Case of leiomyosarcoma of the renal pelvis

A 54-year-old man presented at the Mibayashi clinic with bowel discomfort. Ultrasonography showed a left renal mass and the patient was referred to Noto General Hospital for urological evaluation. Results of the physical examination were unremarkable, but computed tomography and magnetic resonance imaging demonstrated a large tumor in the middle of the left kidney. The patient underwent left nephrectomy. On hemisection of the kidney, a firm tumor, measuring 8 x 7.5 cm, was seen occupying the renal pelvis. The histological diagnosis was leiomyosarcoma arising from the right renal pelvis. No treatment was provided after surgery and no recurrence was observed 6 months postoperatively.     

Leiomyosarcoma of kidney – a case report with long term result after radiotherapy and chemotherapy

Leiomyosarcoma of the kidney is a rare entity with poor prognosis. Among renal sarcomas, it is the most common histologic subtype amounting to 50–60% of all cases. The tumors usually arise from either the renal capsule or smooth muscle tissue in the renal pelvic wall. We describe a case of renal leiomyosarcoma that presented with history of left flank pain. Physical examination was normal. Abdominal ultrasound showed a solid lesion of 38 × 36 mm arising from the left kidney. Intravenous urography showed cut off of both major and minor calyces of the left kidney from its pelvis with a normal right kidney. Exploratory laparotomy revealed a well-encapsulated mass confined to the renal parenchyma for which radical nephrectomy was performed. Histopathology showed a Grade I leiomyosarcoma arising from the renal capsule. Adjuvant chemotherapy and sandwich radiotherapy was given and he is disease free after six and half years of follow up. The rarity of this disease, its severity and poor prognosis, uncommon form of presentation, resulting delay in diagnosis and difficulty in management is highlighted and reported.     

Renal leiomyosarcoma: plea for aggressive therapy.

We report a case of renal leiomyosarcoma arising from the renal pelvis with immunohistochemical confirmation of the diagnosis. Treatment was extirpative surgery for both primary and metastatic lung lesions as well as adjunctive radiation and chemotherapy. This patient remains disease-free twelve months following treatment.     

Leiomyosarcoma of the renal pelvis.

We report a case of renal leiomyosarcoma arising from the renal pelvis with immunohistochemical confirmation of the diagnosis. In this instance clinical presentation and imaging finding are not helpful in accurately establishing the diagnosis preoperatively. Wide surgical excision would appear to be the treatment of choice.     

A case of squamous cell carcinoma of the renal pelvis accompanying an ectopic opening with vesicoureteral reflux of complete duplication of uretero pelvis

Squamous cell carcinoma of the renal pelvis is a relatively rare disease. Recently, we observed a case of squamous cell carcinoma of the renal pelvis with vesicoureteral reflux in a 49-year-old female patient. Her main symptom was abdominal pain on the left side. The complete duplications of uretero-pelvis on both sides, and vesicoureteral reflux in the upper left part of the kidney were recognized by means of various examinations. During the operation, a tumor was found in the upper left renal pelvis, and in the ureter belonging to the upper left renal pelvis. Pathologically, it was diagnosed as a squamous cell carcinoma. After the extraction of the left uretero-pelvis, 50 Gy of radiotherapy was administered to the patient. However, she died four months after the operation.     

Rupture of renal pelvis due to urolithiasis: report of two cases

Two cases of renal pelvis rupture caused by urolithiasis are reported. The first case was in a 62-year-old male who had left flank pain. Urological examination including drip infusion pyelography (DIP) and abdominal computed tomography (CT) revealed a spontaneous rupture of the left renal pelvis. The rupture was assumed to have been caused by a small ureteral stone. The stone passed spontaneously, and the extravasation disappeared with conservative therapy. The second case was in a 84-year-old male who was admitted with high fever. Urological examination including DIP and abdominal CT showed a suspected rupture of the left renal pelvis due to a renal stone at the ureteropelvic junction. Percutaneous nephrostomy was performed and antegrade pyelography showed extravasation from the left renal pelvis. Extravasation disappeared on the 12th postoperative day. Extracorporeal shock wave lithotripsy was performed three times. The renal stone was completely discharged and the nephrostomy tube was removed successfully.     

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.     

Leiomyosarcoma of the kidney with tumor thrombus to the inferior vena cava

A 76-year-old female presented with edema in the bilateral lower legs and computed tomography (CT) subsequently revealed a tumor under the right side of the kidney that extended to the inferior vena cava. Under suspicion of a right renal sarcoma or malignant teratoma, we performed a right nephrectomy and tumor thrombectomy. Histopathological features of the resected specimen were compatible with a leiomyosarcoma originating from either extrarenal blood vessels or muscle fibers of the renal pelvis. Immunohistological findings showed that the tumor cells were spindle-shaped, arranged in bundles, and stained positive for α-smooth muscle actin and desmin. The patient was free from recurrence 10 months after surgery. The prognosis of patients with a renal leiomyosarcoma with venous thrombus has been considered to be poor. Herein, we provide details of our case and conclude that radical tumor resection is necessary for a long-term cure.     

