Primary carcinoma in situ of the upper urinary tract: a case report]

A case of primary carcinoma in situ of the upper urinary tract in a 72-year-old woman is reported. The patient who complained of left lower abdominal pain was referred for a suspicion of left ureteral stone. An excretory pyelogram showed mild left ureteral stricuture at the level of L3, but a stone was not detected in the ureter at the same level. Cytology of voided urine was positive for malignant cells several times. Cystoscopic examination revealed no abnormality in the bladder. Retrograde left pyelogram demonstrated the ureteral stricture and no lesions either of stone or tumor in the ureter. However malignant cells were detected cytologically in the left ureteral catheteral urine. Left total nephroureterectomy with the bladder cuff was carried out under the preoperative diagnosis of carcinoma in situ of the upper urinary tract. Macroscopically, the wall of the ureter at the stenotic level had induration without apparent tumor mass. The pathological diagnosis was transitional cell carcinoma in situ from the renal pelvis to the mid-ureter. The primary carcinoma in situ of the upper urinary tract is rare. To our knowledge, this case is the 26th case reported in the Japanese literature.     

Primary lymphoepithelioma-like carcinoma of the urinary bladder: Case report and literature review

A lymphoepithelioma-like carcinoma (LELC) is a rare neoplasm of the urinary bladder. A 71-year-old man presented with gross hematuria for several weeks. On cystoscopy, a solid sessile tumor was observed in the bladder dome. A partial cystectomy was performed. Histopathological findings showed that the lesion was a pure LELC of the urinary bladder. The patient was followed up for 24 months without tumor recurrence. We present the case to highlight the significance of differentiating this rare tumor and discuss the prognosis and treatment options.     

Percutaneous bacillus Calmette-Guerin perfusion of the upper urinary tract for carcinoma in situ

Ten pyeloureteral systems in 8 patients (mean age 74 years) with cytologically proved ureteral carcinoma in situ (1 combined with ureteral papillary tumors) were perfused with bacillus Calmette-Guerin via a percutaneous nephrostomy tube. In 4 patients cytology results remained negative after 1 treatment course during an observation time of 18 to 28 months. In 1 patient a papillary tumor persisted while cytology results became negative for carcinoma in situ. Two patients with bilateral disease had repeated perfusion of bacillus Calmette-Guerin until cytology results became negative and they remained negative during observation for 18 months in 1. The other patient had a multifocal recurrence of carcinoma in situ, combined with a stage T1, grade 3 urothelial cancer in the bladder after 12 months and a recurrence of carcinoma in situ in 1 ureter after 24 months. In 1 patient treatment was stopped prematurely after severe septicemia. Although our short-term results are promising, percutaneous perfusion of bacillus Calmette-Guerin for carcinoma in situ of the upper urinary tract should be considered as an investigational treatment modality until long-term results are available.     

Histopathological review of transitional cell carcinoma of the upper urinary tract

A histopathological review of 30 patients with transitional cell carcinoma (TCC) of the upper urinary tract showed that 21 patients had dysplastic epithelium adjacent to the tumour, irrespective of the degree of invasion; 20 patients had multifocal disease with some degree of dysplasia or carcinoma elsewhere. It is concluded that radical surgery should be performed whenever possible, even in the superficial low grade tumour.     

Appendiceal carcinoma masquerading as recurrent urinary tract infections: case report and review of literature

We report on a female patient who presented with recurrent urinary tract infections. The investigations revealed an adenocarcinoma of the appendix fistulating into the bladder and causing irritative symptoms. After right hemicolectomy and partial cystectomy, she was well at 3 months without any need for adjuvant therapy. This unusual situation reminds us that the finding of bladder adenocarcinoma is rare, and it would be prudent to examine the lower gastrointestinal tract thoroughly to look for a bowel source, before recommending any ablative surgery.     

