Primary adenocarcinoma of the renal pelvis: An uncommon tumor, a case report.

INTRODUCTION AND IMPORTANCE: Primary adenocarcinoma of the renal pelvis is a rare and unique malignancy, representing a small fraction of renal cancers and posing significant diagnostic challenges due to its unusual presentation and similarity in symptoms to more common excretory tract disorders. This case emphasizes the importance of distinguishing this pathology from other renal neoplasms and metastatic adenocarcinomas that originate in the digestive tract. CASE PRESENTATION: We report the case of a 34-year-old man with no significant medical history who presented persistent lower back pain but no hematuria, which is atypical for renal pathologies. Initial imaging identified a 30 × 14 mm enhancement mass in the right renal pelvis. Surgical intervention was performed through right nephroureterectomy, including excision of the bladder cuff. Histopathological examination confirmed the diagnosis of primary intestinal-type adenocarcinoma of the renal pelvis, characterized by necrotic carcinomatous proliferation with varying architectural patterns and occasional signet ring cells. CLINICAL DISCUSSION: The diagnosis of primary renal pelvis adenocarcinoma is complicated by its nonspecific symptomatology and the potential for misdiagnosis as a more common urothelial carcinoma or a metastatic digestive-origin adenocarcinoma. Immunohistochemical staining supported a primary rather than metastatic digestive tract origin. This case underscores the need for a comprehensive diagnostic approach, including advanced imaging and meticulous histopathological analysis, to effectively differentiate this rare entity from other neoplasms. CONCLUSIONS: This case highlights the diagnostic complexities and the critical need to be aware among clinicians about rare renal cancers such as primary adenocarcinoma of the renal pelvis. It also stresses the importance of interdisciplinary collaboration in the diagnosis and management of such rare cases, improving our understanding and requiring timely and accurate treatment.

Heavy metals, welding fumes, and other occupational exposures, and the risk of kidney cancer: A population-based nested case-control study in three Nordic countries.

OBJECTIVES: To determine whether occupational exposure to heavy metals (chromium (VI), iron, nickel, lead) and welding fumes is associated with the risk of kidney cancer and to describe whether other occupational exposures included in the Job Exposure Matrix of the Nordic Occupational Cancer (NOCCA) study are associated with the risk. MATERIALS AND METHODS: Nested case-control study among individuals registered in population censuses in Finland, Iceland, and Sweden in 1960-1990. A total of 59,778 kidney cancer cases, and 298,890 controls matched on sex, age, and country. Cumulative occupational exposures to metals (chromium (VI), iron, nickel, lead), welding fumes, and 24 other occupational exposure covariates, lagged 0, 10, and 20 years. RESULTS: Overall, there was no or very little association between kidney cancer and exposures studied. The risk was elevated in individuals with high exposure to asbestos (OR 1.19, 95%CI 1.08-1.31). The risk was significantly decreased for individuals characterized with high perceived physical workload (OR 0.86, 95%CI 0.82-0.91), high exposure to ultraviolet radiation (OR 0.85, 95%CI 0.79-0.92), and high exposure to wood dust (OR 0.82, 95%CI 0.71-0.94). The risk of kidney cancer under the age of 59 was elevated in individuals with high exposure to nickel (OR 1.49, 95%CI 1.03-2.17). The risk of kidney cancer in age 59-74 years was elevated for individuals with high exposure to iron (OR 1.41, 95%CI 1.07-1.85), and high exposure to welding fumes (OR 1.43, 95%CI 1.09-1.89). CONCLUSIONS: The only markedly elevated risks of kidney cancer were seen for the highest exposures of nickel and iron/welding fumes in specific age strata.

Primary Tubulovillous Adenocarcinoma of Renal Pelvis: An Unusual Genitourinary Tumor.

Prolonged inflammation or irritation due to renal calculi can induce glandular metaplasia of the urothelium and even malignant neoplasm. Primary adenocarcinoma in pelvicalyceal system is a rare tumor in such patients. Here, a case of carcinoembryonic antigen (CEA) positive primary tubulovillous adenocarcinoma in pelvicalyceal system is reported. A 57-year-old male with right abdominal pain and microscopic hematuria and the history of nephrolithotomy for recurrent renal calculi referred to our center. Radiological findings showed well-defined lobulated mass with calcification in interpolar region of right kidney extending up to pelvicalyceal system along with calculi in pelvicalyceal system and ureter with moderate hydroureteronephrosis. Laparoscopic right radical nephrectomy was performed. Histopathological examination revealed tubulovillous adenocarcinoma of renal pelvicalyceal system with CEA positivity. Patient was asymptomatic and had no recurrence after one and a half years. Primary tubulovillous adenocarcinoma in renal pelvis though rare, is usually associated with intestinal metaplasia of urothelium induced by prolonged chronic inflammation and renal calculi.

