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The case for a percutaneous approach to transitional cell carcinoma of the renal pelvis.

Percutaneous treatment of transitional cell carcinoma of the renal pelvis in 4 patients is reported. The presenting symptom was hematuria in 2 patients, while in 2 diagnosis was made by chance at excretory urography. Endoscopic removal of the tumor was not possible in the 2 patients who underwent transurethral ureteroscopy due to the location of the lesion. Percutaneous electroresection of the tumor was performed after puncture of an inferior (3 patients) or middle (1) calix and dilation of the nephrostomy tract up to 30F. Pathological findings revealed a grade 1 papillary carcinoma in 3 patients and a well differentiated inverted papilloma in 1. A single-J ureteral catheter was left in place after the procedure. Cytological, radiographic and endoscopic studies were negative 11, 13, 18 and 24 months after the treatment, respectively. We believe that the percutaneous approach is a feasible option in cases of small, single, low grade lesions not removable via ureteroscopy, particularly in patients at high surgical risk.

Aged↗

Instillation of bacillus Calmette-Guerin into the renal pelvis of a solitary kidney for the treatment of transitional cell carcinoma.

Intravesical bacillus Calmette-Guerin is effective in the treatment and prophylaxis of superficial urothelial cancer of the bladder. There have been few reports of its efficacy and toxicity when instilled into the upper urinary tract. We elected to use intracavitary bacillus Calmette-Guerin in a patient with recurrent high grade transitional cell carcinoma in the renal pelvis of a solitary autotransplanted kidney. The patient required hospitalization and triple-drug therapy after 5 instillations. She was free of tumor 1 year after bacillus Calmette-Guerin instillations.

Antitubercular Agents↗

Primary tumors of the renal pelvis: evaluation of clinical and pathological features in a consecutive series of 10 years.

We operated on 36 patients for primary carcinoma of the renal pelvis between 1975 and 1984. The patients were evaluated for etiological factors, symptoms, diagnostic modalities, treatment, histological type and grade of dedifferentiation, presence of invasion, abnormalities in the urothelium adjacent to the tumor, abnormalities in the epithelium of the collecting tubules and patient survival. No etiological factors were found. The main symptom was hematuria. Diagnosis was made by excretory urography with tomography. Urine cytology examination was of no help in the diagnosis. The survival was high in patients with low grade tumors, tumors without invasion and tumors without coexisting atypia in the adjacent urothelium but it was poor in those with high grade tumors, tumors with invasion and tumors with atypia of the adjacent urothelium.

Aged↗

Transitional cell carcinoma of the renal pelvis: nuclear deoxyribonucleic acid ploidy studied by flow cytometry.

Nuclear deoxyribonucleic acid ploidy analysis by flow cytometry was performed successfully on 109 formalin-fixed paraffin-embedded tissue specimens of transitional cell carcinoma of the renal pelvis. Tumor tissues were from patients who were operated upon between 1960 and 1975, so that long-term clinical followup was available. There were good correlations among deoxyribonucleic acid ploidy pattern and histological grade, pathological stage and clinical outcome. For high grade, high stage tumors deoxyribonucleic acid ploidy pattern provided no additional prognostically important information. However, for the more common low grade, low stage tumors the occasional detection of deoxyribonucleic acid aneuploidy patterns identified an important subgroup of patients who experienced significantly poorer survival.

Actuarial Analysis↗

Inverted papilloma of renal pelvis associated with contralateral ureteral malignancy and bladder recurrence.

We report a case of an inverted papilloma of the renal pelvis diagnosed at the same time as transitional cell carcinoma of the contralateral ureter. The diagnostic studies and surgical management are presented. Recurrence of an inverted papilloma in the bladder 1 year after treatment was confirmed histologically. Recurrence of this lesion and the association with urothelial malignancy suggest the need for close followup of patients with an inverted papilloma.

Carcinoma, Transitional Cell↗

Cholesteatoma of the renal pelvis: endoscopic management.

We report 2 cases of renal cholesteatoma, 1 of which was associated with inactive renal tuberculosis and the other with urinary stone disease. Both cases were managed by endourological techniques. The diagnosis of cholesteatoma was suspected at ureteroscopic examination of the renal pelvis and it was confirmed by histological examination of biopsy material in both cases. Treatment consisted of endoscopic extraction of the keratinous debris from the collecting system. In 1 case this was achieved with the ureteroscope and in the other case the nephroscope was used.

Adult↗

Conservative surgery for transitional cell carcinoma of the renal pelvis.

