Extensive bilateral renal pelvis, ureter and bladder leukoplakia

We are presenting a case of leukoplakia spread to the bilateral renal pelvis, ureter and bladder in a 52-year-old woman. We believe this case is important because it involves leukoplakia that is more extensive than in any cases previously cited in the literature. No other possible etiologic cause except a heavy smoking habit was defined. Conservative follow-up was preferred to aggressive surgery.     

Endoscopic treatment of urothelial tumours of the renal pelvis and ureter

Endoscopic treatment of urothelial tumors of renal pelvis and ureter is gaining acceptance as a conservative treatment modality. Technological advances have increased its applicability. Ureteroscopic and percutaneous tumor ablation have become reasonable treatment options for patients with imperative indications, such as bilateral disease, renal insufficiency or solitary kidney. However, endoscopic tumor ablation is being utilized more frequently for patients with UTTCC even in the setting low grade disease and a normal contralateral kidney, provided long-term close surveillance to detect and treat recurrences is ensured. This paper reviews the current role of endoscopic management of UTTCC.     

A case of adenocarcinoma in the renal pelvis and urinary bladder in a patient with chronic renal failure

The patient was a 61-year-old male who had undergone right nephrectomy for nephrolithiasis 35 years before. He had been on hemodialysis for 6 years for chronic renal failure caused by left renal staghorn calculus and hydronephrosis. He was admitted to our hospital because of macroscopic hematuria and sense of residual urine which had persisted for 3 months. Cystoscopic examination showed an extensive papillary tumor in the urinary bladder, which histologically was an adenocarcinoma. Giant left hydronephrosis associated with staghorn calculus noted by KUB and CT scan. Total cystectomy, intraoperative radiotherapy, and left nephrostomy were performed under the diagnosis of adenocarcinoma of the urinary bladder and left hydronephrosis. The bladder tumor was found to be a mucinous adenocarcinoma. The patient died from a cerebral hemorrhage on the 17th postoperative day. At autopsy, tumors were found in the pelvis of the left kidney and the middle and lower regions of the ureter, which were adenocarcinoma like the bladder tumor. Adenocarcinoma occurring simultaneously in the renal pelvis and bladder has not been previously reported to our knowledge, in Japan or elsewhere.     

Eicosanoid synthesis in the isolated human renal pelvis, ureter and bladder

Prostaglandin synthetase inhibitors are used for the treatment of ureteric colic. However, there is controversy regarding the mechanism of action of these drugs. In this study, differential prostaglandin synthesis in the human renal pelvis, ureter and bladder was measured using specific radioimmunoassays and gas chromatography/mass spectrometry. There was a significant quantitative predominance of the smooth muscle constrictor eicosanoids, PGF2 alpha and TXA2 over the dilatory PGE2 in tissue from all sites--renal pelvis, ureter and bladder. The results indicate that prostaglandins play a direct role in smooth muscle activity of the upper urinary tract and the inhibition of this activity with indomethacin indicates a further mode of its action in pain relief in ureteric colic.     

A clinicopathological study on tumor of the renal pelvis and ureter

We report 42 patients with urothelial tumors in upper tract admitted to our hospital between August, 1969 and August, 1988. The patients consisted of 33 males and 9 females; their ages ranged from 42 to 85 years with a mean of 66.2 years. Total nephroureterectomy with bladder cuff resection was employed as the surgical method in 24 cases, total nephroureterectomy without bladder cuff resection in 11 cases, total nephroureterectomy with total cystectomy in 2 cases and partial ureterectomy only in 2 cases. Tumor lesions had a positive correlation with grade and stage. The survival rate for all the patients at 1, 3 and 5 years was 76.0, 58.8 and 54.6%, respectively, as measured by the Kaplan-Meier's method. The prognosis of the patients with renal pelvic tumor and ureter tumor was dependent upon grade, stage and intravascular tumor-emboli. Vesical recurrence was observed in 10 cases and found frequently in low grade tumor and/or low stage tumor cases. The frequency of vesical recurrence was not positively correlated with cuff resection The 5-year survival rate was not different between the patients with vesical recurrence and those without vesical recurrence.     