Upper urinary tract tumours in Hong Kong (1972-1987)

A retrospective analysis of all primary upper urinary tract tumours (300) filed in the pathology department of a regional hospital in Hong Kong during 1972-87 showed that renal cell carcinoma (143) was the commonest malignant tumour. Transitional cell carcinoma of the renal pelvis (62) was the next most frequent. Fibromas, which occurred as frequently as angiomyolipomas (28) and outnumbered tumours such as squamous cell carcinoma (13) and nephroblastoma (12), were of little clinical significance since they were invariably incidental findings. Nephrectomies were seldom performed for kidneys involved in secondary malignancies. Rare tumours encountered were adenocarcinoma of the renal pelvis, leiomyosarcoma, malignant fibrous histiocytoma, adenoma, oncocytoma, mesoblastic nephroma and multilocular cystic nephroma. Angiomyolipomas were responsible for most cases of surgical emergency.     

UPPER URINARY TRACT TUMOURS IN HONG KONG (1972–1987)

A retrospective analysis of all primary upper urinary tract tumours (300) filed in the pathology department of a regional hospital in Hong Kong during 1972–87 showed that renal cell carcinoma (143) was the commonest malignant tumour. Transitional cell carcinoma of the renal pelvis (62) was the next most frequent. Fibromas, which occurred as frequently as angiomyolipomas (28) and outnumbered tumours such as squamous cell carcinoma (13) and nephroblastoma (12), were little clinical significance since they were invariably incidental findings. Nephrectomies were seldom performed for kidneys involved in secondary malignancies. Rare tumours encountered were adenocarcinonia of the renal pelvis, leiomyosarcoma, malignant fibrous histiocytoma, adenoma, oncocytoma, mesoblastic nephroma and multilocular cystic nephroma. Angiomyolipomas were responsible for most cases of surgical emergency.     

Angiomyolipoma in the renal pelvis

A 54-year-old male presented with massive hematuria with bladder tamponade. Computed tomography and magnetic resonance imaging showed a 7.5 x 6.5 x 4.5 cm. mass centered in the left renal pelvis, which is composed of macroscopic fat and soft-tissue component. Differential diagnosis included liposarcoma, lipoma and angiomyolipoma. Urothelial carcinoma was also undeniable because urine cytology was equivocal. Subsequently, a left nephroureterectomy was performed. Pathological examinations revealed a renal angiomyolipoma protruding into the renal pelvis. We present a rare case of angiomyolipoma in the renal pelvis and review the literature concerning these unusual findings of this common neoplasm.     

The primary mucinous adenocarcinoma of renal pelvis: a case report

A case of primary mucinous adenocarcinoma of the renal pelvis is reported. A 55-year-old man visited our clinic with lumbar pain. He had a history of left renal stone and had left partial nephrectomy four years previously. Physical examination revealed a hard, child-head-sized, unmovable and uneven tumor in the left side of the abdomen. Intravenous pyelography revealed the non-functioning left kidney with calcification, in which hydronephrosis was detected by computed tomography. In transabdominal sonography a huge mass with mixed echo pattern was observed. Aspiration biopsy under interventional ultrasound was performed, aspirating yellow-white semi-transparent mucinous substance, which was highly suspicious of malignancy by cytology. He died 74 days after the first admission. Autopsy revealed primary mucinous adenocarcinoma of the renal pelvis. This was thought to be the 14th case of primary mucinous adenocarcinoma of the renal pelvis reported in the Japanese literature.     

Solitary contralateral renal pelvis metastasis 9 years after removal of renal adenocarcinoma.

Extremely rarely, renal cell carcinoma metastasizes to the contralateral renal pelvis or ureter. The present report concerns a case where a metastatic tumour was successfully removed from the left renal pelvis 9 years after right nephrectomy for the primary tumour.     

Leiomyosarcoma of renal vein and inferior vena cava

A case of leiomyosarcoma of the right renal vein and inferior vena cava causing total obstruction of the vena cava is reported. This rare condition was treated successfully after two previous operations had deemed it unresectable. Treatment consisted of a right nephrectomy and resection of the vena cava and ligation of the left renal vein. Because of the slow growth of the well-differentiated leiomyosarcoma, there was no problem with venous return from the left kidney, and the patient recovered promptly without evidence of renal function impairment. Postoperatively, she received chemotherapy consisting of doxorubicin (Adriamycin) and vincristine. She is well and free of tumor over four years postoperatively. The good result, in this case, is attributed to complete surgical excision and multimodal therapy.     