Case report: percutaneous management of transitional-cell carcinoma of the upper urinary tract using the bipolar resectoscope

BACKGROUND: The traditional management of upper-tract urothelial tumors is radical nephroureterectomy. However, in recent years, minimally invasive nephron-sparing endoscopic approaches have been utilized. We present our initial experience using the bipolar resectoscope with saline irrigation in the management of renal transitional-cell carcinoma (TCC). CASE REPORT: A 74-year-old woman presented with a 3.5-cm filling defect in the collecting system on CT. Cystoscopy and retrograde ureterography demonstrated normal bladder mucosa and a normal contralateral ureter. Ureteroscopy revealed a papillary TCC in the renal pelvis. Ureteroscopic treatment was declined because of the lesion's size. We elected to proceed with percutaneous resection. Using the bipolar resectoscope, the lesion was removed completely. The procedure was accomplished in 90 minutes. The estimated blood loss was 50 mL. The hospital stay was 23 hours. Pathology examination revealed a low-grade TCC. Follow-up for 9 months has shown no recurrence. CONCLUSION: In our initial experience, percutaneous treatment of upper-tract urothelial tumors may be accomplished using the bipolar resectoscope with favorable results.     

Percutaneous Bacillus Calmette-Guerin perfusion of the upper urinary tract for carcinoma in situ]

We performed percutaneous perfusion of the upper urinary tract with Bacillus Calmette-Guerin (BCG) in 3 patients. Two of them had undergone unilateral nephrectoureterectomy for ureter carcinoma in situ and one had undergone radical cystectomy with bilateral ureterocutaneostomy for invasive bladder carcinoma. However, they suffered recurrent upper urinary tract carcinoma in situ within 2 years after their operation. Under ultrasound control a percutaneous nephrostomy tube was placed in the patient. Before BCG perfusion unobstructed flow from the renal pelvis to the bladder was confirmed and pyelovenous or pyelolymphatic back flow was excluded under fluoroscopy. A dose of 240 mg BCG was dissolved in 150 ml 0.9% saline. The flask was placed 20 cm above the kidney of the resting patient. A continuous flow of approximately 1 ml per minute was maintained. The perfusion was stopped after 2 hours and the nephrostomy tube was closed. Therapy was repeated at weekly intervals for a total of 6 perfusions (1 treatment course). In each of them urine cytology results became negative after 1 treatment course. No severe side effects were observed. Further investigation is also needed to determine whether BCG perfusion of the upper urinary tract could become a conservative treatment for carcinoma in situ of the upper urinary tract.     

Case report and literature review of Ewing's sarcoma in the gastrointestinal tract

We present a case of a young female patient with extraosseous Ewing's sarcoma (EES) arising in the lesser sac, as confirmed by membranous staining for CD99 and an ESWR1 gene translocation on fluorescence in situ hybridization. We also provide comprehensive review of the English literature of Ewing's sarcoma (ES) occurring in the gastrointestinal tract (GIT). A systematic review of the PubMed database was carried out with the following MeSH terms: Ewing's AND sarcoma AND (oesophagus, stomach, small bowel OR intestine, large bowel OR intestine, colon, sigmoid, rectum, pancreas, peritoneum, lesser sac, greater sac, liver and gallbladder). Fifty‐seven cases were collated from 46 articles. The most common overall symptom was pain (60.71 per cent), which occurred in patients as young as 2 years and as old as 72 years. The median age was 31 years, and the mean age was 29 years. No bimodal distribution was demonstrated. More females appeared to be affected than males. EES of the GIT is rare. It differs from ES with respect to patient age and sex. No standard therapy for EES has been widely adopted.     

Renal cell carcinoma with heterotopic bone formation. Case report and review of the Japanese literature

A case of renal cell carcinoma with heterotopic bone formation is presented. We will review the reports and radiographic findings of Japanese cases and comment on their hypovascularity.     

