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This article discusses coverage of the posterior and inferior pelvis, coverage of the anterolateral pelvis and hip, and coverage of the femur. Special problems associated with these procedures are addressed also.
Primary small-cell carcinomas of the kidney are rare, locally aggressive, and rapidly fatal neoplasms in elderly people. We report an example of combined small-cell and transitional cell carcinoma of the renal pelvis in a 71-year-old woman who had a history of heavy smoking. The cells that pertained to the small-cell component were morphologically mostly of an intermediate type. Immunohistochemically, they reacted with synaptophysin, carcinoembryonic antigen, and epithelial markers (Lu-5, EAB902, EAB903, and cytokeratin 19), and they contained scanty neurosecretory granules at the ultrastructural level. We review the literature on small-cell carcinoma of the kidney and renal pelvis, and we discuss the histogenesis of such a tumor.
A case of double inferior vena cava associated with congenital hydronephrosis is reported. A 6-year-old girl was referred to our hospital with the chief complaint of severe left flank pain of sudden onset which occurred after she fell down some steps. Abdominal computerized tomographic (CT) scan revealed a huge perinephric urinoma, severe left hydronephrosis with obstructive atrophy and double inferior vena cava. Left nephrectomy was performed under a diagnosis of traumatic rupture of the left renal pelvis associated with left congenital hydronephrosis and double inferior vena cava. Rupture of the renal pelvis and ureteropelvic junction obstruction with severe parenchymal thinning were found. The postoperative course was uneventful. Double inferior vena cava is a relatively rare anomaly and most cases in recent years have been incidentally found by ultrasonography and CT scan. Urologists should keep in mind the possibility of this anomaly of the inferior vena cava, especially when reforming left nephrectomy.
PURPOSE: We evaluated the prognostic significance of the Ki-67 labeling index in 70 patients with primary urothelial tumors of the renal pelvis and ureter. MATERIALS AND METHODS: Immunohistochemical staining for Ki-67 in archival tumor materials was done by the streptavidin-biotin method. RESULTS: Univariate survival analysis showed that the prognosis of patients with a high Ki-67 labeling index of 21.7 or more was significantly worse than that of patients with an intermediate labeling index of 13.3 to less than 21.7 (p < 0.01) or a low labeling index of less than 13.3 (p < 0.001). Multivariate survival analysis showed that staining for Ki-67 labeling index was significantly correlated with prognosis (p < 0.01). CONCLUSIONS: Analysis of Ki-67 labeling index provides useful prognostic information about patients with primary urothelial tumors of the renal pelvis and ureter.
PURPOSE: The renal parenchymal expression of transforming growth factor-beta (TGF-beta) is increased in experimental obstructive uropathy. To better understand the pathophysiology of hydronephrosis, we pursued this observation by determining if the expression of TGF-beta is also increased in the obstructed renal pelvis. MATERIALS AND METHODS: The expression of TGF-beta mRNA was evaluated in experimental and clinical ureteropelvic junction obstruction by reverse transcriptase polymerase chain reaction (RT-PCR). Southern blot analysis with labeled human cDNA probes for TGF-beta was then done to verify the results. RESULTS: Experimentally, pelves subjected to ureteral constriction showed significantly higher TGF-beta mRNA expression than normals. After reversal of obstruction, the expression of TGF-beta remained significantly higher than normals but was not different from pelves with ongoing obstruction. Clinically, there was a significantly higher level of TGF-beta mRNA expression in obstructed pelves than in nonobstructed ureters. High levels of TGF-beta mRNA expression correlated significantly with good clinical outcome, good renal function, muscle hypertrophy and acute onset of obstruction. CONCLUSIONS: There is increased TGF-beta mRNA expression in the renal pelvis following clinical and experimental ureteropelvic junction obstruction. These data implicate TGF-beta in the adaptive molecular responses that increase muscle and collagen elaboration seen in hydronephrosis.
Tumors of the renal pelvis and ureter are relatively common malignancies in Taiwan. Studying the genetic or biochemical aberrations is a feasible pursuit that has great potential to further our understanding of urothelial cancer and may provide clinically valuable information. We now report a new long-term culture (RTCC-1/KMC) of human TCC derived from the renal pelvis, which is aimed to be used as a target for those studying in this field. The cultured cells exhibited anchorage independence and loss of contact inhibition. Chromosomal analysis revealed an aneuploidy line with a modal number of 50. Population doubling time was about 36 hours at the third passage. Expression of keratin proteins confirmed its epithelial origin. The genetic markers of the RTCC -1/KMC cell line were HLA-A11, B46, B60, Cw1, Cw7, DRw12 and DRw16. The human papillomavirus and herpes simplex virus genomes were not found in this cell line.
