Alpha-fetoprotein-producing esophageal adenocarcinoma: Report of a case

This paper describes a rare case of adenocarcinoma located in the middle portion of the esophagus with liver metastasis. An 80-year-old man was admitted to our hospital with dysphagia and vomiting, following which an upper gastrointestinal series and esophagoscopy located an elevated-type carcinoma in the middle thoracic esophagus. Computed tomography revealed an esophageal tumor invading the left atrium and aorta, and multiple intrathoracic lymph node swellings, and an ultrasonograph of the liver showed multiple liver metastases. The serum carcinoembryonic antigen, carbohydrate antigen 19-9, and squamous cell carcinoma-related antigen levels were normal, but the serum alpha-fetoprotein (AFP) level was 351.5 ng/ml. The patient died 124 days after undergoing an esophageal bypass operation. On post-mortem histological examination, the original esophageal tumor was diagnosed as a poorly differentiated adenocarcinoma without a squamous component and immunohistochemical staining for AFP showed positive granules in the cytoplasm. All the metastatic nodules, including the lymph nodes, liver, spleen, and lungs, showed the same histological type and AFP-staining pattern as the original esophageal tumor. To our knowledge, this is the first case of AFP-producing esophageal carcinoma to be reported in Japan.     

Primary adenocarcinoma of the ureter. Case report

Primary ureteral adenocarcinoma is an infrequent histological type of urinary neoplasm. Many authors consider intestinal metaplasia the pivotal event of the pathogenetic process, whether it occurs on a pre-existing urothelial carcinoma or on a normal urothelium. Diagnosis is essentially based on case history and clinical findings (hematuria and pain) and on diagnostic imaging. Treatment is surgical and the ideal procedure is nephroureterectomy with excision of a bladder margin adjacent to the ureteral opening and ispilateral para-aortoiliac lymphadenectomy. A 76-year-old man with primary adenocarcinoma of the ureter case is reported.     

Papillary adenocarcinoma of ureter

A well-differentiated papillary adenocarcinoma developed in a ureteral stump thirty-six years after nephrectomy and was associated with a combined transitional-epidermoid carcinoma in the urinary bladder. Carcinoma in a ureteral stump is not uncommon and should be suspected in patients with a ureteral stump and hematuria. The very rare adenocarcinoma of the ureter is typically papillary and is associated with urinary tract infection and stones. At present successful treatment requires the early identification and extirpation of the ureteral tumor and consideration of associated cancer elsewhere in the urinary tract.     

Implantation metastasis in ureter from a colonic adenocarcinoma.

Metastasis to the ureter is very rare. In most published cases, the diagnosis is only made at postmortem examination or when gross metastasis is present. This report presents a case in which the metastasis from a colonic tumour occluded the ureteral lumen from inside.     

Primary non-mucinous, non-papillary adenocarcinoma of the ureter

We report a case of primary, non-mucinous, non-papillary ureteral poorly differentiated adenocarcinoma. The primary focus could only be detected during surgical exploration, because computed tomography (CT), ultrasonography (US), intravenous urography (IVU) and other radiologic and endoscopic procedures revealed no primary neoplastic focus, only lymph node and various bone metastases. Total nephroureterectomy with a bladder cuff was performed to decrease pain of the patient and to remove the primary tumoral focus.     

Primary adenocarcinoma of the ureter: report of a case

The patient was a 66-year-old man who presented with asymptomatic hematuria. Left hydronephrosis was observed on drip infusion pyelography (DIP), and retrograde pyelography (RP) was performed because the image of the ureter was poor. On RP, stenosis was observed in the left ureter at the L5 vertebral level. The same findings were obtained by antegrade pyelography in combination with nephrostomy. A white-colored tumor was observed at the site ofstenosis by flexible pyeloscopy, and biopsy was performed. Adenocarcinoma was identified by histopathological examination. Total left renal nephroureterectomy was performed after its diagnosis as primary adenocarcinoma of the ureter (T2, NO, MO). To our knowledge, this is the 12th case reported in Japan.     

Alpha-fetoprotein-producing renal cell carcinoma

Alpha-fetoprotein (AFP) is recognized as a tumor marker of yolk sac tumors, liver cancer and some other cancers of the digestive organs. Renal cell carcinoma (RCC) producing AFP is a rare entity. A case of AFP-producing RCC with solitary bone metastasis, but without liver involvement, is reported. The stain specific to AFP proved the presence of AFP in the cytoplasms of more cells of the renal tumors. Additionally, the other published cases are reviewed. These cases indicate that mesoderm-originating malignant tumors such as RCCs can produce AFP in some situations. So, AFP is probably more universal than believed, although it is generally a popular and useful tumor marker for hepatocellular carcinomas and yolk sac tumors.     

Primary adenocarcinoma of the ureter associated with hypocalcemia: report of a case

A case of primary adenocarcinoma of the ureter, associated with severe hypocalcemia in a 73-year-old man is reported. The patient had undergone left nephrectomy for pyonephrosis due to a ureteral stone, 29 years previously. On November 4, 1986, he visited the hospital with dysuria and overflow incontinence as the chief complaints. He was admitted with suspicion of prostatic carcinoma, but prostatic stones and chronic prostatitis were proven. However, urine cytology showed adenocarcinoma cells, and a ureteral tumor was found at the right ureterovesical junction. On December 10, right partial ureterectomy, total cystectomy and right ureterocutaneostomy were performed. Moderately differentiated, invasive adenocarcinoma was found at the right ureteral end, 1.5 cm in length and in part poorly differentiated transitional cell carcinoma was present continuously to the adenocarcinoma. Hypocalcemia was cured easily with activated vitamin D3. The patient, 9 months after the operation, is apparently free of the ureteral tumor.     

Re-implantation of the ureter.

For 10 years a modified Politano-Leadbetter technique with extravesical as well as intravesical exposure has been used for re-implantation of the ureter. The results suggest that the passive mechanism of prevention of reflux is more important than any active mechanism and that it is unnecessary to excise the lower end of the ureter.     

Malacoplakia of the ureter.

Malacoplakia of the urinary tract affects primarily the bladder and secondarily the distal ureter. Characteristic gross and microscopic lesions have been well described. A case of malacoplakia is reported in a 55-year-old woman who presented with hydronephrosis in a solitary kidney. The only lesion in the urinary tract was an apple-core type mass of the distal ureter, which was resected. This represents a rare and unusual presentation of malacoplakia. The differential diagnosis and pertinent literature are discussed.     

Trauma of the ureter.

Thirty-three ureteric injuries were treated over a 2-year period. The majority of patients presented late. The most common modes of repair were either ureteroneocystostomy or transuretero-ureterostomy. Complications were few and of little significance.     

Endometriosis of the ureter.

Endometriosis of the ureter is an exceptional cause of ureteral obstruction. Pathogenesis and clinical picture are demonstrated on the basis of 2 cases, giving an example for the spread of endometrial tissue via the lymphatics. It is emphasized that young women should have a gynecological examination in case of pelvic ureteral obstruction. Final diagnosis of the isolate ureteral endometriosis can only be made by histological examination. Therapy is usually surgical followed by hormonal treatment. The routine use of excretory urograms in women suffering from endometriosis should prevent urological complications.     

Endometriosis of the ureter.

Five patients with ureteric endometriosis are described. Extensive pre-operative investigation failed to reveal the aetiology of the unilateral upper urinary tract obstruction seen in all of these patients. Due to the dense fibrosis that invariably accompanies ureteric endometriosis, early surgical excision of the ureteric stricture permits effective resolution of upper tract dilatation and improved renal salvage.