Prognostic factors in patients with primary transitional cell carcinoma of the upper urinary tract

A total of 50 patients with primary transitional cell carcinoma of the upper urinary tract underwent deoxyribonucleic acid ploidy characterization by flow cytometric analysis of paraffin embedded specimens. The primary tumor was diploid in 29 patients (58%) and aneuploid in 21 (42%). Aneuploidy was identified more frequently in grade 3 than in grades 1 and 2 neoplasms (p = 0.001). Additionally, grade 3 neoplasms occurred more often with invasive (stages T2 to T3) compared to superficial (stages TA, TIS and T1) tumors (p = 0.002). However, deoxyribonucleic acid ploidy was not significantly associated with tumor stage. Among the 49 patients treated by a definitive operation the median survival free of disease and median over-all survival were 33.7 and more than 120 months, respectively. Variables examined included deoxyribonucleic acid ploidy, tumor grade, tumor stage, primary tumor site and type of operation. In the univariate analysis deoxyribonucleic acid ploidy was the only significant predictor of survival free of disease (p = 0.04). Aneuploid tumors had a median survival free of disease of 19 versus 59 months for diploid tumors. However, in the multivariate analysis of factors affecting survival free of disease, the type of operation performed was the only significant variable. Patients undergoing nephroureterectomy with en bloc bladder cuff excision had a favorable survival free of disease (p = 0.04). Tumor stage was the only significant factor associated with over-all survival in univariate and multivariate analyses (p = 0.02 and 0.005, respectively). Patients with superficial tumors had a median survival of more than 120 versus 72 months for patients with invasive tumors. The data suggest that deoxyribonucleic acid ploidy may be a useful parameter to identify risk groups and plan the management of patients with primary transitional cell carcinoma of the upper urinary tract.     

Renal medullary carcinoma. Case report and review of the literature

Young patients with sickle cell trait or disease present a higher risk for renal medullary carcinoma, an aggressive renal tumor, with dismal prognosis, with a median survival of 4 months from the time of diagnosis. We report a 26-year-old patient with a 2-month history of bone pain at the right iliac crest, loss of weight, recurrent macroscopic hematuria and abdominal mass. Imaging studies demonstrated a 10-cm mass in the right kidney. Pathological evaluation revealed a medullary carcinoma and the patient died after 4 months, despite adjuvant treatment. Whenever a patient with sickle cell trait or disease presents with hematuria and/or flank pain, the possibility of a renal medullary carcinoma should always be kept in mind, with thorough investigation and expeditious treatment.     

Clinical review of conservative management of upper urinary tract transitional cell carcinoma

We reviewed 18 patients with transitional cell carcinoma of the renal pelvis and ureter undergoing nephron-sparing surgery between April 1990 and Febrary 2003. The mean age of the patients, 17 males and one female, was 69 years (range 33-88 years). The tumor site was the renal pelvis in 2, ureter in 13 and ureteral orfice in 2. Six of them were imperative cases and 12 were elective. Eight patients underwent endourological treatment and 10 patients open surgery including partial ureterectomy performed on 8 patient. The follow up period was 3 to 104 months (mean 37 months). Among those defined as imperative, the histopathological stage was pT1 in one, pT2 in one, pT3 in 3 and one in pT4. Among the elective cases, the histopathological stage was pTa in 7, pT1 in 2, pT2 in one, pT3 in 2 patients. Of the three defired as elective with tumors cT2 or higher, two died of disease. The 5-year survival rate was 50% and 68% in the imperative and elective cases, respectively. In the patients with tumors pT2 or higher and/or grade 3, the prognosis was poor which suggests the need for intensive therapy including lymph node dissection and/or adjuvant chemotherapy. It is necessary to consider the possibility of selecting nephron-sparing surgery for locally advanced tumors.     

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.     

Malignant triton tumour of the sinonasal tract: Case report and literature review