Non-transitional cell carcinoma of the upper urinary tract: A case series among 305 cases at a tertiary urology institute.

Non-transitional cell carcinomas (non-TCC) of the upper urinary tract as squamous cell carcinoma (SCC), adenocarcinoma, and small cell carcinoma (SmCC) are rare with few case reports in the literature. We retrospectively reviewed our patients who surgically treated for upper tract urothelial carcinoma from 1983 to 2013 for non-TCC pathological cancer characteristics and survival. Among 305 patients, only 5 (1.6%) cases were found: One case of SmCC, another had adenocarcinoma, and 3 SCC cases. None of them had intravesical recurrence and the cancer-specific survival for non-TCC cohort is markedly decreased (log-rank = 0.01) compared to TCC patients.

Computer aided design of 3D printing combined with hemi pelvic replacement surgery / 现代临床护理

Objective To summarize the key points of cooperative nursing care to patients with pelvic, acetabular and peripheral tumors treated with half pelvic prosthesis replacement with computer aided 3D printing. Methods Night patients with pelvic, acetabular and peripheral tumors treated with half pelvic prosthesis replacement with computer aided 3D printing during April 2014 and March 2017 were included in the study. Before replacement, the entity models were printed for confirmation of tumor range, surgical simulation and planning. After resection of tumors, the half pelvic prosthesis by 3D printing was used to reconstruct the bone defects. The points for nursing cooperation were summarized. Result All the patients lived through the replacement and survived by short-term follow-ups, reporting no complications and normal function of hip joint at movement. Conclusion In view of nursing the patients with with pelvic, acetabular and peripheral tumors treated with half pelvic prosthesis replacement with computer aided 3D printing, such nursing measures as careful preoperative preparation for the surgery, specialized nursing assessment, body position nursing, aseptic operation and tumor free technique, dynamic observation of vital signs and close nursing cooperation are critical for the success of half pelvic prosthesis replacement.

Aggressive Angiomyxoma in the Vulva: A Case Report

Aggressive angiomyxoma is a rare benign tumor that originates in the pelvic or perineal organs of women. We report a case of an aggressive angiomyxoma as a huge vulvar mass, and present its clinical and image characteristics with a review of the literatures.

Usefulness of Enteral Contrast Media in MR Evaluation of Pelvic Mass

PURPOSE: To assess the value of enteral contrast media for the evaluation of pelvic masses by MR imaging. MATERIALS AND METHODS: Between April and July 1998, 16 women with pelvic masses were examined by MRI. The origin of the lesion was the ovary in twelve cases, the uterus in three, and the sigmoid in one. Using a 1.5T scanner(Magnetom Vision, Siemens), T1-weighted axial spin echo(SE), T2-weighted turbo spin echo(TSE), two-dimensional fast low-angle shot(FLASH 2D), and half-Fourier TSE(HASTE) images were obtained in all patients after the administration of Magnevist Enteral (Shering, Berlin, Germany). In each MR imaging sequence, distinction between the lesion and adjacent bowel (1, not distinguished; 2, partly distinguished; 3, clearly distinguished), artifact (0, absent; 1, mild; 2, severe), image quality (1, poor; 2, fair; 3, good), were compared before and after the use of enteral contrast media. Changes in MRI impression after the use of enteral contrast media were also evaluated. Two radiologists reached a consensus after reviewing the images. Statistical significance was determined by Wilcoxon's signed ranked test. RESULTS: For distinguishing lesions, SE T1WI and FLASH 2D with enteral contrast media were significantly superior to SE T1WI without enteral contrast media (p<0.05). With regard to image quality, FLASH 2D and HASTE, both with enteral contrast media, were significantly superior to SE T1WI and TSE T2WI, respectively, both without enteral contrast media (p<0.05). Artefacts were more frequently found after the application of enteral contrast media in conventional sequences but were not present in breathhold sequences. In two patients, MRI impression changed after the appilication of enteral contrast media. CONCLUSION: In a limited number of cases, enteral contrast media improved lesion detection, image quality and diagnostic accuracy when breathhold fast MR imaging was applied.