Mucinous adenocarcinoma probably arising in the renal pelvis and ureter: a case report

A patient with widely disseminated mucinous adenocarcinoma had polypoid tumors in the left renal pelvis and ureter. While no certain primary site was determined, either clinically or at postmortem examination, microscopic examination of the left renal pelvis and ureter revealed atypical glandular metaplasia adjacent to the tumors and made the upper urinary tract a likely site of origin for the adenocarcinoma.     

Port site metastasis of primary adenocarcinoma of the renal pelvis after a laparoscopic nephrectomy: a case report

We report a case of port site metastasis of primary adenocarcinoma of the renal pelvis after a laparoscopic nephrectomy. A 76-year-old woman was admitted to our hospital with a complaint of anorexia, general malaise and left abdominal distension. Computed tomography revealed severe hydronephrosis in the left kidney. Laboratory examination revealed a high serum level of CA19-9 (155 U/ml). However, antegrade and retrograde pyelography revealed no filling defects and urine cytopathology for renal pelvis showed no malignancy. Thus, on the suspicion of a ureteropelvic junction stenosis, a laparoscopic nephrectomy was performed. There were some papillary tumors in the renal pelvis and a histopathological examination of the tumor revealed a papillary adenocarcinoma. Twelve months after nephrectomy, left iliopsoas muscle metastasis was found. Thus irradiation therapy with a total of 30 Gy was performed. However, 3 months later, the patient developed metastasis at the trocar site and the serum level of CA19-9 elevated to 6,720 U/ml. She died of multiple metastases from adenocarcinoma of the renal pelvis 4 months after port site metastasis.     

Renal pelvic extravasation of urine associated with ureteral stones: report of two cases]

We report a case of spontaneous rupture of the renal pelvis and a case of spontaneous peripelvic extravasation, which were associated with ureteral stones. Case 1 was in a 73-year-old man with complaint of left flank pain. Excretory urograms showed left spontaneous rupture of the renal pelvis associated with left ureteral stone. Double-J ureteral stent was placed immediately and transurethral ureterolithotripsy (TUL) was performed after disappearance of extravasation. Case 2 was in a 34-year-old woman with complaint of left flank pain. Excretory urograms showed left ureteral stone and spontaneous peripelvic extravasation. The stone passed spontaneously and the extravasation disappeared with conservative therapy.     

Inflammatory myofibroblastic tumor of the renal pelvis

Inflammatory myofibroblastic tumor (IMT) of the genitourinary tract is rare and has been classified into separate groups based on their anatomical site and postulated aetiology. Herein, we present a case of IMT of the renal pelvis. A 44-year-old man presented with gross hematuria. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) revealed a tumor of the left renal pelvis. Under the diagnosis of left renal pelvic tumor, he underwent left nephrectomy and ureterectomy. Microscopic examination revealed fascicular spindle cell proliferation in an oedematous myxoid background with an infiltrate of plasma cells. The spindle cells were strongly positive for smooth muscle actin (SMA) and vimentin, and negative for desmin and anaplastic lymphoma kinase (ALK). Diagnosis of the lesion was IMT of the renal pelvis.     

An unusual case of multilocular cystic nephroma with prominent renal pelvis involvement

Multilocular cystic nephroma (MCN) is a relatively rare, benign tumor of uncertain etiology. It typically arises from the renal parenchyma and is often treated with nephrectomy. We report a case of MCN with unusual prominent renal pelvis extension. A left nephrectomy was performed. A multilocular cystic lesion was found in the removed specimen, which had a direct tumor extension into the renal pelvis. There were no signs of malignancy. The tumor extension into the renal pelvis has been found in very few reports. This growth pattern might be one of the characteristics of this benign renal tumor.     

A case of renal cell carcinoma metastasizing to the contralateral kidney and renal pelvis

Extremely rarely renal cell carcinoma metastasizes to the contralateral renal pelvis or ureter. A 42-year-old man had undergone left radical nephrectomy for renal cell carcinoma (pT1b, grade 2) in March, 2000. Fifteen months later, he complained of macroscopic hematuria. Computed tomographic scanning and retrograde pyelography showed a right renal pelvic tumor. Enucleation of pelvic tumor was performed and a parenchyma mass incidentally identified in the right kidney was also resected. Histopathological examination of each tumor revealed renal cell carcinoma identical to the primary tumors in the left kidney suggesting metastasis to renal pelvis and de novo tumor or metastasis in the right kidney.