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CASE REPORT
Year : 2002  |  Volume : 18  |  Issue : 2  |  Page : 156-157
 

Papillary mucoid adenocarcinoma of renal pelvis and ureter - a case report


Department of Urology and Pathology, BJ Medical College, Pune, India

Correspondence Address:
S R Rane
c/o Rane Laboratory, 141/4. Shastri Apartment, Next to Coffee House, 4. Moledina Road, Camp. Pune (Maharashtra) - 411 001
India
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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

How to cite this URL:
Rane S R, Patankar S B, Sathe A G. Papillary mucoid adenocarcinoma of renal pelvis and ureter - a case report. Indian J Urol [serial online] 2002 [cited 2020 Apr 4];18:156-7. Available from: http://www.indianjurol.com/text.asp?2002/18/2/156/37623



   Introduction Top


Tumors of the renal pelvis form not more than 8% of those of renal parenchyma. [1] Relative frequency of tumors of renal pelvis are transitional 91-92%, squamous 8%, adenocarcinoma and undifferentiated carcinoma together less than 1%. [2],[3]

Mucin-secreting adenocarcinoma of renal pelvis is a dis­tinctly rare tumor, not more than 40 cases have been re­ported in the world literature. [4]

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. [5]

Here we present a case of mutinous papillary adeno­carcinoma arising in renal pelvis and ureter because of its rarity.


   Case Report Top


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 Top


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. [6] 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. [7] 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 Top

1.Wagle DG. Monre RH. Murphy GP. Primary carcinoma of renal pelvis. Cancer 1974; 33: 1642-1649.  Back to cited text no. 1    
2.Grabstald H. Whitmore WP, Melmed MR. Renal pelvis tumors. JAMA 1971: 218: 845-854.  Back to cited text no. 2    
3.Solanki RL. Ramdeo IN. Gupta DR Mahawal BS. Primary tumors of renal pelvis. Indian J Cancer 1989: 17: 230-236.  Back to cited text no. 3    
4.Sushma Bhargava, Tandon V, Sharma KC. Arora MM. Papillary mucoid adenocarcinoma of renal pelvis: Report of a case with review of literature. Indian Cancer 1979: 16: 78-81.  Back to cited text no. 4    
5.Spires SE. Banks ER, Cibull ML et al. Adenocarcinoma of renal pelvis. Arch Pathol Lab Med 1993; 117: 1156-1160.  Back to cited text no. 5    
6.Grabstald H. Whitmore WF, Melamed MP. Renal pelvic tumors. JAMA 1971: 218-845-854.  Back to cited text no. 6    
7.Kim YL. Yoon DH, Lee SW, Lee C. Multicentric papillary adeno­carcinoma of the renal pelvis and ureter. Cancer, 1988; 62: 2402­-2407.  Back to cited text no. 7    


    Figures

  [Figure - 1], [Figure - 2]



 

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