INTRODUCTIONThe objective is to report a rare tumour of the sinonasal tract and conduct a literature review.Malignant triton tumour is a subtype of malignant schwannoma with rhabdomyoblastic differentiation. It is a very rare tumour, with only 15 reported cases involving the sinonasal region.PRESENTATION OF CASEForty-seven years old female presented with a right-sided epistaxis, progressive right sided nasal obstruction and anosmia and a visible mass in the right nasal cavity. Imaging studies showed a mass extending from the piriform aperture to the nasopharynx in contact with the dura and the orbital content. The mass was biopsied and the result was consistent with malignant triton tumour. The patient refused the surgery at first so chemotherapy with MAID protocol was started. After the fourth course of chemotherapy the treatment was stopped due to patient intolerance and a thrombosis of the jugular vein. Patient then underwent surgery with frontal craniotomy and dural excision, endoscopic control was done at the end to insure a complete removal. The patient received Radiotherapy in the postoperative period (56 Greys). At 5 years of follow up the patient is doing fine with no signs of recurrence and normal ophthalmological findings.DISCUSSIONSixteen cases, including our case, have been reported to date in the literature. The mean age at presentation is 61 years. None of cases were associated with neurofibromatosis type 1. Eight patients were reported to be alive 5 years post-treatment, and 2 patients were reported to have died of the disease. The prognosis for triton tumours in the sinonasal tract is better than that for triton tumours in other locations.CONCLUSIONMalignant triton tumour is a rare malignancy of the sinonasal tract. Otolaryngologists should be aware of this disease. The optimal treatment should include radical resection of the tumour.     

伴原位癌的上尿路尿路上皮癌患者行根治性肾输尿管切除术的预后荟萃分析

目的系统性评价伴原位癌对上尿路尿路上皮癌患者根治性肾输尿管切除术后肿瘤学预后的影响。方法根据PRISMA原则由2名独立研究员检索PubMed、EMBASE、Web of Science、中国数字图书馆、万方数据库中有关伴原位癌与根治性肾输尿管切除术后患者肿瘤生存结局方面的研究,并且手工检索与之相关的所有参考文献。检索时间为建库至2019年6月,检索语种为英文和中文。英文检索词为upper urinary tract tumor、renal pelvis、radical nephroureterectomy、concomitant carcinoma in situ、prognosis、survival,中文检索词为上尿路尿路上皮癌、肾盂癌、伴原位癌、根治性肾输尿管切除术。采用QUIPS文献质量评价工具对纳入的文献进行方法质量学评价,并使用Stata 12.0和RevMan 5.3软件进行相关数据的统计分析。结果共纳入16篇相关文献,发表时间2012—2019年。上尿路尿路上皮癌患者共11131例,其中伴原位癌患者1774例,阳性率为15.9%。伴原位癌患者根治性肾输尿管切除术后的肿瘤特异性生存率[HR=1.10,95%CI 1.05~1.16,P<0.001]、无复发生存率[HR=1.15,95%CI 1.09~1.21,P<0.001]和总体生存率[HR=1.10,95%CI 1.03~1.17,P=0.003]均低于不伴原位癌患者。Begg's发表偏倚分析显示在肿瘤特异性生存率(P=0.822)、无复发生存率(P=0.348)、总体生存率(P=0.452)方面均无显著的发表偏倚。结论伴原位癌的上尿路尿路上皮癌患者根治性肾输尿管切除术后的临床预后较差。伴原位癌可作为此类患者术后生存结局的独立影响因子。     

Caliceal urinary fistula in renal allotransplantation. Case report and review of the literature

A patient is described in whom a caliceal fistula occurred after renal transplantation due to secondary thrombosis of a branch of a revascularized polar artery. A review of the literature shows that caliceal fistula is an unusual vascular complication which can be avoided by careful removal and meticulous bench surgery. Study of the radionuclides should enable an early and reliable diagnosis. Surgical treatment is needed as soon as the diagnosis is confirmed. Omentoplasty gives the best results.     

Primary tubulovillous adenoma of the urinary bladder: Case report and literature review

Primary tubulovillous adenomas are scarcely encountered in the urinary tract, and most of these tumors arise from the intestinal segments of urinary reconstruction. We report the extremely rare case of tubulovillous adenomas primarily occurring in the urinary bladder in this article. A 50-year-old female patient initially presented with painless gross hematuria for several times within 1 month. Image studies, including abdominal ultrasonography and computed tomography, demonstrated one urinary bladder tumor with suspicious perivesical invasion. The diagnosis was made by a transurethral resection and histopathology, and no involvement of muscularis propria was confirmed. Although the pathogenesis and clinical behavior are not well understood, tubulovillous adenomas may have a tendency to undergo malignant transformation into the form of invasive adenocarcinomas. Complete resection and rigorous follow-up are strongly recommended.