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Inflammatory myofibroblastic tumor of renal pelvis presenting with prolonged fever and abdominal pain in children: report of 1 case and review of literature.

Inflammatory myofibroblastic tumor is a reactive proliferative lesion that occurs extremely rarely in the renal pelvis, especially during childhood. We report 1 such case that occurred in a child who presented with prolonged fever and abdominal pain. Ultrasonography and abdominal computed tomography revealed a left renal pelvic mass. She received conservative surgical treatment. The diagnosis was confirmed by pathological and immunohistochemical studies. Distinguishing inflammatory myofibroblastic tumor from other malignant renal pelvic tumors in children is essential to preventing unnecessary nephrectomy.

Abdominal Pain↗

Monte Carlo dose calculations in the treatment of a pelvis with implant and comparison with pencil-beam calculations.

In the present paper, dose distribution calculated with the Monte Carlo code EGS4 and with a pencil-beam algorithm are compared for the treatment of a pelvis with an implant. Overestimations of dose values inside the target volume by the pencil-beam algorithm of up to 10% were found, which are attributed to the underestimation of the absorption of photons by the implant. The differences in dose distributions are also expressed by comparing the tumor control probability (TCP) of the Monte Carlo dose calculations with the TCP of the pencil-beam calculations. A TCP reduction of order of 30% was found.

Algorithms↗

MR imaging of congenital/developmental and acquired disorders of the pediatric hip and pelvis.

This article reviews the MR imaging findings of some of the more common congenital and acquired disorders of the pediatric hip and pelvis,with the intent of increasing the awareness of radiologists and facilitating early and accurate diagnosis and treatment. The importance of MR imaging in the pediatric population is underscored by its ability to evaluate these disorders well and without the use of ionizing radiation.

Adolescent↗

Comparative study of ureteral stripping versus open ureterectomy for nephroureterectomy in patients with transitional carcinoma of the renal pelvis.

OBJECTIVES: To evaluate the clinical outcome of nephroureterectomy with endoscopically assisted transurethral ureteral stripping for transitional cell carcinoma of the renal pelvis in a comparative study. METHODS: Sixty patients with localized renal pelvic cancer were enrolled in a prospective comparative nonrandomized study. Of these, 28 patients underwent nephroureterectomy with endoscopically assisted transurethral ureteral stripping and 32 underwent conventional nephroureterectomy with a bladder cuff. Both short-term and long-term results were analyzed in this series. RESULTS: The operating time for patients with ureteral stripping was significantly shorter than for those with a standard two-incision nephroureterectomy (median 183 versus 250 minutes, P = 0.0231), and the amount of blood loss was significantly less (median 150 versus 390 mL, P = 0.0002). Intravesical recurrence was detected in 10 (35.7%) of the 28 patients with ureteral stripping, and the 1-year and 3-year recurrence-free rate was 68.0% and 57.7%, respectively. Seven patients treated by the standard two-incision nephroureterectomy (21.9%) experienced intravesical recurrence, with a 1-year and 3-year recurrence-free rate of 96.8% and 75.0%, respectively. The recurrence rate was significantly greater in the group with ureteral stripping (P = 0.0287). CONCLUSIONS: Compared with conventional nephroureterectomy with a bladder cuff, nephroureterectomy with transurethral stripping is a minimally invasive procedure with a shorter operating time and less blood loss, but a statistically significantly greater intravesical recurrence rate. Greater consideration should be taken before selecting this procedure.

Aged↗

Metastatic cancer to the renal pelvis: a novel approach to management.

We describe a novel application of percutaneous renal surgery for the management of an unusual and challenging urologic problem. Two patients with symptomatic, metastatic adenocarcinoma in the renal pelvis were treated with percutaneous resection. The lesion was in a solitary kidney in 1 patient, and was bilateral in the second. Percutaneous resection resulted in complete relief of symptoms and obstruction. Although both patients ultimately died of their primary disease, their quality of life was significantly improved in the interim. Percutaneous resection of renal pelvic tumors is accepted management for select patients with upper tract transitional cell carcinoma. These 2 cases demonstrated both an unusual presentation for metastatic adenocarcinoma and an expanded application for percutaneous renal surgery.

Adenocarcinoma↗

Synchronous inverted papilloma of bladder and renal pelvis.

Inverted papilloma of the urinary tract is a rare tumor that consists of uniform urothelial cells with an inverted configuration and a normal urothelial lining. Despite several published reports, the prognostic significance and the potential biologic behavior remain uncertain. We detail a case of synchronous inverted papilloma of the urinary bladder and the renal pelvis and review the published data.

Humans↗

Sarcomatoid carcinoma of transitional cell origin confined to renal pelvis.

