CA19-9-producing transitional cell carcinoma of the renal pelvis: a case report

We report a case of CA19-9-producing transitional cell carcinoma of the renal pelvis. A 59-year-old male patient with left hydronephrosis was referred to us from a local physician. Retrograde pyelogram revealed irregular filling defects involving calices, pelvis and proximal ureter. The serum CA19-9 level was elevated. Under the diagnosis of renal pelvic tumor, we performed radical left nephroureterectomy. The tumor was histologically diagnosed as transitional cell carcinoma. The tumor cells showed positive immunostaining for CA19-9. The serum CA19-9 level was normalized after the operation. To our knowledge, this is the 28th case of a CA19-9-producing tumor in the Japanese literature.     

A case of CA19-9 producing transitional cell carcinoma of the ureter

We report a case of CA19-9 producing urothelial carcinoma of the right ureter. A 61-year-old male patient who had an extremely high value of serum CA19-9 (1,185 U/ml) with right hydronephrosis was referred to us. Magnetic resonance urography and retrograde ureterography revealed a long irregular filling defect in the right distal ureter. Under the diagnosis of right ureteral tumor, we performed right total nephroureterectomy and pelvic lymphadenectomy. The tumor was histologically diagnosed as grade 1 transitional cell carcinoma and pelvic lymphnodes were positive (pT1N2M0). The tumor cells showed positive immunostaining for CA19-9. The serum CA19-9 level was normalized after the operation and successive adjuvant chemotherapy (M-VAC 2 course). No recurrence was found for 15 months after operation. In this case, the serum CA19-9 level was useful as a tumor marker.     

Primary mucinous adenocarcinoma of the renal pelvis with elevated CEA and CA19-9

Primary adenocarcinoma of the renal pelvis is rarely reported in the literature. Here we present a case of primary mucinous adenocarcinoma of the renal pelvis with elevated serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) levels. A 56-year-old woman was referred to our center with intermittent fever and left-sided back pain for 1 month. Computed tomography showed bilateral nephrolithiasis, mild right hydronephrosis and left pyonephrosis accompanied with ambiguous soft tissues. A radionucleorenogram showed that the glomerular filtration rate of the left and right kidney was 0 and 79 ml/min, respectively. Left nephrectomy was performed without lymph node dissection. Histopathology revealed mucinous adenocarcinoma and elevated serum CEA and CA19-9 levels were found. She died of multiorgan metastasis after 5 months. A review of the literature is also reported.     

A case of transitional cell carcinoma of the urinary bladder with high serum level of CEA and CA19-9

An 85-year-old male with asymptomatic gross hematuria was diagnosed with invasive bladder tumor, transitional cell carcinoma grade 3. Serum levels of CEA and CA19-9 were elevated and histological examination revealed expression of both markers in the cytoplasm of cancer cells. Out of therapeutic options, intra-arterial chemotherapy and radiotherapy were selected because of his age. During the treatment, serum levels of CEA and CA19-9 decreased along with reduction of tumor size. These serum markers have been reported to be elevated in 10 to 60% of patients with bladder tumor and are useful markers for evaluation of the treatment as suggested in the present case.     

A case of CA19-9 producing transitional cell carcinoma of the ureter effectively responsive to combination chemotherapy]

We report a case of CA19-9 producing transitional cell carcinoma of the right ureter effectively responsive to combination chemotherapy (methotrexate, vinblastine, doxorubicin and cisplatin (M-VAC) regimen) in a 53-year-old woman. The maximum level of serum CA19-9 showed 3,000 U/ml and clinical staging of the tumor was T4 N3 M0. Marked regression of the tumor was identified by computed tomographic scan and the level of serum CA19-9 returned to the normal range after 3 courses of M-VAC therapy. Right total nephro-ureterectomy and partial cystectomy was done and the surgical specimen revealed no viable tumors. She is alive without evidence of local recurrence or metastasis at 6 months after resection. The serum CA19-9 level was useful for monitoring the clinical course.     

A mixture of transitional cell carcinoma and adenocarcinoma of the renal pelvis

An 85-year-old male was admitted to our hospital with the chief complaint of a left hydronephrosis. Computed tomography (CT) revealed left hydronephrosis and a left ureteral tumor. We performed left nephroureterectomy. Microscopically, the neoplasm was composed of a mixture of transitional cell carcinoma and adenocarcinoma. To our knowledge, this case is the 14th report of mixed carcinoma of the upper urinary tract.     