A clinical study of tumor of the renal pelvis and ureter

We report 54 patients with urothelial tumors in upper urinary tract admitted to our hospital between July, 1962 and December, 1985. The patients consisted of 38 males and 16 females; side their ages ranged from 47 to 88 years with a mean of 63.4 years. The affected side was the right side in 21 cases, and the left side in 33 cases. Macro-or microhematuria was observed in 87% of the patients. Pathologically, 53 of the patients had transitional cell carcinoma and 1 had papilloma. Six patients had a past history of bladder tumor. Simultaneous bladder tumor was identified in 10 cases. Vesical recurrence was observed in 5 cases. Total nephroureterectomy with bladder cuff resection was employed as the surgical method in 21 cases, and total nephrectomy without bladder cuff resection in 11 patients. The actual five-year survival rate was 53% for all the patients; 52% for patients with renal pelvic tumors, 75% for those with ureteral tumors and 15% for those with renal pelvic and ureteral tumors. The patients who received nephroureterectomy had a postoperative survival rate similar to that of those who received nephroureterectomy with bladder cuff resection. A simultaneous bladder tumor lowered the survival rate.     

Metastatic tumor of renal pelvis and ureter from prostatic cancer: a case report]

An 86-year-old man was admitted to our hospital with a complaint of gross hematuria. Urological examination revealed right hydronephrosis and poorly differentiated adenocarcinoma of the prostate with bone metastases. Abdominal computed tomographic scan and retrograde pyelography showed thickening of the ureteral wall with irregular stenosis in the right upper ureter. Right nephroureterectomy demonstrated diffuse lymphatic infiltration of PSA-positive cancer cells in the submucosa and muscle layer of the ureter as well as renal pelvis. This is the 6th reported case of metastatic ureteral tumor from prostate cancer in the Japanese literature.     

Primary adenocarcinoma of renal pelvis and ureter suspected as metastatic tumor: a case report

A 58-year-old man, who had undergone sigmoidectomy for sigmoid colon adenocarcinoma 3 years earlier, was referred to our clinic because of left ureteral tumor incidentally found by computed tomography (CT). Under the diagnosis of left ureteral carcinoma, retroperitoneoscopic left nephroureterectomy was performed. Pathological examination revealed adenocarcinoma of the left renal pelvis and ureter. Subtype of the adenocarcinoma was 'enteric type'. Five months later, urine cytology was positive and multiple non-papillary tumors were found on cystoscopy. By the transurethral resection of the tumors, bladder tumors appeared to be adenocarcinoma. Carefully considering the pathological findings and clinical course, we concluded that the tumor was not metastatic but primary adenocarcinoma followed by intravesical recurrence.     

A clinical study on tumor of the renal pelvis and the ureter

The 39 cases of renal pelvic and ureteral tumors treated in our hospital from 1974 to 1983, were reviewed retrospectively. The 39 cases included 15 renal pelvic tumors, 21 ureter tumors and 3 ureteropelvic tumors. The incidence of these tumors was 0.15% among all new outpatients. Sex distribution was 25 males to 14 females, and mean age was 65.2 years old. Hematuria was the most frequent initial symptom and chief complaint. Of the patients, 28.6% had come to our hospital within one month after their initial symptoms appeared. "Filling defect", an important finding of IVP and RP, was revealed most frequently. The positive rate of urine cytology was 33.4%. Histological examination revealed 14 transitional cell carcinoma and 1 papilloma of 15 renal pelvic tumors and 19 transitional cell carcinoma, 1 polyp and 1 metastatic adenocarcinoma of 21 ureter tumors. Operative therapy was performed on 36 patients; 26 by nephroureterectomy with partial cystectomy. Vesical recurrence rate was 18.9%. The 5-year survival rate was 37.4% on renal pelvic tumor and 40.7% on ureter tumor. The factors, high grade, high stage, and ureteropelvic double tumor, which reflect the specificity of the malignant potential, also affected prognosis. In conclusion, post-operative adjuvant therapy was thought to be valuable in the near future.     

