|Year : 2002 | Volume
| Issue : 2 | Page : 156-157
Papillary mucoid adenocarcinoma of renal pelvis and ureter - a case report
SR Rane, SB Patankar, AG Sathe
Department of Urology and Pathology, BJ Medical College, Pune, India
S R Rane
c/o Rane Laboratory, 141/4. Shastri Apartment, Next to Coffee House, 4. Moledina Road, Camp. Pune (Maharashtra) - 411 001
Source of Support: None, Conflict of Interest: None
Keywords: Adenocarcinoma; Renal Pelvis.
|How to cite this article:|
Rane S R, Patankar S B, Sathe A G. Papillary mucoid adenocarcinoma of renal pelvis and ureter - a case report. Indian J Urol 2002;18:156-7
| Introduction|| |
Tumors of the renal pelvis form not more than 8% of those of renal parenchyma.  Relative frequency of tumors of renal pelvis are transitional 91-92%, squamous 8%, adenocarcinoma and undifferentiated carcinoma together less than 1%. ,
Mucin-secreting adenocarcinoma of renal pelvis is a distinctly rare tumor, not more than 40 cases have been reported in the world literature. 
Adenocarcinoma originating in the pelvis are usually associated with chronic nephropathy with calculi, hydronephrosis or pyelonephritis. Derivation from associated glandular or intestinal metaplasia is generally postulated, as epithelial metaplasia is commonly present in these conditions. 
Here we present a case of mutinous papillary adenocarcinoma arising in renal pelvis and ureter because of its rarity.
| Case Report|| |
A 40-year-old male presented with pain and tenderness in the left loin. There was no history of hematuria or pyuria. On USG he was diagnosed as hydronephrosis with hydroureter with stone; in addition there was 7 cms mass in upper and lower pole.
Renal function tests were minimally deranged. At operation ureteric wall was thickened and oedematous. Calculi were not found.
Nephroureterectomy was performed as the kidney was non-functioning. Grossly kidney was enlarged 15 x 18 x 6 cms. It was irregularly distorted and bosselated. Small 3 cms of ureter was also attached. On cut section the kidney was entangled in thick adherent capsule with thick peripelvic fat.
In the middle part there was seen large round mass nearly 5 cms in diameter with yellowish and hemorrhagic areas. Calyceal system was dilated and showed thickened whitish lining. Piece of ureter was dilated. On opening showed thickened wall with necrotic mass in lumen. No calculi were evident in either the kidney or the ureter [Figure - 1]. Microscopy sections from mass in the middle part showed large areas of hemorrhages surrounded by cholesterol granulomas and hemosiderin-laden macrophages. There was no tumor. These changes were interpreted as "Chronic hemorrhage".
Sections from ureteric pelvis showed adenocarcinoma in the form of glands with papillary fronds at places. They were lined by tall columnar cells with hyperchromatic nuclei. The glands were infiltrating the muscle coat. There were also seen large areas of extracellular mucin amidst which were seen few tumor cells [Figure - 2]. There was no hemorrhage or necrosis. Morphologic changes of glandular or intestinal metaplasia were not seen. PAS stain and mucicarmine stain were done and they were positive.
| Comments|| |
Malignancies originating within the renal pelvis are uncommon. Only one malignant renal pelvis tumor is detected for every ten occuring in the parenchymal aspect of the kidney.  Adenocarcinoma have been reported to comprise only 1 % of all renal pelvic malignancies. Papillary mucinous adenocarcinoma is even rarer. Adenocarcinoma are found near the sites of metaplasia. But for PMA such metaplasia was not observed. Some investigators speculate that nephrogenic metaplasia is a potential precursor for this tumor because of close histopathological and ultrastructural similarities.  The renal parenchyma showed extensive destruction with hemorrhage and changes of chronic diffuse pyelonephritis, as also described by Bhargava S (1979), which supports the hypothesis of nephrogenic metaplasia.
Present case is reported here for its rarity and it is the single case occurring in last 10 yrs. from our institute.
| References|| |
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[Figure - 1], [Figure - 2]