|Year : 2002 | Volume
| Issue : 2 | Page : 160-163
Primary adenocarcinoma of renal pelvis & ureter: Report of three cases
Anup Kumar Kundu, Amita Giri, Sankar Prasad Kaviraj
Department of Surgery, Pathology & Radiology, North Bengal Medical College & Hospital, Darjeeling, India
Anup Kumar Kundu
4, P.C. Sarkar Sarani, Hakimpara, Siliguri (W.B.) - 734 401
Source of Support: None, Conflict of Interest: None
| Abstract|| |
3 rare cases of primary adenocarcinoma of renal pelvis and ureter are illustrated here.
Keywords: Renal Pelvic Tumour; Adenocarcinoma; Ure-teric SOL; Haematuria
|How to cite this article:|
Kundu AK, Giri A, Kaviraj SP. Primary adenocarcinoma of renal pelvis & ureter: Report of three cases. Indian J Urol 2002;18:160-3
| Introduction|| |
Primary adenocarcinoma of renal pelvis and ureter is an extremely rare tumour, representing less than 1 % of all renal tumours. , Magumi et al  reported 92 nd case of primary adenocarcinoma of the renal pelvis. Most of the cases are reported from Japan. ,,, We had encountered 3 such cases which are described here.
| Results|| |
All the patients in our series had good postoperative recovery except the male diabetic one who had burst abdomen and was managed accordingly. Histopathology of all the cases showed adenocarcinoma of renal pelvis and ureter. All of them are in regular follow-up for last 38 months without any recurrence.
| Discussion|| |
The majority of the tumours in the renal pelvis and ureter (uro-epithelial tumours) are transitional cell carcinomas (TCC). Less common are squamous cell carcinomas (metaplastic, about 10%) and rarest are primary adenocarcinomas.  The rare primary adenocarcinoma of the renal pelvis and ureter is usually associated with calculi, long-term urinary obstruction and inflammation. , These tumours are subdivided into i) tubulovillous, ii) mucinous, and iii) papillary non-intestinal categories. The first two groups representing intestinal adenocarcinoma constitute 93% of cases.  The mucinous adenocarcinoma have a better prognosis and occur in elder patients, but the papillary non-intestinal variety occurs in younger individuals and is not necessarily associated with infection. Most of the tumours are solitary. either in renal pelvis or in the ureter. But Lauritzen et al  observed multifocal tumours of both renal pelvis & ureter, in 4 out of 37 cases of their series. We have also the same experience.
The radiological investigations to be done are : ultrasonography (USG). intravenous (IVU) and retrograde urography, CT and if needed Doppler study. IVU shows the functional status of the affected kidney and combined with retrograde urography, usually shows a filling defect in the renal pelvis and ureter alongwith hydronephrosis and hydroureter (due to obstruction). USG shows a iso or hypoechoic soft tissue (solid) SOL at the renal pelvis extending into the upper end of ureter with or without hydronephrotic changes. CT is the investigation of choice and demonstrates the tumour with a total evaluation, e.g., appearance, extent, local spread and its effect on renal function. The final diagnosis is certainly by post-operative biopsy.
The treatment of these tumours is radical nephrectomy and total ureterectomy including the intravesical part. The prognosis depends on the grade and stage of the tumours. Again Lauritzen et al  state that adenocarcinoma and squamous cell carcinoma were high grade and late stage tumours in their series which is not in our case. Radio and chemotherapy had little role to play in these tumours. The initial diagnosis by ureteroscopy and brush biopsy may be helpful.
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[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]
[Table - 1]
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