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We report a case of 2 concurrent serious renal problems in opposite kidneys. The patient presented with gross hematuria, which resulted in a diagnosis of transitional cell carcinoma of the renal pelvis and tuberculosis of the contralateral kidney. Intraoperative nephroscopy allowed for appropriate diagnosis and surgical therapy.
To clarify whether the epithelium of the human urinary tract possesses an active transepithelial sodium transport, the unidirectional sodium fluxes and the electrical parameters of the epithelium were determined on isolated pieces of renal pelvis. The epithelium was incubated in isotonic Ringer's solution at 37.3C in Ussing-type chambers. The transepithelial potential difference was found to be 15.8 +/- 3.0 mV and the transepithelial electrical resistance 760 +/- 48 omega . cm.-2. The transepithelial, unidirectional sodium fluxes were measured under short-circuit conditions. From both the unidirectional sodium influx from the luminal to the serosal side (7.01 +/- 2.17) and from the efflux in the opposite direction (0.45 +/- 0.07) a transepithelial sodium net flux of 6.56 +/- 2.20 nmol. . minutes-1. cm.-2 was calculated. Since there are no passive forces across the epithelium under short circuited conditions to explain the net flux, an active sodium transport has to be postulated. In all experiments, the simultaneously measured short circuit current (6.43 +/- 2.18 nmol. . minutes-1 . cm-2) was not significantly different from the net sodium flux, and can therefore be taken as a measure of the net flux.
This is the first report on the use of the red cell surface antigen test in predicting the malignant potential of transitional cell carcinoma of the ureter and renal pelvis. In 29 cases evaluated there was an 80 per cent correlation. The red cell surface antigen determination was shown to have practical value in the management of these tumors.
Computerized tomography has been used in the evaluation of 5 patients with radiolucent masses of the collecting system. There were 3 cases of renal calculi. 1 peripelvic cyst and 1 squamous cell carcinoma of the renal pelvis. The results of computerized tomography scanning are correlated with the results of excretory urography and ultrasonographic scanning. The diagnostic advantage of computerized tomography scanning for evaluation of radiolucent masses of the upper collecting system is elucidated.
During a 22-year period 224 patients were seen for treatment of transitional cell carcinoma of the renal pelvis or ureter. Of these patients 49 (22 per cent) had grade 1 lesions. Followup ranged from 5 to 25 years. The most common symptom was hematuria. In only 54 per cent of the 49 patients was a filling defect noted on excretory urography. Forty-seven patients (96 per cent) had stage I disease. Treatment included total nephroureterectomy, nephrectomy or segmental resection. In 11 patients (23 per cent) evidence of bladder tumor developed 8 months to 12 years (average 4 years) after the diagnosis of tumor of the upper urinary tract and 73 per cent of these recurrences were noted within the first 3 years. In 1 patient a tumor developed in the opposite upper urinary tract. In only 1 of 15 patients who had had partial ureterectomy or local excision tumor developed in the ipsilateral ureter. Patient survival time was identical to that in an age-matched control group. We conclude that the most significant findings are the subsequent high incidence (23 per cent) of bladder tumor and the comparable survival in these pateints and in an age-matched control group. Furthermore, these results suggest that operations preserving the renal parenchyma, that is segmental resection, should be used more frequently.
A case of transitional cell carcinoma of the pelvis, which presented with vascular occlusion, is reported.
Renal calculi weighing in excess of 100 gm. are rare, since most stones cause arrest of renal function before they reach giant proportions. We report a rare case of a 100 per cent struvite calculus weighing 698 gm., associated with transitional cell carcinoma of the ipsilaterl renal pelvis. A summary of the large calculi reported in the recent literature is included.
Three patients with advanced transitional cell carcinoma of the renal pelvis were treated with 5 mg./m.2 body surface vinblastine intravenously weekly and 130 mg./m.2 chloroethyl-cyclohexyl-nitrosourea orally with 6-week intervals. One patient had a partial remission for 1.5 months and 2 had stationary disease for 6 and 2 months.
Primary carcinoma in situ of the ureter or renal pelvis is rare. We describe 3 patients, each of whom had a different mode of presentation. When malignant cells in the urine from the upper urinary tract are associated with urographic evidence of an appropriate lesion, aggressive surgical therapy is indicated. In the absence of such a urographic abnormality patients with positive cytologic examinations should be followed closely because the exfoliated cells usually are from poorly differentiated neoplasms.
A case of hypercalcemia associated with documented squamous cell carcinoma of the renal pelvis without bony metastasis is reported. Pseudohyperparathyroidism was suspected strongly because of the radioimmunoassay values of parathormone. This was confirmed by the prompt decrease of serum calcium after removal of the neoplasm. The radiologic findings were non-specific.
An unusual heterologous carcinosarcoma of the renal pelvis is reported. The differential diagnosis, problems related to nomenclature and histogenetic implications of this rare neoplasm are discussed.
The first reported case of rupture of the renal pelvis associated with transplantation is presented. The obstruction was in the ureteral tunnel of the hypertrophic bladder. The cause of the weakness in the pelvic wall could not be determined. Differential diagnosis was acute rejection and lymphocele. Excretory urography was diagnostic. Treatment included revision of the ureteroneocystostomy with repair of the defect and internal stenting. Postoperative morbidity was minimal and satisfactory graft function was maintained.
A case of an apparently benign urothelial tumor of the renal pelvis is reported. Morphologically, the lesion resembles an inverted papilloma. An article summarizing the findings in 28 of these tumors occurring in the bladder is quoted.
A case of transient filling defects in the renal pelves and ureters, secondary to spontaneously occurring acquired anticoagulants, is presented. The relationship of this entity to hemophilia, immunologic disorders, such as systemic lupus erythematosis, and normal post partum patients is discussed. The differential diagnosis for filling defects in the renal pelvis is reviewed.
A case of transitional cell carcinoma of the renal pelvis in a 4-month-old japanese boy is reported. This patient is the youngest one described in the literature with a tumor of this type. The differential points of Wilms tumor and other types of neonatal renal tumors are discussed.
A case of mucinous adenocarcinoma of the renal pelvis is reported. The role of infectious agents and the embryologic formation in relation to the malignancy are discussed. Diagnosis of this rare malignancy rests on a high degree of suspicion, coupled with radiologic and cytologic procedures.
Eight cases of unusual radiolucent filling defects in the renal pelvis and calices are reported. With reference to the literature and these cases, such defects have been classified etiologically as tumors, calculi, blood clots, air bubbles, congenital anomalies, vascular phenomena, infections and associated conditions, foreign bodies and miscellaneous conditions. Most of these conditions are rare but their accurate delineation with modern diagnostic techniques will allow for more conservative surgical procedures and for maximal preservation of renal substance.
We report a case of Aspergillus fumigatus infection of a total hip arthroplasty. This rare infection was demonstrated at surgical revision of a loosened prosthesis with migration of the cup into the pelvis associated with a false aneurysm of the femoral artery. A vascular time was required before the orthopedic revision. This case illustrates the importance of the preoperative work-up in the event of cup migration. The double approach was required in our patient to control and repair the vascular structures. The difficult treatment of Aspergillus fumigatus is also discussed.