Simultaneous bilateral renal pelvic tumors: a case report]

A case of simultaneous bilateral renal pelvic tumors is reported. A 64-year-old man with the chief complaint of gross hematuria and left flank pain was admitted. Clinical investigations revealed a tumor in the right pelvis and ureter, and another tumor in the left renal pelvis. The right ureteral tumor had invaded the bladder. Right nephroureterectomy, total cystectomy, left partial pyelectomy and ureterocutaneostomy were performed. By pathological examination, right renal pelvic and ureteral tumors were non-papillary transitional cell carcinoma, grade 3, pT4, and the left renal pelvic tumor was papillary transitional cell carcinoma, grade 2, pT1. To our knowledge, this is the 16th case of simultaneous bilateral urothelial tumors of the upper urinary tract in Japan.     

Transitional cell carcinoma of the ureter with inverted proliferation accompanied with papillary bladder tumor: a case report

An 85-year-old female was referred to our hospital with chief complaints of right flank pain and gross hematuria. Ultrasonography demonstrated right hydroureteronephrosis and a thumb head-sized solid mass in the lower third of the right ureter. Cystoscopy revealed papillary tumors near the right ureteral orifice. Under the preoperative diagnosis of right ureteral tumor and bladder tumor, transurethral resection of bladder tumor, right nephroureterectomy and partial cystectomy were performed. The gross specimen of the ureter contained a 5 x 3 x 1 cm, polypoid and smooth-surfaced tumor. The pathological diagnosis of the ureteral tumor was transitional cell carcinoma with inverted proliferation, grade 1 > grade 2. On the other hand, the bladder tumor was papillary transitional cell carcinoma, grade 1. This is a case in which tumor development showed two different types.     

Transitional cell carcinoma of the renal pelvis in a woman discovered at childbirth

We report a case of transitional cell carcinoma of a renal pelvis in a woman discovered after childbirth. A 38-year-old woman, who delivered an immature male infant in cesarean section 29 days prior to hospitalization, was admitted complaining of asymptomatic gross hematuria. Excretory urography and retrograde pyelography showed a filling defect of the right renal pelvis, Spontaneous urine cytology indicated class 5. Renal computed tomographic scan demonstrated a mass lesion in the right kidney. Right total nephroureterectomy and partial cystectomy was performed for diagnosis and treatment. Pathological diagnosis was papillary transitional cell carcinoma (grade 2). This is the first case of transitional cell carcinoma of the renal pelvis occurring in a childbearing woman in Japan.     

Simultaneous occurrence of renal cell and transitional cell carcinoma in the same kidney and ureter. A case report

An unusual case of 2 concurrent primary renal tumors within the same kidney is reported. A 70-year-old woman presented with gross hematuria when she was in the hospital for cerebral infarction. Excretory urography revealed a marked expansion of the right kidney with no renal function. CT scan showed a mass arising from the right kidney, the hydronephrotic right renal pelvis, and a mass in the lower right ureter. Selective renal angiogram showed marked neovascularity of the mass. There was an encasement of the intrarenal artery to the lower pole. Angiographic findings were highly suggestive of a renal cell carcinoma with a second neoplasm in the renal pelvis. Subsequently, the patient underwent right radical nephroureterectomy and partial cystectomy. Section of the removed specimen revealed a 4.0 X 3.8 cm solid tumor confined to the kidney in the upper pole and a transitional cell carcinoma arising from the renal pelvis. In addition, transitional cell carcinoma was present in the distal ureter.     

A case of synchronous ipsilateral renal cell carcinoma and transitional cell carcinoma]

A case of synchronous ipsilateral renal cell carcinoma with renal pelvic and ureteral transitional cell carcinoma is reported. A 80-year-old man, who had had transurethral resection of bladder tumor three times, was admitted on August, 1989 for recurrence of bladder tumor. Excretory pyelography revealed a filling defect of left renal pelvis. Findings of retrograde pyelography and computed tomography were in accord with those of the excretory urograms. Under a diagnosis of the left renal pelvic and ureteral tumor associated with the bladder tumor, left nephroureterectomy with bladder cuff resection was performed. Pathological diagnosis was renal pelvic and ureteral transitional cell carcinoma with renal cell carcinoma, which existed incidentally in the same kidney. Double unrelated primary carcinoma in urinary tract, especially, double dissimilar primary carcinoma in the same kidney, is rare. To our knowledge, this case is the 20th double cancer in upper urinary tract reported in Japan.     