Thirteen reported cases of renal pelvic sarcomatoid carcinoma have been documented since 1961, and all patients presented with metastatic disease or advanced renal parenchyma involvement. The mean survival was shorter than 9 months, and adjuvant therapy appeared to offer no benefit. We present the case of a 61-year-old man with gross hematuria and a large filling defect on computed tomography excretory urography. Surgical pathologic examination after laparoscopic nephroureterectomy was consistent with renal pelvis-confined sarcomatoid carcinoma of transitional cell origin. Adjuvant therapy was not given secondary to the organ-confined nature of disease. The patient was without recurrence for more than 1 year.

Carcinoma, Transitional Cell↗

Laparoscopic nephroureterectomy for transitional cell carcinoma of renal pelvis and ureter: Nagoya experience.

OBJECTIVES: To evaluate the efficacy of retroperitoneoscopic nephroureterectomy for transitional cell carcinoma of the renal pelvis and ureter, we analyzed the clinical outcomes and long-term cancer control of 89 patients. METHODS: In 36 patients, the kidney was retroperitoneoscopically dissected and the ureteral end was resected with open procedure (combined laparoscopy group). In 53 patients, the ureteral end with a bladder cuff was transected using an endoscopic stapler (pure laparoscopy group). Sixty patients underwent open nephroureterectomy (open group). The median follow-up period was 35, 31, and 17 months in the open, combined, and pure laparoscopy groups, respectively. RESULTS: The average operative time and bleeding volume was 5.4 hours and 665 mL in the open group, 5.1 hours and 580 mL in the combined laparoscopy group, and 4.3 hours and 354 mL in the pure laparoscopy group, respectively. The cause-specific patient survival rate at 3 years was 81% in the open group, 86% in the combined laparoscopy group, and 80% in the pure laparoscopy group. The bladder recurrence-free rate at 3 years was 51% in the open group, 65% in the combined laparoscopy group, and 45% in the pure laparoscopy group. The extravesical recurrence-free rate at 3 years was 71% in the open surgery group, 76% in the combined laparoscopy group, and 71% in the pure laparoscopy group. No statistically significant difference was seen in patient survival, bladder recurrence, or extravesical recurrence rates among the three groups. CONCLUSIONS: Our retroperitoneal laparoscopic nephroureterectomy is less invasive than open surgery and is a safe and effective alternative.

Aged↗

Plastic within renal pelvis on nephroscopy: a potential hazard during percutaneous nephrolithotomy.

The use of adhesive plastic drapes is common throughout laparoscopic and percutaneous surgery. We report a case in which a significant portion of the plastic drape was translocated into the renal pelvis during tract dilation for percutaneous nephrolithotomy. The complication was recognized only on endoscopy and the plastic successfully removed. The potential for morbidity in other patients in the future remains, and we recommend operators be aware of this unusual, but entirely preventable, complication. We highlight some measures to help avoid and check for this complication before the end of the procedure.

Adult↗

The radiology of the hip joints and pelvis in cerebral palsy.

Thw radiological appearances found in the pelvis and hip joints in 79 patients with cerebral palsy, aged 5--16 years, have been studied. These findings have been recorded and correlated with the clinical severity and distribution of the disease. Subluxation of the hip joints was found in 14% and dislocation in a further 6%. Spasticity was the predominant neuromuscular handicap in 69 out of 79 cases (88%). The acetabular angle and femoral neck shaft angle were related to the degree of migration of the femoral head. The acetabular angle, iliac angle, iliac index and femoral neck shaft angle were all significantly increased in the deranged group. In the dislocated group, the mean neck-shaft angle was 154 degrees. When the degree of spasticity was asymmetrical, there was a striking relationship between the laterality of the spasticity and the laterality of the deranged hip, pelvic obliquity and increased acetabular angle. A typical teardrop-shaped femoral head was seen in 48% spina bifida occulta of the lower lumbar and sacral spine in 32% and pseudoarthrosis in 3.8%. No ectopic calcification or ossification of soft tissue was noted. An awareness that these children are at risk from subluxation and dislocation of the hip and the importance of early diagnosis and treatment are emphasised.

Adolescent↗

Striation of the renal pelvis and ureter in bilharziasis.

The intravenous urograms of 80 patients aged 16 to 29 (mean 23) with urinary bilharziasis were reviewed to determine the frequency of striation of the renal pelvis and ureter. Another 345 patients aged 16 to 29 (mean 22) with various abdominal and urological symptoms, had intravenous urography during the same period and were used as a reference group. Striation of the upper urinary tract was demonstrated in 21% of the patients with urinary schistosomiasis but in only 3% of the reference group. Striation constitutes an early radiological change in this disease.

Adolescent↗

The computed tomographic appearances of lymphangiectasia in the pelvis.

We describe the CT appearances of lymphangiectasia in the pelvis of a 21-year-old male who presented with fever, abdominal pain and swelling of the right thigh. Previous histological examination of a biopsy specimen from the patient's thigh had demonstrated lymphangiectasia.