Gadolinium-enhanced Fat-Suppression MR Imaging of the Female Pelvis

PURPOSE: To compare the value of Gd-DTPA enhanced, fat-suppression T1-weighted (Gd-FST1SE) MR images in thediagnosis of female pelvic disorders with that of fast spin-echo T1-weighted(T1FSE) and fast spin-echoT2-weighted(T2FSE) MR images. MATERIALS AND METHODS: Pelvic MR images of 42 women (24 ovarian disorders, 19uterine disorders) were reviewed by two radiologists. Discrimination of normal anatomic structures, identificationof pathologic lesions and recognition of internal structure of the lesions such as solid and cystic portion,papillary nodule, septa and wall were evaluated using a scoring system. The Friedman two-way ANOVA test was usedfor data analysis. RESULT: T2FSE was useful for evaluation of the uterine cervix(T1/T2/Gd, 2.5/3.9/2.8,respectively), junctional zone(1.6/3.1/2.5), endometrium (2.0/3.3/3.0), ovary(1.1/2.1/1.7) and uterine myoma(1.7/2.4/2.1)(P<0.001), but secondary degeneration was best visualized on Gd-FS T1SE. The Gd-FS T1SE ;lymphadenopathy(3.4/1.5/3.7) was better visualised on this modality than on eithor TIFSE or T2FSE. Gd-FS T1SEimages also clearly depicted papillary projection(2.4/3.1/3.8) and the solid component (2.9/3.1/3.5) of ovariancystic neoplasm(P<0.01). The confidence level in the identification of ovarian mass, internal septation andsurrounding wall of cystic neoplasm was not improved on Gd-FS T1SE. CONCLUSION: The Gd-FS T1SE images were usefulfor the evaluation of metastatic lymphadenopathy in uterine cervical malignancy and for identification of thesolid component and papillary projection of ovarian cystic neoplasm.

Aggressive Angiomyxoma in Female Pelvic Cavity: A Case Report

Aggressive angiomyxoma is a rare neoplasm occurring in the female pelvic cavity or perineum, and tends torecur. The radiographic findings of angiomyxoma have not been previously reported in Korea ; we describe a case ofaggressive angiomyxoma in the female pelvic cavity, with emphasis on the pathologic and radiologic findings, andreview the literature.

Granular Cell Tumor of the Presacral Space: A Case Report

Granular cell tumors are rare lesions of probable Schwann cell origin and are composed of oval to fusiform cells with abundant granular eosinophilic cytoplasm. We report ultrasonography, barium enema, computed tomography and magnetic resonance imaging findings in a case of granuar cell tumor in the presacral space in a 34-year-old woman.

CT characteristics of extra-organic primary tumor in pelvis and the anatomic bases / 中华放射学杂志

Objective To analyze the CT contrast enhanced features of the extra-organic primary tumors in pelvis and to evaluate anatomic bases of these imaging characteristics.Methods CT findings in 14 patients with pathologically proved extra-organic primary tumors in pelvis were reviewed retrospectively for tumor size,density,margins,contrast enhanced characteristics,location and relationship of the lesions with surrounding organs and tissues.Results There were benign tumors (n=3) and malignant tumors(n=11) in this study.There were 6 lesions in peritoneal cavity and 6 in retroperitoneal space of pelvis respectively,and two other masses were in both peritoneal cavity and retroperitoneal space of pelvis.CT scan revealed that there were 6 solid masses and 8 cystic-solid masses.The enhanced characteristics of lesions were homogeneous and heterogeneous in 3 and 11 patients respectively.The fatty space surrounding the lesion was invasive in 7 cases and all of them were malignant tumor.The fatty space surrounding lesion was clear in other 7 cases including 3 benign tumors and 4 malignant tumors.CT revealed calcification in 4 lesions including benign teratoma (n=2) , malignant teratoma (n=1), and carcinoid (n=1).Conclusion In the diagnosis of extra-organic primary tumors in pelvis,CT enhancement scan can reveal the anatomic location and relationships of the lesions with surrounding organs and tissues and can differentiate benign and malignant tumor to some degree.