Carcinosarcoma of the renal pelvis and ureter: a case report

We report a case of carcinosarcoma of the renal pelvis and ureter arising in an 89-year-old man who presented at our hospital with gross hematuria. Abdominal computed tomography, excretory pyelography, and retrograde pyelography demonstrated that left hydronephrosis was caused by an ureteral tumor. Left urine cytology indicated transitional cell carcinoma. The patient underwent chemotherapy and radiation therapy. However, gross hematuria recurred, and the patient underwent left nephroureterectomy. The surgical specimen showed carcinosarcoma in the renal pelvis and ureter histologically. He has been free of cancer for 1.5 years.     

A clinicopathological evaluation of prognostic factors of urothelial tumors of the renal pelvis and ureter]

We investigated the clinicopathological features of 109 patients with urothelial tumors of the renal pelvis and ureter who underwent surgery at four institute from April, 1975 to September, 1997. The patients consisted of 71 males and 38 females, and the mean age was 66.8 years, ranging from 41 to 92 years. Mean followup period was 43 months. The prognostic significance of the pathological factors; pT, Grade, INF, tumor size, pL, pV and pN were evaluated. All these factors affected the survival rates significantly in univariate analysis. Multivariate analysis showed the most influential prognostic factors to be pT and pN.     

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".     

Unilateral extended amyloidosis of the renal pelvis and ureter: a case report

Localized amyloidosis of the genitourinary tract is a rare phenomenon. The differential diagnosis between amyloidosis and malignancy is difficult. We report the case of an 81-year-old man with extensive unilateral localized amyloidosis of the renal pelvis, ureter and ureteral orifice. Diagnosis of amyloidosis was confirmed only postoperatively.     

Carcinomatous meningitis from urothelial carcinoma of bladder and ureter: case report

Carcinomatous meningitis from urothelial carcinoma of the bladder and ureter is rare. A 77-year-old man with invasive bladder cancer and right ureter cancer had been treated with 3 courses M-VAC (methotrexate, vinblastine, epirubicin, cisplatin) chemotherapy. After chemotherapy we performed radical cystectomy and right nephroureterectomy (ileal-neobladder) (TCC, G3, pT3, N0, M0). Sixteen months after operation, patient complained of anorexia, muscular weakness, stiff neck. CT of chest and abdomen, and bone scintigraphy showed no metastasis. Brain CT and MRI showed hydrocephalus but no evidence of parenchymal metastasis. Because we suspected carcinomatous meningitis, we performed lumbar puncture. Cerebrospinal fluid cytology revealed class V (urothelial carcinoma). Patient died 6 days after diagnosis of carcinomatous meningitis.     

A case of congenital mesoblastic nephroma growing with a polypoid pattern in the renal pelvis and ureter

Congenital mesoblastic nephroma (CMN) is an unusual renal tumor, similar in some respects to Wilms' tumor and reported only in infants. We report a case of CMN in a 2-year-old boy. He was referred to us with a right abdominal mass. Excretory urogram, arteriogram and computed tomogram revealed a large malignant renal tumor on the right side. With a clinical diagnosis of Wilms' tumor of the right kidney, he received radiation and chemotherapy. After radiation and chemotherapy, tumor size was decreased. Right nephrectomy was performed on April 22, 1982. The kidney and tumor weighed 270 g and measured 12 X 7 X 5 cm. The tumor extended to the renal pelvis and the ureter with polypoid growth pattern. Microscopically, the tumor was composed of compact interlacing bundles of elongated fibromyomatous cells. Islands of entrapped glomeruli and tubules were also detected within the tumor. He was well and had no signs of recurrence of tumor at the age of 3 years.     

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.     

Retrocaval ureter with carcinoma of the renal pelvis: Report of a case

A case of retrocaval ureter associated with carcinoma of the renal pelvis has been presented. This is the 2nd such case out of 110 cases reported in Japan. It is suggested that long term stagnation of urine is the cause for such a high incidence of malignant neoplasm involving the renal pelvis.