Lymphangiectasis↗

Renal pelvi-ureteric injury in traumatic paraplegia.

Three cases of pelvi-ureteric injury associated with traumatic paraplegia are described. The diagnosis of such injuries is usually late and the consequences can seriously affect the outlook of the patient. The problems of late diagnosis are discussed and recommendations made concerning earlier diagnosis.

Adolescent↗

Obstruction of the renal pelvis due to an insoluble blood clot after epsilon-aminocaproic acid therapy: resolution with intraureteral streptokinase instillations.

PURPOSE: We demonstrate the effectiveness of intraureteral streptokinase instillations for the resolution of an insoluble blood clot in the renal pelvis. MATERIALS AND METHODS: A patient with renal adenocarcinoma had prolonged hematuria related to involvement of the "pyelum" by the tumor. An insoluble blood clot obstruction of the left renal collecting system developed as a consequence of epsilon aminocaproic acid therapy, which was treated with low dose streptokinase through a ureteral catheter. RESULTS: Complete resolution of the clot and obstruction occurred within 3 days of therapy. CONCLUSIONS: This relatively simple approach should be used for the treatment of obstruction before radical surgery is performed.

Aged↗

Transitional cell carcinoma of the renal pelvis and ureter: prognostic relevance of nuclear deoxyribonucleic acid ploidy studied by slide cytometry: an 8-year survival time study.

In 72 patients with urothelial carcinoma of the renal pelvis or ureter the ploidy, deoxyribonucleic acid (DNA) heterogeneity and counts of cell cycle phases in the tumor were analyzed by means of single cell DNA cytophotometry with the intention of finding new prognostic factors in addition to those already known (stage and grade). Followup ranged from 1 to 8 years. The results of the DNA analyses were related to the tumor categories, histopathological grading of the tumors and clinical course. Malignancy grade 1 tumors showed DNA frequency peaks in the diploid range, while tumors assessed as malignancy grade 2 showed heterogeneous DNA distribution patterns. Malignancy grade 3 tumors exhibited 71% aneuploid and 29% tetraploid DNA values. The proliferation rate of the tumor cells was statistically significantly higher in malignancy grades 2 and 3 than in malignancy grade 1. The prognosis for grade 1 tumors is good, whereas it is unfavorable in the case of grade 3 tumors. For these 2 groups (patients with grades 1 and 3 tumors) DNA ploidy affords no additional prognostic information. Grade 2 tumors, on the other hand, are heterogeneous in respect to DNA ploidy although they exhibit the same histomorphological degree of differentiation. These tumors can be subclassified as aneuploid (biologically aggressive) and diploid or tetraploid (biologically less aggressive) tumors. There was also a positive correlation between T category and DNA ploidy. The cell lines were aneuploid in 38% of the patients with stage T1 tumors, 56% with stage T2 tumors and almost 85% with stage T3, N+ tumors. A significant correlation was found between the results of DNA cytophotometry and the clinical course of the disease. Patients with diploid tumor cell nuclei had no metastases and no local tumor progression for up to 8 years, whereas patients with aneuploid tumor cell nuclei suffered metastasis and local tumor progression within 24 to 36 months. The patients died of the tumor 36 months after primary diagnosis on the average. The determination of DNA ploidy, tumor heterogeneity and tumor cell proliferation by means of DNA cytophotometry affords valuable clues as to prognosis.

Adult↗

Microanatomy and morphometry of the hydronephrotic "obstructed" renal pelvis in asymptomatic infants.

There has been limited histological study of the obstructed ureteropelvic junction in patients less than 1 year old. We present our prospective studies on the histomorphometry of the ureteropelvic junction complexes of 35 infants, of whom 23 underwent pyeloplasty for obstruction and 12 were age matched autopsy normals. Qualitatively, the major abnormalities of the pelvic microanatomy in the hydronephrotic obstructed kidneys included a lamina muscularis that was significantly thicker than normal and the presence of collagen fibers between muscle fascicles. Additionally, variable amounts of elastin were present in the adventitia and lamina muscularis. At the ureteropelvic junction the abnormalities were an increase in the number of inner longitudinal muscle bundles, collagen between muscle bundles (p less than 0.016) and elastin in the adventitia. Quantitatively, for the pelvis the lamina muscularis was significantly thicker in 18 obstructed kidneys compared to 7 controls (1,075 +/- 79 mu. versus 420 +/- 63 mu., mean +/- standard error of mean, p less than 0.001). The percentage area density of smooth muscle in the obstructed versus normals was increased (45.1% versus 35.2%, p less than 0.039). The percentage area density of collagen in the obstructed specimens versus normal showed an upward trend (38.6% versus 27.6%), which was not significant. In conclusion, the obstructed ureteropelvic junction complexes of kidneys in asymptomatic infants show significant qualitative and quantitative differences from normal.

Humans↗