Circumcaval ureter with synchronous ipsilateral transitional cell carcinoma of the renal pelvis and the urinary bladder: Report of a case and review of the literature

We report a case of concomitant transitional cell carcinoma (TCC) in a circumcaval ureter and invasive bladder cancer. The diagnosis was based on the findings of excretory urography (IVU) and contrast-enhanced computed tomography (CT). IVU showed a typical J-shaped deformity in the dilated right proximal ureteric segment with moderate hydronephrosis and a filling defect in the renal pelvis, while abdominal CT with contrast showed right hydronephrosis with an intrapelvic tumor. The patient underwent radical cystoprostatectomy and nephroureterectomy. No recurrence was detected after 12 months of follow-up.     

Total nephroureterectomy with ureteral intussusception and transurethral ureteral detachment and pull-through

We describe a technique for nephroureterectomy that includes ureteral intussusception and transurethral ureteral resection and our method for transurethral ureteral pull-through. These adjuncts permit total nephroureterectomy through a single skin incision and are appropriate in all cases except in patients with known high-grade transitional cell carcinoma of the renal pelvis or ureter. In 18 cases, these techniques have been shown to be reliable, safe, and rapid; in the 14 patients under observation for five years or longer, there have been no local recurrences of tumor.     

Malignant lymphoma of the ureter: a case report

We report a case of malignant lymphoma (ML) of the ureter. A 71-year-old man was admitted to our hospital with the chief complaint of macroscopic hematuria. IVP showed the dilation of left ureter and renal pelvis. Retrograde pyelography showed a 2cm filling defect in the right middle ureter. From the data given, a right ureteral tumor was suspected, and we performed tumor biopsy under an ureteral scope. Since it was diagnosed not as transitional cell carcinoma (TCC) of ureter but as ML with strong inflammation, partial ureterectomy and uretero-uretero anastomosis were done. Histological diagnosis was B cell follicular center lymphoma. Because Ga-scintigraphy revealed no evidence of other involement, it was diagnosed as ML originating from ureter. ML secondarily invading the urinary tract organs is commonly found, but ML originating from the urinary tract is rare. Especially, in regards to ML originating from ureter, only 16 cases have been reported in Japan.     

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".     

Pelvio-ureteral tumor 5 years after uretero-cutaneostomy

A 70-year-old woman visited our hospital with the chief complaint of intermittent gross hematuria from right ureterocutaneostoma. She had received total cystectomy and bilateral ureterocutaneostomy because of bladder tumor (transitional cell carcinoma, grade 3, stage T2) 5 years earlier. Urine cytology showed transitional cell carcinoma (TCC). The right retrograde pyelogram showed shadow defects of right pelvis and upper ureter, computed tomographic scan showed fatty density mass of right pelvis. Preoperative diagnosis was right pelvic and ureteral tumors. Right nephroureterectomy was performed on May 26, 1986. Histology revealed TCC, grade 3 on the pelvis and upper ureter. Cases of pelvio-ureteral tumors of ureterocutaneostomy were collected from the literature and reviewed.     

Spontaneous peripelvic extravasation associated with primary ureteral tumor: a case report]

A case of spontaneous peripelvic extravasation associated with primary ureteral tumor is reported. A 56-year-old woman presented with left flank pain. Excretory urogram and abdominal computed tomographic (CT) scan demonstrated left hydronephrosis with extravasation of contrast materials around the renal pelvis. Retrograde pyelogram showed the filling defect in the left upper ureter. Under diagnosis of ureteral tumor, total nephroureterectomy was performed. Histological findings revealed transitional cell carcinoma. 80 cases of spontaneous peripelvic extravasation in Japan were reviewed and discussed briefly.     

Mixed epithelial and stromal tumor of the kidney (MEST) simulating an upper tract TCC

We present a rare and interesting case of a mixed epithelial and stromal tumour (MEST) of the kidney. The case is unique as it involves a male patient with no history of hormonal therapy presenting with a filling defect in the renal collecting system and positive urine cytology. The patient was diagnosed with transitional cell carcinoma of the renal pelvis and subjected to nephroureterectomy, which revealed a solid tumour arising from the lower calyces and extending into the renal pelvis and upper ureter. Pathology revealed a MEST. The patient was disease-free at the 6-month follow-up.     