Mucinous adenocarcinoma of the renal pelvis associated with transitional cell carcinoma in the renal pelvis and the bladder

We report a case of mucinous adenocarcinoma of the renal pelvis associated with bladder carcinoma in situ (CIS). Transitional cell carcinoma (TCC) of the renal pelvis and CIS were also observed adjacent to the adenocarcinoma. Immunohistochemical assessment of the pelvic adenocarcinoma revealed positive expressions for mucin, epithelial membrane antigen, cytokeratin 7, cytokeratin 19 and carcinoembryonal antigen, but not vimentin or chromogranin. Based on the histopathological examinations, the adenocarcinoma of the renal pelvis in the present case may have a similar biological nature to conventional TCC and probably originated by development of pre-existing TCC of the renal pelvis.     

A case of primary urotherial carcinoma with glandular differentiation of the renal pelvis with high serum level of carbohydrate antigen 19-9 (CA19-9)

A 63-year-old man visited our hospital with body weight loss. Laboratory examination revealed a high serum level of carbohydrate antigen 19-9 (CA19-9) and LDH. There were no abnormal findings in the gastrointestinal tract. Enhanced abdominal computed tomography (CT) revealed a renal tumor, 5×3 cm in diameter, in the right lower pole and multiple lymph node swelling. The right renal tumor was not a typical renal cell carcinoma, so we considered the presence of bellini duct carcinoma and renal pelvis carcinoma, we performed right nephroureterectomy. Histopathological diagnosis was urothelial carcinoma with glandular differentiation of the renal pelvis. Post operation chemotherapy with GC (gemcitabine/cisplatin: 3-cycle), MVAC (methotrexate/vinblastine/doxorubicin/cisplatin: 1-cycle), TS-1 + CBDCA (tegafur-gimeracil-oteracil potassium/carboplatin: 3-cycle) was performed for lymph node metastasis, but he died of cachexia 18 months after operation.     

A case of CA19-9-positive retroperitoneal mucinous adenocarcinoma

We report a case of retroperitoneal mucinous adenocarcinoma in a 44-year-old woman, who was admitted to our hospital complaining of low grade fever. Computed tomography and magnetic resonance imaging demonstrated a cystic tumor located at the lower pole of left kidney with irregular wall, which was enhanced by contrast medium. Open surgery was performed. Macroscopically, the tumor was clearly separated from the left kidney, and diagnosed as retroperitoneal in origin. Histopathological diagnosis was mucinous adenocarcinoma of retroperitoneum and immunohistochemical staining was positive for CA19-9, but not for CA125. The patient had no recurrence for 19 months post-operatively.     

A case of transitional cell carcinoma of renal pelvis with an extremely high serum carcinoembryonic antigen (CEA) level]

A case of urothelial tumor with extremely high serum carcinoembryonic antigen (CEA) levels is described. A 68-year-old female presented with macroscopic hematuria and left flank pain. Laboratory examination revealed an extremely high serum level of CEA (194 ng/ml) and elevated levels of serum CA 19-9 (235 U/ml) and squamous cell carcinoma (SCC)-Antigen (10.7 ng/ml), while urine CEA remained within normal limits. No abnormal findings were recognized in gastrointestinal and respiratory systems, but left renal pelvic tumor (T4N2M0) was discovered. Nephroureterectomy with regional lymph node dissection was done. The pathologic anatomy was infiltrating non-papillary transitional cell carcinoma (TCC, G2 = G3, pT4N2M0). More than 30% of the tumor cells were positive for CEA by ABC-peroxidase staining. Levels of tumor markers remained higher than normal after the operation and were normalized after M-VAC (methotrexate, vinblastine, adriamycin and cisplatin) chemotherapy. However, 6 months after the operation, levels of tumor markers rose again and lung metastases appeared. She died 10 months after the operation.     

Superficial urothelial carcinoma of ureter with elevated serum CA19-9 and CEA

We report a 77-year-old Japanese man with superficial ureteral carcinoma with elevation of serum CA19-9 and carcinoembryogenic antigen (CEA) at recurrence. We performed radical nephroureterectomy and partial bladder resection for the right ureteral carcinoma. Pathological diagnosis was UC, G2 > G1, pTa, NO, MO (according to UICC classification). Eighteen months later, local recurrence and multiple metastases were observed, accompanied by the elevation of serum CA19-9 and CEA. His autopsy specimens showed positive immunostaining for serum CA19-9 and CEA. In Ki-67 labeling index, the autopsy specimens showed higher scores than the surgical specimen.     