From 1972 to 1986, 14 patients underwent a conservative operation for transitional cell carcinoma of the renal pelvis. Most of these patients had low grade (12), noninvasive (10) tumors involving a solitary functioning kidney (12). The operations performed were open pyelotomy with tumor excision and fulguration (8 patients), partial nephrectomy (5) and percutaneous nephroscopic fulguration (1). There was 1 operative death. Of the 13 surviving patients 8 (62 per cent) remained free of transitional cell carcinoma postoperatively, while 5 (38 per cent) had recurrent disease. Six patients (46 per cent) presently are free of tumor 6 months to 5 years postoperatively. Conservative surgical techniques can provide satisfactory treatment for selected patients with renal pelvic transitional cell carcinoma when preservation of functioning renal parenchyma is necessary to avoid kidney failure.

Adult↗

Endocrine cells in renal pelvis and ureter, an immunohistochemical analysis.

A systematic detection of endocrine cells in the renal pelvis and ureter was carried out, using Grimelius stain and immunohistochemical techniques. Ninety specimens of pelvic and ureteral mucosae were investigated. Throughout the pelvic urothelium, endocrine cells were very uncommon, patchily distributed, and serotonin-storing. They have been disclosed in only two cases among normal-appearing transitional epithelium. Whether cells so scanty are normal and permanent inhabitants of this territory is debatable. The material examined did not provide opportunity to demonstrate endocrine cells throughout the normal ureter. Surprisingly, one case of supernumerary ureter with an ectopic distal orifice into the urethra harbored abundant serotonin cells. This remarkable endocrine profile, which departed appreciably from that of normal ureter, showed a close similarity with that of the urethra. This raises the question whether such endocrine differentiation might reflect, for this ectopic ureteric bud, urogenital sinus origin rather than wolffian origin.

Fluorescent Antibody Technique↗

The postoperative irradiation of transitional cell carcinoma of the renal pelvis and ureter.

The role of adjuvant irradiation in the treatment of transitional cell carcinoma of the renal pelvis and ureter was reviewed. Between June 1966 and March 1981, 41 patients underwent curative resections. A poor risk group was identified, with 23 patients demonstrating disease greater than grade 2 or stage B. Postoperative irradiation was administered to 11 of 23 patients. Median patient followup was 40 months. Two-thirds of all failures occurred within the first 12 months and no failure was seen beyond 35 months. Patients with poor prognostic features had a 60 per cent failure rate compared to 11.8 per cent of the patients with good risk factors (p equals 0.023). The median survival of the 2 groups was 28 and 99 months, respectively (p less than 0.001). Outcome of the poor risk patients was analyzed whether or not the patient received postoperative irradiation. None of the irradiated patients failed with local disease only, while there was 1 patient with local and distant recurrence. In contrast, the nonirradiated group had 5 local failures and twice the number of failures over-all. Median survival of the irradiated and nonirradiated patients was 35 and 26 months, respectively. The number of patients treated is too small to permit valid statistical conclusions and indicates the need for a multi-institutional study to determine if these suggestive findings of improved local control will be corroborated and translate into an improved survival rate.

Adult↗

Squamous cell carcinoma of the renal pelvis associated with hypercalcemia and the presence of parathyroid hormone-like substances in the tumor.

A case of hypercalcemia associated with documented squamous cell carcinoma of the renal pelvis without bone metastasis is reported. High levels of cross-reacting parathyroid hormone-like material in serum and its presence in tumoral tissue were detected. To our knowledge this is the fourth case described in the literature and the first in which tumoral production of parathyroid hormone-like material is demonstrated.

Calcium↗

Analgesics and tobacco as risk factors for cancer of the ureter and renal pelvis.

In a case-control study of 36 men with cancer of the ureter and 307 male controls with the same age distribution tobacco smoking conferred a relative risk for this cancer of 2.9, whereas consumption of analgesics of any kind did not increase the risk. The relative risk for cancer of the renal pelvis, determined for 29 men, was 2.4 for tobacco and 6.0 for phenacetin-containing analgesics. Analgesics containing no phenacetin conferred no increased risk for cancer at this site. Data for 13 women with ureteral cancer, 5 of whom had taken phenacetin, are presented but not analyzed.

Aged↗

Mucinous and squamous metaplasia of the renal pelvis.

Mucinous and squamous cell metaplasia of the transitional cell epithelium occurs in response to chronic irritation and is predominantly found in the bladder. When the 2 forms of metaplasia occur simultaneously they usually are associated with malignancy. We report 2 cases of mucinous and squamous metaplasia of the epithelium of the renal pelvis that were not associated with malignancy. This is believed to be the fourth report of this divergent metaplasia. The mechanism for these changes is discussed.

Adult↗