偽裝成腎臟積膿的原發性腎盂黏液腺癌之案例分享與文獻回顧
1李翊維 1羅華安 1林志明 2楊垂勳
1國泰綜合醫院外科部 泌尿科 2國泰綜合醫院內科部 腎臟內科
Primary mucinous adenocarcinoma of the renal pelvis mimicking as pyonephrosis – A case report and literature review
1Yi-Wei Lee 1Wah-On Lo 1Chi-Min Lin 2Chui-Hsun Yang
1Division of Urology, Department of Surgery, Cathay General Hospital, Taipei City, Taiwan
2Division of Nephrology, Department of Internal medicine, Cathay General Hospital, Taipei City, Taiwan
Primary adenocarcinoma of the renal pelvis accounts for less than 1% of tumors in the renal pelvis. We present a patient with hydronephrosis who was found to have mucinous adenocarcinoma of the renal pelvis.
A 69-year-old woman presented with fever, dizziness, palpitation, dyspnea. Abdominal computed tomography showed right hydronephrosis and hydroureter, right pyonephrosis and psoas abscess was also noted. Right pyelonephritis was impressed initially. Right ureterorenoscopy was performed that great amount of pus and debris in the bladder and ureteral lumen. However, intermittent fever was still noted after intravenous antibiotic treatment for 2 weeks. Thus, we urologist were consulted for infection control. Right radical nephrectomy was done smoothly. Grossly, the renal pelvis was dilated and filled with greenish polypoid lesions. There was gelatinous content over the collecting system.
Microscopically, the specimen was found that columnar tumor cells arranged in exophytic tubulopapillary patterns floating in extracelluar mucin pool or mucopurulent exudate as well as presence of focal area of mucin lake dissecting the stroma. The tumor was multifocal and had invaded into the subepithelial connective tissue.
Primary mucinous adenocarcinoma of renal pelvis is associated with long-term chronic inflammation and irritation by stone. A preoperative diagnosis is difficult to achieve due to the nonspecific clinical presentation, and the final diagnosis is exclusively based on histopathologic findings. The pathologic features in this patient included columnar metaplasia and extracellular mucin production. Exclusion of other primary origins is essential. According to most of the reported cases, hydronephrosis and non-functional kidney caused by renal calculi were diagnosed by computed tomography. No standard surgical procedures have been proposed for this adenocarcinoma.