肾原发性上皮样血管肉瘤伴肾盂移行细胞癌

作者报道应用临床病理学、免疫组织化学和电子显微镜检查，发现１例左肾原发性上皮样血管肉瘤伴肾盂移行细胞癌。该病例第八因子相关抗原、荆豆凝集素、内皮细胞抗体、波形蛋白、细胞角蛋白和上皮膜抗原（ＦⅧＲＡ、ＵＥＡ、ＣＤ３１、Ｖｉｍｅｎｔｉｎ、Ｃｙｔｏｋｅｒｅｔｉｎ和ＥＭＡ）阳性，电镜查见Ｗ－Ｐ小体。作者认为该病是一种罕见肿瘤，预后差，其形态学和免疫组织化学类似于上皮性肿瘤，易导致误诊。电镜和内皮性标志物ＦⅧＲＡ、ＣＤ３１、ＵＥＡ的联合应用可确诊本瘤。     

An unusual case of transitional cell carcinoma of renal pelvis presenting with brain metastases

We report a rare case, who had presented with a constellation of neurological symptoms (due to multiple brain metastases), but without any urological symptoms, to the department of neurosurgery. The patient was managed with gamma knife stereotactic radiosurgery for the metastatic lesions. During an evaluation for primary, he was found to be having transitional cell carcinoma (TCC) of right renal pelvis, for which palliative radical nephroureterectomy was performed, following which he received four cycles of paclitaxel and carboplatin chemotherapy. The patient is alive with stable disease at 22-months follow-up.     

Papillary adenocarcinoma of the renal pelvis and ureter producing carcinoembryonic antigen, carbohydrate antigen 19-9 and carbohydrate antigen 125

We report a case of advanced renal pelvis and ureter adenocarcinoma producing carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9) and carbohydrate antigen 125 (CA125). A 72-year-old woman was diagnosed with right renal pelvic and ureter tumor with para-aortic lymph node swelling. Biopsy of the ureteral mass revealed papillary adenocarcinoma. Serum levels of CEA, CA19-9 and CA125 were extremely elevated. The patient was successfully treated with paclitaxel/carboplatin chemotherapy followed by surgery.     

Bilateral renal cell carcinoma and synchronous occurrence of transitional cell carcinoma of renal pelvis

A case is reported of the unusual occurrence of a primary bilateral renal cell carcinoma and synchronous occurrence of a papillary transitional cell carcinoma of the renal pelvis in one kidney. The literature is reviewed.     

Conservative surgery for transitional cell carcinoma of the renal pelvis

From 1972 to 1986, 14 patients underwent a conservative operation for transitional cell carcinoma of the renal pelvis. Most of these patients had low grade (12), noninvasive (10) tumors involving a solitary functioning kidney (12). The operations performed were open pyelotomy with tumor excision and fulguration (8 patients), partial nephrectomy (5) and percutaneous nephroscopic fulguration (1). There was 1 operative death. Of the 13 surviving patients 8 (62 per cent) remained free of transitional cell carcinoma postoperatively, while 5 (38 per cent) had recurrent disease. Six patients (46 per cent) presently are free of tumor 6 months to 5 years postoperatively. Conservative surgical techniques can provide satisfactory treatment for selected patients with renal pelvic transitional cell carcinoma when preservation of functioning renal parenchyma is necessary to avoid kidney failure.     

A clinical study on transitional cell carcinoma of the renal pelvis and ureter

Thirty-three patients in which transitional cell carcinoma was histologically diagnosed in the upper urinary tracts were statistically analyzed. Clinical analysis was done according to a new TNM system proposed by Akaza. Tumor grade and stage well correlated with survival. TS and TE group showed 89.5 and 17.1% 3-year survival, respectively. The survival rates showed significant difference between grade, 1, 2 and 3. T category and grade were also significantly correlated. Furthermore, histology and cytology were well correlated. Finally, prognosis in our series was significantly influenced by stage and grade of the tumor. Prognosis is considered to be good for 1) grade 1, 2) grade 2, superficial tumors with negative cytology, and 3) No and M0 cases. We emphasize that the new classification proposed by Akaza correlates well to survival and adapts well to the definition of regional lymph nodes.