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At least 631 records · Page 35Linked to original sources

The pelvis after surgery for rectal carcinoma: serial CT observations with emphasis on nonneoplastic features.

Ten asymptomatic patients who had undergone resection of rectal carcinoma were evaluated prospectively by at least three serial computed tomographic (CT) examinations of the pelvis within 24 months of surgery. Of the seven patients who had undergone abdominoperineal resection, five were found to have a presacral mass due to normal postoperative changes within the first 4 months. The mass showed a variable diminution between 4 and 9 months after operation and developed a more distinct outline, partial separation from the sacrum, or a change in configuration to a thin transverse sliver. These changes indicate the possibility of CT differentiation of a normal postoperative mass from local recurrence. In the other five patients, no postoperative mass was observed. In one patient CT demonstrated a solitary 1.5 cm lymph node metastasis. This patient was asymptomatic and had a normal carcinoembryonic antigen level. From these observations, a baseline CT study of the pelvis within 2-4 months of resection of rectal carcinoma, followed by serial CT examinations at about 6-month intervals is recommended for the detection of early asymptomatic pelvic recurrence and to facilitate differentiation from persistent postoperative changes.

Carcinoma↗

NMR scanning of the pelvis: initial experience with a 0.3 T system.

Pelvic NMR scans were obtained on 29 patients using a 0.3 T superconducting magnet system. Pathologies studied included four bladder carcinomas, four prostatic carcinomas, four ovarian dermoid cysts, three ovarian cysts, three endometrial carcinomas, two endometriomas, and one each of serous cystadenoma of the ovary, benign prostatic hypertrophy, pelvic hematoma, and undifferentiated sarcoma. NMR is a very promising method for characterizing pelvic masses and in staging pelvic malignancies. It can show primary tumors of the prostate, bladder, and uterus and reveals tumor extension into pelvic fat. The pelvis is particularly well suited to NMR scanning because of the abundant natural contrast provided by pelvic fat and by urine in the bladder and gas in the bowel. There is also less motion blurring than in the upper abdomen and chest because there is relatively little respiratory motion of pelvic organs. Various pulse sequences were used in scanning the pelvis; their relative merits are discussed.

Female↗

Anatomic changes in the pelvis after uncomplicated vaginal delivery: a CT study on 14 women.

We analyzed CT scans of the pelvis made within 24 hr of an uncomplicated term vaginal delivery in 14 women to document the anatomic changes that occur in the immediate postpartum period. Scans were interpreted by three radiologists, and the results were compared with those from pelvic CT scans made from normal, age-matched, nonpregnant women. In addition to soft-tissue windows, bone windows also were obtained to assess the pubic symphysis and sacroiliac joints in both the postpartum women and the control subjects. The mean uterine length, transverse width, and anteroposterior diameter in the postpartum women (14 +/- 1.4, 12 +/- 1.5, and 9 +/- 1.6 cm, respectively) were significantly larger than in the nonpregnant women (7 +/- 1.4, 5 +/- 0.8, and 4 +/- 0.9 cm) (p less than .0001). CT scans showed intrauterine blood in nine of the postpartum women (64%), and three (21%) had intrauterine gas. There was widening of the sacroiliac joint in one (7%) of the postpartum women compared with none of the control subjects. Widening of the pubic symphysis was present in six (42%) of the postpartum women and in none of the control subjects. Six (42%) of the postpartum women had gas in the sacroiliac joints, 33% of which occurred bilaterally; gas in the pubic symphysis was seen in four (28%) of the postpartum scans. In one patient, an asymptomatic muscle hematoma was discovered. We conclude that normal changes in the pelvis after uncomplicated term vaginal delivery include enlargement of the uterus, intrauterine blood, widening of the symphysis and sacroiliac joints, and gas in the sacroiliac joints.

Adult↗

CT features of Castleman disease of the abdomen and pelvis.

OBJECTIVE: The purpose of this study was to describe the CT features of Castleman disease in the abdomen and pelvis. CONCLUSION: The most frequent appearance of abdominal or pelvic Castleman disease is of a single, well-defined enhancing mass. Smaller tumors (<5 cm) display homogeneous contrast enhancement; larger tumors (>5 cm) show heterogeneous enhancement and attenuation when correlated with central necrosis and degeneration. Calcification was seen in 31% of the cases. Castleman disease may be considered in the differential diagnosis of a discrete enhancing mass in the abdomen or pelvis.

Abdomen↗

Anatomical changes in the pelvis after modified Chiari pelvic osteotomy.

