was reported as well differentiated RCC. This is a rare case of combined renal malignancies.     

Malignant lymphoma of the ureter: a case report

We report a case of malignant lymphoma (ML) of the ureter. A 71-year-old man was admitted to our hospital with the chief complaint of macroscopic hematuria. IVP showed the dilation of left ureter and renal pelvis. Retrograde pyelography showed a 2cm filling defect in the right middle ureter. From the data given, a right ureteral tumor was suspected, and we performed tumor biopsy under an ureteral scope. Since it was diagnosed not as transitional cell carcinoma (TCC) of ureter but as ML with strong inflammation, partial ureterectomy and uretero-uretero anastomosis were done. Histological diagnosis was B cell follicular center lymphoma. Because Ga-scintigraphy revealed no evidence of other involement, it was diagnosed as ML originating from ureter. ML secondarily invading the urinary tract organs is commonly found, but ML originating from the urinary tract is rare. Especially, in regards to ML originating from ureter, only 16 cases have been reported in Japan.     

A case of urothelial tumor involving renal pelvis, ureter and bladder in a patient receiving hemodialysis

A 59-year old male who had undergone hemodialysis for 5 years, visited our hospital with a complaint of asymptomatic gross hematuria. Urinary cytology was positive and random biopsy revealed invasive transitional cell carcinoma of the bladder. The patient underwent total cystectomy and ureterocutaneostomy. Also right nephrectomy was performed because pathological examination during the operation revealed that the right ureteral margin had carcinoma in situ. Carcinoma in situ involved the right renal pelvis, the right ureter and the bladder in the resected specimen. Frequency of urothelial tumor in patients who undergo hemodialysis is still unknown, and the number of reported cases is too small to acknowledge the natural history of the urothelial tumor in patients on hemodialysis.     

Apoptotic cell death and Smad4 expression in transitional cell carcinoma of the renal pelvis and ureter

PURPOSE: To investigate the frequency of apoptosis and the expression of Smad4 protein as well as their roles in transitional cell carcinoma (TCC) of the renal pelvis and ureter. METHODS: Apoptosis was detected by using terminal deoxynucleotidyl transferase (TdT)-mediated dUTP-biotin nick end labeling (TUNEL) technique in 34 formalin-fixed and paraffin-embedded specimens of renal pelvic and ureteral TCC. The expression of Smad4 was immunohistochemically studied. RESULTS: The incidence of apoptosis ranged from 1.10 to 3.75% with a median of 2.50% in TCC of the renal pelvis and ureter. The incidence of apoptosis was noted to be closely related to histologic grade but not to pathologic stage of the cancer. The expression of Smad4 was detected in six of 34 cases (17.6%). Regarding subcellular distribution, Smad4 protein was localized both in cytoplasm and nucleus of the cancer cells. In comparing the incidence of apoptosis with the expression of Smad4, no significant associations were seen between them. The expression of Smad4 was not related to the tumor grade nor stage of the cancer. CONCLUSIONS: The present study demonstrated close association of the incidence of apoptosis with the tumor grade of TCC of the renal pelvis and ureter. Significance of Smad4 expression was not noted in the study. It suggests that apoptotic cell death may play an important role in the tumor progression of renal pelvic and ureteral TCC.     

Superficial bladder cancer with lung metastasis without local invasion: a case report

A 66-year-old woman presented with a coin-size lesion in the right lung. Bronchoalveolar lavage cytology showed class V. Thoracoscopic partial pneumonectomy of right upper lobe was performed and pathologic finding was metastatic transitional cell carcinoma (TCC). She had a history of superficial bladder tumors which were treated with transurethral resection (TURBT). All pathologic findings demonstrated low grade superficial TCC. After the pneumonectomy, recurrent tumors were detected in the bladder after three months' follow up. Intravesical instillations and TURBT were performed and the pathologic finding showed superficial TCC. There have been no signs of recurrence during the six-year follow up. The case reported here is of superficial cancer with a metastatic lesion in the lung without local invasion in the urinary bladder.     

A case of amyloidosis of the renal pelvis

We report a case of localized amyloidosis of the renal pelvis and upper ureter arising in a 74-year-old man who presented at our hospital with gross hematuria. The intravenous pyelogram showed right hydronephrosis and stenosis of right renal pelvis and upper ureter. The cystoscopy view was normal, but the right retrograde-ureteropyelogram showed a long irregular stricture of the renal pelvis. Ureteroscopy was performed and rubbing biopsy of edematous, bleeding lesion suggested class IIIb, transitional cell carcinoma. With the diagnosis of a right renal pelvic tumor, right nephroureterectomy was performed. The histology report stated "massive deposits of amyloids are seen in the segment of macroscopically abnormal renal pelvis". Amyloidosis of the renal pelvis is a rare entity and 12 cases were reported in the Japanese and English literature.     