A brief description of normal MR anatomy is presented, followed by a discussion of the main indications for MR imaging of the pelvis in children. The evaluation of congenital anomalies of the genital tract in boys and girls, including ectopic testes, abnormalities of the uterus and vagina, and of the anorectal region, are reviewed. A discussion of the role of MR imaging in evaluating the internal characteristics and extent of benign and malignant pelvic masses is included. The main indications for MR of the pelvis in children are discussed, after a brief description of normal anatomy.
MR imaging has enhanced our ability to evaluate anatomic and pathologic processes in the male pelvis. Its remarkable soft-tissue contrast provides a unique depiction of the internal anatomy of the pelvic organs. Coupled with this superior soft-tissue characterization, its multiplanar capacity allows for greater depiction of tumor extension and staging. This article discusses some general MR techniques and concepts about MR imaging of the male pelvis and the normal MR anatomy and specific MR imaging techniques regarding each of the male pelvic organs.
Linear renal pelvis calcifications in a native kidney due to Corynebacterium urealyticum are described. These micro-organisms have an opportunistic behaviour and can be responsible for nosocomial urinary tract infection. Alkaline incrusted cystitis with linear vesical calcifications are considered as the most typical pattern. Renal pelvis may also be concerned, with parietal calcifications.
MR imaging has proved to be an extremely powerful tool for the evaluation of the female pelvis. Improved imaging techniques and widespread availability of MR imaging have made the routine acquisition of high-quality images possible. MR imaging has a well-documented use for the diagnosis and staging of pelvic malignancies. Recent efforts have also demonstrated the usefulness of MR imaging as an adjunct to sonography or as the primary imaging modality for the diagnosis and characterization of benign diseases of the pelvis.
A 9-year-old girl visited our clinic with recurrent high fever as her chief complaint. Her excretory urogram showed only a few dilated upper calyces. Retrograde pyelography revealed ureteropelvic junction stenosis with hydronephrosis, so that the ureteral catheter could not be passed through the ureteropelvic junction. A fold-like filling defect was also seen above the ureteropelvic junction. At operation the ureteropelvic junction was found to be markedly obstructed, and a semilunar valve-like structure was also observed above it. The valve-like structure was seen where the fold-like filling defect appeared on the retrograde pyelogram. En bloc resection of the lower part of the renal pelvis with the valve-like structure and the ureteropelvic junction was performed, followed by dismembered uretero-pyeloplasty. Histologically, the valve-like structure was a transverse mucosal fold with a muscle layer and without adventitia. Many cases of ureteral valves have been reported, but none with valves or valve-like structures within the renal pelvis as in our case.
We evaluated postnatal management after the prenatal diagnosis of moderate dilatation of the renal pelvis (antero-posterior diameter superior to 1 mm per month of pregnancy and inferior to 15 mm at full term). Eighty-nine neonates who had a moderate dilatation in utero were evaluated by ultrasound and voiding cysto-urethrography. Ultrasound was performed between day 2 and day 7 in 83 cases, after day 7 in 6 cases. Voiding cysto-urethrography was performed during first month in 80 cases, after this period in 9 cases. Sixty-five neonates were shown to have a malformation of the urinary tract: reflux (n = 27), megaureter (n = 20), uretero-pelvic junction obstruction (n = 19), renal duplication (n = 7), posterior urethral valves (n = 2), horseshoe kidney (n = 1), ureteric cyst (n = 1). Reflux which is frequent in neonates with urinary tract infection, is the most frequent cause of moderate dilatation of the fetal renal pelvis. Combination of ultrasound and voiding cysto-urethrography in neonates allows a quick, full diagnosis. It helps rationalize the use of prophylactic antibiotic treatment.
We describe four affected children belonging to a large, highly inbred Muslim family originating from the North West Frontier Province of Pakistan. All children have a similar pattern of skeletal abnormalities, including aplasia/hypoplasia of the ulnae, hypoplasia of the pelvis, aplasia/hypoplasia of the femora, fibular aplasia, and variable digital abnormalities and absent/dysplastic nails. The phenotype overlaps with the syndromes of Fuhrmann, Al-Awadi, and Raas-Rothschild. The present and previously reported families probably share the same geographic and racial origin, indicating a common genetic basis of the reported skeletal abnormalities in these limb-pelvis aplasia and hypoplasia syndromes. A possibility of a new autosomal recessive syndrome in the present family cannot be excluded. Further delineation and molecular studies are required to clarify the genetic cause and phenotypic variation in Fuhrmann, Al-Awadi, and Raas-Rothschild syndromes.