Ureteral polyp occurring as renal dysfunction with contralateral ureteral calculi: a case report

A 46-year-old man was admitted to our hospital complaining of macroscopic hematuria with dull pain in the right flank. Laboratory finding showed renal dysfunction and abdominal ultrasound sonograph revealed bilateral hydronephrosis (right > left). Retrograde pyelography showed left ureteral calculi and a filling defect in the middle portion of the right ureter. Renal function improved after bilateral single-J ureteral stent placement. Selective wash cytology of right renal pelvis was class II. Ureteroscopy demonstrated right ureteral obstruction with smooth-surfaced protruded tumor and cold cup biopsy was performed. Histopathological diagnosis was a fibroepithelial polyp but with no malignancy. In addition, left transurethral lithotripsy was performed under ureteroscopy. After the endoscopic examination, a double pigtail stent inserted into the right ureter. We performed conservative management by repeat urine cytologies and retrograde pyelography due to thrombocytopenia. The urine cytologies all proved negative and retrograde pyelography showed no abnormal changes. A ureteroscopic procedure is considered to be useful for the diagnosis of ureteral polyps. Transurethral resection of ureteral polyps with a ureteroscope is recommended for treatment.     

A case of urothelial tumors which occurred simultaneously in bilateral upper urinary tracts and bladder presenting with anuria]

A 72-year-old male was admitted with a chief complaint of anuria. Clinical examinations showed that he was in uremic state and had bilateral hydronephroses. An endoscopic examination revealed a left ureteral tumor and a bladder tumor. Left nephroureterectomy with partial cystectomy and transurethral resection of the bladder tumor were performed. Pathological examinations showed an invasive left renal pelvic tumor (pT3, G3), an invasive left ureteral tumor (pT4, G3), and a bladder tumor (pTis, G3). Following the operation, roentgenological and urinary cytological findings showed a right ureteral carcinoma. He died of multiple liver and bone metastases and local recurrence at 5 months postoperatively.     

后腹腔镜肾输尿管全长与膀胱袖状切除术的三种术式比较（附110例报告）

目的：探讨后腹腔镜肾输尿管全长与膀胱袖状切除的最佳手术方式.方法：对110例肾盂或输尿管癌伴膀胱癌患者采用三种不同术式行肾输尿管全长及膀胱袖状切除术：A术式即后腹腔镜肾输尿管全长切除＋下腹部切口膀胱壁内段袖状切除术,共行32例 B术式即后腹腔镜肾输尿管全长切除＋经尿道电切膀胱袖状切除＋经腹部切口取肾术,共行19例 C术式即经尿道电切膀胱袖状切除＋后腹腔镜肾输尿管全长切除＋经腹部切口取肾术,共行59例.结果：手术经过均顺利.三种术式的手术时间、术中出血量、平均住院时间差异无统计学意义.围手术期死亡3例.出院后获定期随访58例,随访8～85个月,平均38.3个月,46例失访.因肿瘤转移死亡4例,因气胸、脑血管病死亡各1例.三种术式术后早期并发症、对侧病变、膀胱痛复发情况差异无统计学意义 但C术式术后死亡及转移例数较少.结论：肾盂或输尿管癌伴膀胱癌者可优先选择经尿道电切膀胱袖状切除＋后腹腔镜肾输尿管全长切除＋经腹部切口取肾术,而仅有肾盂或输尿管癌者可考虑行后腹腔镜肾输尿管全长切除＋下腹部切口膀胱壁内段袖状切除术.     

A case of amyloidosis of the renal pelvis

We report a case of localized amyloidosis of the renal pelvis and upper ureter arising in a 74-year-old man who presented at our hospital with gross hematuria. The intravenous pyelogram showed right hydronephrosis and stenosis of right renal pelvis and upper ureter. The cystoscopy view was normal, but the right retrograde-ureteropyelogram showed a long irregular stricture of the renal pelvis. Ureteroscopy was performed and rubbing biopsy of edematous, bleeding lesion suggested class IIIb, transitional cell carcinoma. With the diagnosis of a right renal pelvic tumor, right nephroureterectomy was performed. The histology report stated "massive deposits of amyloids are seen in the segment of macroscopically abnormal renal pelvis". Amyloidosis of the renal pelvis is a rare entity and 12 cases were reported in the Japanese and English literature.     