肾移植术后并发泌尿系统恶性肿瘤22例

目的 分析肾移植受者泌尿系统恶性肿瘤的发病情况,并探讨其发病机理及治疗方法.方法 回顾性分析1978年至2010年12月间肾移植受者发生泌尿系统恶性肿瘤22例的资料.结果 22例的病理检查结果分别为膀胱移行上皮细胞癌9例(其中1例第3次手术后发现转化为腺癌),膀胱鳞状细胞癌1例,膀胱腺癌1例,肾透明细胞癌3例(其中2例为双侧肾癌),肾低分化癌1例,肾盂移行细胞癌1例,肾盂+膀胱移行细胞癌1例,输尿管移行细胞癌2例,输尿管+膀胱移行细胞癌2例,输尿管移行细胞癌+膀胱腺癌1例.肾癌及输尿管癌均发生在患者原肾及输尿管.11例膀胱癌患者中9例存活,均保有全部或部分肾功能;4例肾癌患者均在发病后半年内死亡;肾盂癌、输尿管癌除2例术后早期死亡外,其余5例存活.22例发现肿瘤后1年存活率为73.7%.结论 肾移植后泌尿系统恶性肿瘤可见少见的病理类型.治疗中应注意免疫抑制剂的使用和移植肾功能保护的问题.肾实质性恶性肿瘤预后很差.

Abstract：

Objective To investigate the incidence of urological malignancy in renal allograft recipients and explore the mechanism of increased incidence in China and the management. Methods A retrospective study was performed on 22 patients with urological malignancy in renal allograft recipients between 1978 and 2010. Results Twenty-two cases of urological malignancy were diagnosed by pathologic evidence, including 9 cases of transitional cell carcinoma (TCC) of bladder, 1 case of squamous cell carcinoma of bladder, 1 case of adenocarcinoma of bladder, 1 case of TCC of pelvis, 1 case of TCC of bladder and pelvis, 1 case of TCC of ureter complicated with adenocarcinoma of bladder, 2 cases of TCC of ureter, 2 cases of TCC of ureter and bladder, 3 cases of clear cell carcinoma of kidney, and 1 case of undifferentiated carcinoma of kidney. All the malignancies belonged to native organs. All the patients suffering bladder cancer had normal function of allograft. Five patients with TCC of pelvis or ureter survived and 2 cases died early after operation. All the patients suffering renal carcinoma deceased within 6 months after diagnosis. One-year survival rate was 73. 7 % after the diagnosis of urological malignancy. Conclusion Urological malignancy ranked highest in malignancy in renal allograft recipients, and rare pathological types of urological malignancy in non-renal allograft recipients are often demonstrated. The strategy of treatment should take consideration of the relationship between the usage of immunosupressive agents and the preservation of allograft function. It is critical for the therapy of malignancies to possess satisfactory allograft function. The prognosis of renal cell carcinoma is poor.     

A case of primary ureteral carcinoma in the duplicated renal pelvis and ureter diagnosed by transurethral uretero-renoscopy

We present a case of primary ureteral carcinoma in the duplicated renal pelvis and ureter diagnosed by transurethral uretero-renoscopy. The case was of a 78-year-old man with the complaint of sudden asymptomatic macrohematuria. An excretory urogram strongly suggested the presence of duplication of the right collecting system, and cystoscopy revealed a gross hematuria from the right ureteral orifice. A retrograde ureteropyelogram revealed incomplete duplication of the right renal pelvis and ureter fused at about the ureter crossing over the iliac vessels, and a polyp-like filling defect in the lower segment of duplicated ureter at about 4 cm from the fusion of the ureters. Transurethral uretero-renoscopy was employed to investigate the filling defect, and a papillary tumor extended into the lower segment of duplicated ureter was revealed. Tumor was resected by a rigid operating instrument under transurethral uretero-renoscopy. The pathological diagnosis was grade I-transitional cell carcinoma of the ureter, so that right total nephroureterectomy with partial cystectomy was carried out subsequently. Surgical specimen after right total nephroureterectomy with partial cystectomy showed no other tumor in the pelvis or ureter macroscopically, and histopathological studies of surgical specimens were no evidence of malignancy. We believe that transurethral uretero-renoscopy significantly increases the diagnostic accuracy in determining the nature of upper urinary tract lesions, and this procedure is indispensable in the diagnosis of ureteral tumors. The present case was the 7th case of primary ureteral carcinoma in the duplicated renal pelvis and ureter in the Japanese literature.     

Smad4在肾盂、输尿管移性细胞癌中的表达及在细胞凋亡中的作用

目的 探讨细胞凋亡及Smad4在肾盂、输尿管移行细胞癌中的表达及其作用。方法 凋亡的检测采用未端脱氧核苷酸转移酶介导生长素标记法（TUNEL法），Smad4检测采用免疫组织化学方法。结果 在肾盂、输尿管移行细胞癌中，细胞凋亡指数为1.10%－3.75%，平均为2.50%，细胞凋亡指数与肿瘤组织学分级有关，但与肿瘤病理分期无关。Smad4阳性表达占17.6%(6/34),Smad4阳性表达位于肿瘤胞浆、胞核内，Smad4表达与肿瘤的分期、分级无关。细胞凋亡指数和Smad4表达之间无明显相关。结论 细胞凋亡指数与肾盂、输尿管移行细胞癌分级有密切关素；Smad4与肾盂、输尿管癌分期分级无关；细胞凋亡指数与Smad4表达无关。