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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR  
Year : 2012  |  Volume : 23  |  Issue : 3  |  Page : 592-593
Incidental primary papillary mucinous adenocarcinoma of the renal pelvis in a case of non-functioning kidney due to chronic pyelonephritis and pelvic calculus


Department of Pathology, Grant Medical College and Sir. J.J. Group of Hospitals, Mumbai, India

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Date of Web Publication7-May-2012
 

How to cite this article:
Sisodia SM, Khan WZ, Bhavsar SP. Incidental primary papillary mucinous adenocarcinoma of the renal pelvis in a case of non-functioning kidney due to chronic pyelonephritis and pelvic calculus. Saudi J Kidney Dis Transpl 2012;23:592-3

How to cite this URL:
Sisodia SM, Khan WZ, Bhavsar SP. Incidental primary papillary mucinous adenocarcinoma of the renal pelvis in a case of non-functioning kidney due to chronic pyelonephritis and pelvic calculus. Saudi J Kidney Dis Transpl [serial online] 2012 [cited 2020 Nov 25];23:592-3. Available from: https://www.sjkdt.org/text.asp?2012/23/3/592/95850
To the Editor,

Primary papillary mucinous adenocarcinoma is an uncommon primary epithelial tumor of the renal pelvis and ureter. [1] Approximately 100 cases of mucinous adenocarcinomas of the re­nal pelvis have been reported in the literature. [2]

We report a case of incidental primary papil­lary mucinous adenocarcinoma of the renal pelvis occurring in association with a non-functioning kidney due to chronic pyeloneph­ritis and renal pelvic calculus, because of its rarity and also for the pathologist, urologist and imaging specialist to look carefully for any neoplastic growth in relation to a long­standing renal calculus. Primary carcinoma originating elsewhere should be excluded.

A 45-year-old man presented with intermit­tent right hypochondriac pain of three years duration. On physical examination, the patient experienced pain in the right hypochondrium on deep palpation. Laboratory investigations showed high creatinine (2.5 mg/dL) and uric acid level (80.6 m/dL), indicating non-functio­ning kidneys. Pelvic X-ray showed a renal pelvis calculus. Ultrasonography of the pelvis re­vealed pyonephrosis and a calculus of size 2 cm × 2 cm × 1 cm in the renal pelvis. Tc99m-DTPA renal scintigraphy showed right kidney obstructive uropathy with extremely impaired renal function. The patient underwent right nephrectomy, during which 200 mL of thick pus was drained from the kidney. On gross pathological examination, the kidney mea­sured 15 cm × 7 cm × 2.5 cm. The renal cap­sule was adherent to the cortical surface, which showed irregular scars. The pelvicalyceal system was dilated, with thinning of the cortex and loss of the corticomedullary differentia­tion. The pelvis showed a grayish-white poly­poid growth measuring 2 cm × 2 cm × 1 cm along with a stone of size 2 cm × 1 cm × 1 cm. Microscopic examination revealed a tumor comprised of papillary and glandular pattern lined by a single layer of columnar epithelium with scattered goblet cells, which resembled an intestinal mucosa. Mitoses were infrequent. Abundant extracellular mucin was noted. The stroma revealed thin fibrovascular tissue with chronic inflammatory infiltrate. The tumor cells extended into the muscle coat. The adventitia was unremarkable [Figure 1]. Mucicarmine stain was positive [Figure 2]. The residual renal parenchyma had features of chronic pyelo­nephritis. At one month post-operation, the pa­tient was asymptomatic.
Figure 1: Photomicrograph shows a tumor arranged in glandular and papillary patterns with pools of mucin (hematoxylin and eosin, ×40).

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Figure 2: Photomicrograph shows a tumor lined by mucin-secreting columnar epithelium (Mucicarmine, ×40).

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The mucinous adenocarcinima of the renal pelvis was first described in 1960 by Hasebe et al, and it was the least common of the renal pelvis tumors, which include transitional cell carcinoma (90%), squamous cell carcinoma (10%) and adenocarcinoma (1%). Adenocarcinomas are further subdivided into (1) tubulovillous, (2) mucinous, and (3) papillary non-intestinal categories. The first two groups resemble intestinal adenocarcinoma and cons­titute 93% of the cases. [3] Patients are often asymptomatic. Hematuria is the most common presenting sign, while loin pain and palpable abdominal mass signifies a late stage. Radio­logical studies may not be able to identify a malignant tumor, as in our case. Metaplasia of the transitional epithelium of the calyces and pelvis into glandular epithelium, may undergo transformation into malignancy. [4] Some authors postulated that formation of the calculi might be the result of over secretion of glycoproteins by the tumor and binding of that with cations such as sodium, calcium and magnesium, for­ming larger calculi. Thus, calculi may not be the cause of the neoplasm. [5]

From the published data, the prognosis appears to be poor, with about 1/2 of the pa­tients dying within two years of surgery. Local recurrence due to both spillage of tumor cells during surgical manipulation and downward seeding in the distal ureter have been reported. Therefore, a radical nephrectomy and com­plete removal of the ureter are the preferred surgical treatment.

 
   References Top

1.Kundu AK, Giri A, Kaviraj SP. Primary adenocarcinoma of renal pelvis & ureter: report of three cases. Indian J Urol 2002;18:160-3.  Back to cited text no. 1
  Medknow Journal  
2.Shah VB, Amonkar GP, Deshpande JR, Bhalekar H. Mucinous adenocarcinoma of renal pelvis with pseudomyxoma peritonei. Ind J of Path Micro 2008;5:536-7.  Back to cited text no. 2
    
3.Fareghi M, Mohammadi A, Madaen K. Pri­mary mucinous cystadenocarcinoma of renal pelvis: a case report. Cases Journal 2009;2: 9395.  Back to cited text no. 3
    
4.Huang KH, Lee WC, Chang SC, Lin BH, Chi HS. Primary Mucinous Adenocarcinoma of the renal pelvis: a case report. JTUA 2004;15:75-8.  Back to cited text no. 4
    
5.Punia RP, Mundi I, Arora K, Dalal A, Mohan H. Primary adenocarcinoma of ureter mimicking pyelonephritis. Urology Annals 2010;2:42-3.  Back to cited text no. 5
    

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Correspondence Address:
Wasif Ali Zafar Ali Khan
Department of Pathology, Grant Medical College and Sir. J.J. Group of Hospitals, Mumbai
India
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