Although plain X-ray analysis is able to reveal anatomical changes in the frontal plane of the pelvis after Chiari pelvic osteotomy involving medial displacement (medialization) in the distal fragment and lateral displacement (lateralization) in the proximal fragment, changes in the horizontal or sagittal plane can not be discerned. Here, I have investigated three dimensional changes in the pelvis using CT in 22 patients before and after Chiari pelvic osteotomy. The various changes were investigated. Medialization in the distal fragment (average 0.4 cm) occurred in the 14 cases and to a slight extent in the other 8 cases. Also anterior or posterior displacement, and anterior rotation occurred in the distal fragment. Lateralization in the proximal fragment (average 0.8 cm) occurred in 19 cases and to a slight extent in the other 3 cases. Furthermore, the acetabular coverage over the femoral head, assessed by superimposing the acetabular region over the femoral head, improved by about 30% of the anterior half of femoral head and by about 20% of the posterior half of femoral head. It is suggested that the acetabular coverage over the femoral head is most affected by lateralization in the proximal fragment.

Adult↗

Tumours of the renal pelvis and ureter. Symptomatology, diagnosis, treatment and prognosis.

Forty-two cases of tumour of the renal pelvis and/or ureter are presented. The primary tumour was in the renal pelvis in 25 cases and in the ureter in nine. A co-existent tumour elsewhere in the uroepithelium was found in 16 of these 34 patients. In the remaining eight patients, tumour of the urinary bladder was the initial diagnosis, but tumours of the upper urinary tract subsequently appeared. The principal symptom (38 of 42 cases) was haematuria, but flank pain and a mass in the kidney region also occurred. In most cases the diagnosis was indicated by the urograms and was confirmed by retrograde pyelography. Nephro-ureterectomy was done in most of the patients. The possibility that local tumour resection may be sufficient is briefly discussed. The tumours were classified as papillary in 24 patients and as solid in nine. There was no histologic classification in nine cases. The mean observation time was 29 months. Since new growths tend to arise at other sites in the uro-epithelium, follow-up examination should always include cystoscopy and urography. The prognosis was particularly poor in solid tumours: two-thirds of these patients died in the first postoperative year. Survival was clearly dependent on the tumour differentiation. High-grade tumours carried a poor prognosis.

Adult↗

The renal pelvis and ureteral peristalsis. II. The pelvic pressure and its relation to the frequency of ureteral peristalsis.

The coordination between the renal pelvis and ureteral peristalsis is an important part of the hydrodynamics of the upper urinary tract. Pelvic pressure and frequency of ureteral peristalsis were registered simultaneously in 28 adult, female dogs. A mathematical analysis of these observation showed a non-linear relation of a "power function" in approximately 85% of the investigations. Hysteresis was demonstrated between the power functions of the increasing and of the subsequent decreasing diuresis in 15 of the examined dogs. It was concluded that the renal pelvis in a monocalyceal system governs the frequency of ureteral peristalsis and that hysteresis represents a viscoelastic action of the smooth muscle tissue.

Animals↗

The relationship between pressure and flow in the normal pig renal pelvis. An experimental study of the range of normal pressures.

The renal pelvis pressure flow relationship of 40 normal pig upper urinary tract was investigated. During standardized studies it was disclosed that the resting pressure has a normal distribution with wide 95% confidence limits (0.3-14.7 cmH2O). When perfusion was introduced, pelvic pressure increased, the normal distribution was lost, and the 95% confidence limits were broadened to more than 30 cmH2O. A normal distribution was regained at higher flow rates. The mean increment beyond 8 ml/minute was small, only 3.7 cmH2O from 8 ml/minute to 20 ml/minute. The wide variation found in pressure responses to high flow rates and the spread of pressures at higher flow rates imply major difficulties in distinguishing, between normal and abnormal pressure flow relationships in renal pelvis.

Animals↗

Carcinoma of the renal pelvis. Experience of 80 cases.

The clinical course and association with other urothelial carcinomas was studied in 80 patients with carcinoma of the renal pelvis. At the time of diagnosis macroscopic haematuria was the most common symptom. Urography and retrograde pyelography gave the most accurate diagnoses. Sixty-eight patients (85%) had transitional cell carcinomas, 39 had a history of another urothelial carcinoma either before or after the diagnosis of the renal tumour, usually in the urinary bladder. A previous urothelial carcinoma together with a small renal tumour were predictive of the subsequent development of another urothelial tumour. Regular cystoscopy is recommended during follow-up because of the short observed interval between the development of carcinoma of the renal pelvis and a subsequent urothelial malignancy. The overall five-year survival was 20%. Survival did not depend on the operation, but was significantly related to the extent of locoregional or distant metastases at the time of diagnosis. Patients with such renal tumours that were preceded by or associated with other urothelial carcinomas had a more favourable median survival (42 months) than patients whose renal tumour was their first urothelial carcinoma (19 months).