A case of carcinoma in situ of the renal pelvis

A case of carcinoma in situ of the renal pelvis in a 70-year-old female is reported. The patient was admitted with the complaints of macrohematuria and left back pain. Urine cytology, which was carried out three times using urine samples collected directly from the urinary bladder proved to be negative. Drip infusion pyelography (DIP) and retrograde pyelography (RP) disclosed stenosis of the left ureter at the level of L3-L4. Selective renal angiography revealed no abnormalities. Based on the DIP and RP findings, the diagnosis of tumor in the left ureter was made, and left total nephroureterectomy with partial cystectomy was performed. The removed kidney showed signs of mild hydronephrosis but no tumor was found macroscopically. The stenosed site of the ureter had scar-like tissue. Microscopic examination revealed that the stenosed ureter consisted of nonspecific granulation tissue but the mucosa of the renal pelvis showed grade III transitional epithelial cell carcinoma, At 24 months after operation, there is no evidence of tumor recurrence, and urine cytology is also negative.     

A clinical study on 34 cases of urothelial cancer of upper urinary tract

Thirty-four cases of tumor of the renal pelvis or ureter or both have been treated in our department during the past decade. The primary tumor was in the renal pelvis in 11 cases, in the ureter in 21 cases and in the ureter and renal pelvis in 2 cases, a co-existent tumor in the bladder was found in 4 cases. Seventeen patients had a tumor on the right side and 17 on the left side. The most frequent symptom was gross hematuria (70.6%) and flank pain was the presenting symptom in 7 cases (20.6%). On the intravenous pyelography, a filling defect in the renal pelvis or ureter (41.2%) and nonvisualization (53.0%) were frequent findings. Twenty-nine cases had undergone total nephroureterectomy with resection of a bladder cuff, 3 had simple nephrectomy and 2 had open biopsy alone. Postoperative radiation therapy was done in 1 case, chemotherapy in 10 cases, and 6 cases of them were treated by CAP therapy (cis-dichlorodiamine platinum, doxorubicin and cyclophosphamide). Actual and relative 5-year survival rates were 53.8% and 63.5%, and no significant difference was found in survival rate between the patients with renal pelvic tumors and those with ureteral tumors.     

Results of the treatment of carcinoma of the renal pelvis and ureter

Twenty-one patients with renal pelvic carcinoma and eighteen patients with ureteral carcinoma were treated with surgical therapy. In 14 of the 39 patients, we performed nephroureterectomy with a bladder cuff (NUpB), nephroureterectomy with total cystectomy (NUtB) in 12, nephrectomy with partial ureteric resection (NpU) in 8 and others in 5. Following surgery, 8 had recurrences and metastasis and 21 died with carcinoma and 10 survived without evidence of disease. The 5-year survival rate of the patients with renal pelvis carcinoma is 33.5% and 52.0% in ureteral carcinoma.     

Bilateral ureteral tumors associated with chronic renal failure: a case report

A 66-year-old female with bilateral ureteral tumors associated with chronic renal failure is presented. She received pan-hysterectomy due to uterine cancer in 1957. She was first referred to our clinic to make internal shunt under a diagnosis of chronic renal failure. In 1979, the diagnosis of neurogenic bladder and bilateral vesicoureteral reflux (rt; grade 3, lt; grade 1) was made. She was admitted to our clinic with complaints of macroscopic hematuria and a temperature of 39 degrees C on April 28, 1983. Cystoscopically, pyuria from the right ureteral orifice was found. Right retrograde pyelography revealed severe dilatation of the right ureter and renal pelvis with some filling defects. For drainage of pus retaining in the right renal pelvis, right percutaneous nephrostomy was made under the guidance of ultrasonography. After her general condition improved, right nephroureterectomy was performed under the diagnosis of right pyonephrosis on June 8, 1983. Right pyelonephritis and right ureteral tumor, grade 3, were pathologically demonstrated. After the operation, an invasive bladder tumor was detected on cystoscopy and ultrasonography, subsequently a total of 3,900 rad irradiation was given to the bladder tumor. She died of pulmonary edema 7 months later. Autopsy demonstrated a transitional carcinoma, grade 3, of the left ureter. Bilateral urothelial tumors of the upper urinary tract is rare, and to our knowledge only 29 cases have been reported in Japan.