A rare case of primary mucinous adenocarcinoma of the renal pelvis is reported. A 76-year-old woman was admitted to our hospital because of right abdominal fullness. Physical examination revealed a melon-sized (22 cm in diameter) tumor located in the middle and lower right quadrant of the abdomen. Computed tomography and transabdominal sonography revealed hydronephrosis and a renal stone. Retrograde pyelography was impossible because of ureteral obstruction on the right side. A diagnosis of severe hydronephrosis was made and a right nephrectomy was performed. The kidney measured 24 x 14 cm in size and contained 1,500 ml of mucinous material. The histological diagnosis was mucinous adenocarcinoma of the renal pelvis. The patient has had neither recurrence nor metastasis for 2 years following postoperative chemotherapy.
The alterations in pelvic structure that occur in bladder exstrophy were evaluated in six children (one girl and five boys) by using three-dimensional computed tomography (3D-CT). The length and angle of anterior and posterior segments and the slanting angle of iliac wings were measured. 3D-CT scans of the pelvis of four patients with a normal pelvis were obtained to serve as controls. Both anterior and posterior segments were abnormally rotated externally in patients with bladder exstrophy. Whereas the length of the posterior segment is normal, the length of the anterior segment is significantly shorter, and the iliac wings projected more inward than those in the age-matched control subjects.
Lymphoepithelial carcinoma is a relatively common malignancy in the nasopharynx, but it rarely occurs at other sites. Described herein is the first case of a renal pelvic neoplasm that closely resembled lymphoepithelial carcinoma, with analyses of histology, immunophenotype, in situ hybridization for the Epstein-Barr viral genome, and flow cytometric DNA ploidy. The tumor was detected in an 70-year-old Japanese man who presented with hematuria Histologic examination showed an undifferentiated round or spindle cell carcinoma (cytokeratin 7+, cytokeratin 20+, epithelial membrane antigen+, vimentin-) with abundant lymphocytes (predominantly UCHL-1+ T cells), plasma cells, and macrophages in and around the tumor cell nests. The tumor was limited to the pelvis, with a minute focus of carcinoma in situ. No Epstein-Barr viral genomic sequences were detected by in situ hybridization. The tumor had an aneuploid DNA content. The patient remains well without disease 6 years after surgery and radiotherapy. Recognition of this type of renal pelvis carcinoma is important to avoid misdiagnosis.
PURPOSE: To evaluate the accuracy of pulsed Doppler ultrasound (PDUS) and color Doppler ultrasound (CDUS) for the screening of arterial occlusive disease in the pelvis and lower extremities. METHODS: We studied 52 patients with intermittent claudication or lower extremity "coolness." Pulsed Doppler waveforms were measured in the inguinal and popliteal regions and were classified according to their pattern. Patients with abnormal waveforms underwent subsequent CDUS evaluation from the aortic bifurcation to the popliteal arteries. All patients also underwent conventional angiography. RESULTS: All stenoses (> 50%) and occlusions on angiography were detected by PDUS. The combination of PDUS and CDUS allowed detection of 78.0% of stenotic lesions (> 50% narrowing) and 96.6% of occlusive lesions in the iliofemoral regions and in 100% of stenotic lesions (> 50% narrowing) and occlusive lesions in the femoropopliteal regions. PDUS required approximately 3 min. About more 5 min are required when CDUS was added. CONCLUSION: Combined PDUS and CDUS appears to be a rapid, highly sensitive means of screening for arterial occlusive disease in the pelvis and lower extremities.
Vascular tumors of the pelvis are a rare, diverse group of neoplasms. These benign or malignant tumors can arise from the endothelium, smooth muscle cells, or pericytes of the arterial venous or lymphatic walls. They are rarely diagnosed by physical examination but more commonly seen with imaging studies such as computed tomography, magnetic resonance imaging, or angiography. Benign and malignant tumors can be differentiated pathologically by the two major anatomic characteristics of vascular channel formation and the regularity of endothelial cell proliferation. This review will focus on the clinical presentation, diagnosis, treatment, outcomes, and surgical approaches to benign and malignant vascular tumors of the pelvis.