Adenocarcinoma↗

MRI of the pelvis in comparison with CT scan.

This study gives results of magnetic resonance imaging (MRI) in the evaluation of male (23 cases) and female (29 cases) pelvis. Thirty nine patients with abnormal pelvis were compared with CT and ultrasounds. MRI and CT have proven equally sensitive to the presence of disease, with a better visualization of calcified tumours or benign lesions with CT, and a superior display of soft tissue spreads and bone metastases with MRI. The signal characteristics from various uterine, bladder and ovarian tumours show an overlap. The same phenomenon is observed between benign and malignant prostatic hypertrophy. The best sequences for pelvic study are, in our experience, IR or short TR spin-echo for T1-weighted images, and spin-echo with 1200 TR for T2 images. Calculated T1 and T2 maps may improve MRI results.

Adult↗

[Renal pelvis mucinous carcinoma. Case report].

OBJECTIVE: There is some controversy in the terminology used for transitional cell tumors with mucinous differentiation. METHODS: We report the case of a 50-year-old male with history of recurrent lithiasis whose radological tests discovered a heterogeneous renal pelvis lesion. RESULTS: The histologic study of the lesions determined the diagnosis of transitional cell carcinoma of the renal pelvis with ample mucinous differentiation. CONCLUSIONS: They are rare tumors in such location and the mucinous differentiation does not seem to influence prognosis.

Adenocarcinoma, Mucinous↗

[A case of adenocarcinoma in the renal pelvis and urinary bladder in a patient with chronic renal failure].

The patient was a 61-year-old male who had undergone right nephrectomy for nephrolithiasis 35 years before. He had been on hemodialysis for 6 years for chronic renal failure caused by left renal staghorn calculus and hydronephrosis. He was admitted to our hospital because of macroscopic hematuria and sense of residual urine which had persisted for 3 months. Cystoscopic examination showed an extensive papillary tumor in the urinary bladder, which histologically was an adenocarcinoma. Giant left hydronephrosis associated with staghorn calculus noted by KUB and CT scan. Total cystectomy, intraoperative radiotherapy, and left nephrostomy were performed under the diagnosis of adenocarcinoma of the urinary bladder and left hydronephrosis. The bladder tumor was found to be a mucinous adenocarcinoma. The patient died from a cerebral hemorrhage on the 17th postoperative day. At autopsy, tumors were found in the pelvis of the left kidney and the middle and lower regions of the ureter, which were adenocarcinoma like the bladder tumor. Adenocarcinoma occurring simultaneously in the renal pelvis and bladder has not been previously reported to our knowledge, in Japan or elsewhere.

Adenocarcinoma, Mucinous↗

[Mucin-producing cystadenoma (borderline malignancy) of the renal pelvis and ureter. A case report].

The patient was a 63-year-old women who visited our hospital with the chief complaints of swelling, chills, fever and right lumbago. Fifteen years ago, she received surgical exploration for right renal stones at another department of urology. A large, soft and round kidney was palpable from the right upper quadrant of abdomen to the right lower abdomen. The parenchyma of the right kidney was thinned and inside the kidney there was a huge amount of yellowish mucin. The histological diagnosis was mucin-producing cyst-adenoma (borderline malignancy) of the renal pelvis and ureter. Mucin-producing cystadenoma of the renal pelvis and ureter origin was very rare, and only 4 similar cases to our patient were so far reported.

Cystadenoma↗

[Production of granulocyte colony-stimulating factor and parathyroid hormone-related protein in squamous cell carcinoma of the renal pelvis accompanied with inferior vena cava thrombus].

A 54-year-old man with general fatigue and lumbago was admitted for further examination of hypercalcemia and leukocytosis. CT showed a huge renal tumor and extension of the tumor thrombus to the inferior vena cava (IVC). Moreover, the serum granulocyte colony-stimulating factor (G-CSF) and the C-terminal of parathyroid hormone-related protein (PTHrP) were elevated. Under the diagnosis of advanced renal tumor, we performed nephro-ureterectomy and throbectomy. Pathological examination revealed squamous cell carcinoma of the renal pelvis. To our knowledge, this is the first case in Japan that of the simultaneous production of G-CSF and PTHrP in squamous cell carcinoma of the renal pelvis accompanied with IVC thrombus.

Carcinoma, Squamous Cell↗

Expression and prognostic value of CD44 isoforms in transitional cell carcinoma of renal pelvis and ureter.

PURPOSE: We retrospectively evaluated the expression and prognostic value of CD44 isoforms in transitional cell carcinoma of the renal pelvis and ureter. MATERIALS AND METHODS: Using a labeled streptavidin-biotin-peroxidase method we performed immunohistochemical staining of archival tissue specimens from 62 men and 26 women with a mean age of 66.5 years who had transitional cell carcinoma of the renal pelvis and ureter. RESULTS: The expression of CD44 standard (CD44s) and splice variant 6 (CD44v6) proteins was significantly decreased in relation to histological grade and pathological stage, while expression of the CD44 splice variant 3 (CD44v3) protein was decreased in relation to histological grade. The prognosis was more favorable in patients with greater versus less than 25% CD44s positive cells. CD44v3 and CD44v6 proteins had no prognostic value. Multivariate analysis indicated that only pathological stage has an independent prognostic value. CONCLUSIONS: The expression of CD44 isoforms is closely associated with tumor differentiation and progression. However, it is not an independent marker and has no statistical significance greater than that of stage.

Adult↗

Pathologic changes in the lumbosacral vertebrae and pelvis in Thoroughbred racehorses.

OBJECTIVE: To describe the prevalence, characteristics, and severity of soft-tissue and osseous lesions in the caudal portion of the thoracic and lumbosacral vertebral column and pelvis in Thoroughbred racehorses. ANIMALS: 36 Thoroughbred racehorses that died or were euthanatized at California racetracks between October 1993 and July 1994. PROCEDURE: Lumbosacral and pelvic specimens were collected and visually examined for soft-tissue and osseous lesions. RESULTS: Acute sacroiliac joint injury was observed in 2 specimens. Signs of chronic laxity or subluxation of the sacroiliac joint were not observed in any specimens. Impingement of the dorsal spinous processes and transverse processes was observed in 92 and 97% of specimens, respectively. Thoracolumbar articular processes had variable degrees of degenerative change in 97% of specimens. Degenerative changes were observed at lumbar intertransverse joints and sacroiliac articulations in all specimens. Some degenerative changes were widespread and severe. CONCLUSIONS: Numerous degenerative changes affected vertebral processes, intervertebral articulations, and sacroiliac joints in these Thoroughbred racehorses. CLINICAL RELEVANCE: Various types of vertebral and pelvic lesions need to be considered during clinical evaluation of the back and pelvis in horses. Undiagnosed vertebral or pelvic lesions could be an important contributor to poor performance and lameness in athletic horses.

Animals↗

[Mucinous adenocarcinoma of the renal pelvis associated with renal calculi of the inflammatory type].

A rare case of mucinous adenocarcinoma of the renal pelvis associated with renal staghorn calculosis in a 60-years-old male patient with pyuria and mucin content of the urine is presented. History was significant for recurrent calculosis of the left kidney. A non functioning hydronephrotic left kidney with staghorn calculosis was diagnosed. Laboratory tests were remarkable only for Carcinoembrionic Antigen (CEA). Pathology of the surgical specimen followed by its immunoreactivity revealed an intestinal type metaplasia and papillary, tubular and mucinous adenocarcinoma of the renal pelvis. Pathogenesis of the intestinal metaplasia and the role of chronic irritation of the urothelium are mentioned.

Adenocarcinoma, Mucinous↗

Cystic hamartoma of the renal pelvis: a rare pathologic entity.

We report a case of a rare cystic renal tumor previously termed cystic hamartoma of the renal pelvis. A 53-year-old woman presented to her gynecologist with menometorrhagia. She subsequently had a computed tomographic scan that demonstrated an incidental cystic mass in the lower pole of the left kidney. Histologically, the tumor was composed of a mixture of benign mesenchymal and epithelial components. The stroma consisted of spindle cells with monomorphic nuclei and abundant eosinophilic cytoplasm that resembled smooth muscle and that reacted positively with antibodies to alpha-smooth muscle actin, desmin, and vimentin. The epithelial component was composed mostly of cysts lined by cuboidal-to-columnar epithelium. Focal dilated cysts were lined by epithelium with oncocytic features. We think that this entity is distinct from other renal tumors, including mesoblastic nephroma, cystic nephroma, or a cystic, partially differentiated nephroblastoma, and that it is best classified as a cystic hamartoma of the renal pelvis.

Female↗