11/77. Viral cytopathic changes in urine cytology of ileal conduit attributed to adenovirus: report of a case. urine cytology from ureteral diversions utilizing intestinal segment as reservoir or conduit, constructed during cystectomy performed usually for advanced bladder neoplasia, differs from bladder urine cytology in that the presence of abundant intestinal mucosal cells with degenerative and inflammatory changes interferes with the recognition of other important cellular changes, particularly of recurrent neoplasia in the upper urinary tract, not to mention other less frequent yet note worthy pathologic changes, such as viral type indigenous to the urinary tract. When confronted with diseases involving the intestinal segment, such as viral enteritides, the diagnostic problem becomes more complex and special effort is needed to recognize and characterize them correctly, differentiating them from other pathologies or artifacts seen in such specimens. We report one such case in which viral changes affecting columnar intestinal epithelium were identified and by immunocytochemistry characterized as adenoviral involving primarily cells of the intestinal conduit. We discuss the significance of such infection in comparison to other viral changes indigenous to the urinary tract, which could also occur in such specimens. ( info) |
12/77. Urinary exenteration on a renal transplant recipient with multifocal urothelial cancers and prostatic adenocarcinoma. The two cancers after renal transplantation (RTx) are transitional cell carcinoma (TCC) and hepatoma reported in taiwan most frequently, versus lymphproliferative diseases and skin cancers in the Western literature. Herein, we present a 49-year-old man with spinal cord injury and end-stage renal disease who developed multifocal TCC in the urologic tract and incidental detection of prostatic adenocarcinoma 15 months after a cadaveric RTx. En bloc complete native urinary tract excision and ileal conduit urinary diversion were performed smoothly. After 2-year follow up, there was no evidence of tumor recurrence, and graft function remained stable, with minimal hydronephrosis. Transplant physicians should carefully monitor any signs of urinary cancers, especially in renal transplant recipients with history of analgesics. Also, aggressive surgical treatment is recommended for these patients to prolong survival. ( info) |
13/77. Upper urinary tract metastases from adenocarcinoma of the colon. An unusual presentation of colorectal metastasis to the upper urinary tract is reported. The metastasis manifested as a filling defect seen during antegrade pyelography. Cytologic evaluation of aspirated material demonstrated metastatic colonic adenocarcinoma. A dilated collecting system may be caused by intraluminal material including tumor and blood clots. Whenever fixed filling defects are encountered, urine cytology should be sent even in the absence of renal parenchymal involvement by tumor. The cytological evaluation may allow for prompt diagnosis and treatment. ( info) |
14/77. Diffuse hemangioma of the rectum detected on multi-slice CT in an 18-year-old woman with Klippel-Trenaunay syndrome. The paper reports a rare case of an 18-year-old woman with Klippel-Trenaunay syndrome, whose multi-phase multi-slice CT revealed diffuse colorectal hemangioma. The patient presented symptoms of consumption coagulopathy (Kasabach-Meritt syndrome) and intense collateral circulation in the course of portal hypertension. The CT lesions and possibilities of multiformat and 3D volume rendering reconstructions are presented. To our knowledge, this is the first report of diffuse hemangioma of the colon and rectum in a patient with KTS detected with multi-slice CT. ( info) |
15/77. Four primary tumors of lung, bladder, prostate, and breast in a male patient. We present a very rare case of quadruple cancers in a 65-year-old male patient. It is a case of both synchronous and metachronous primary malignant neoplasms occurring in four different organs. Immunohistochemical stains showed tumor cell nuclei to be negative for p53 over-expression. To our knowledge, this is the first documented case with this combination of primary tumors. The tumors included an adenosquamous cell carcinoma of the lung, transitional cell carcinoma of the urinary bladder, and adenocarcinomas of the prostate and the breast. We also review the medical literature for the possible causes of multiple primary malignant neoplasms. ( info) |
16/77. Sudden late onset of gross hematuria in a previous renal transplant recipient 3 months after transplant nephrectomy. Causes of gross hematuria in a patient with end-stage renal disease are limited compared with those in patients with normal renal function. Given the increased likelihood of patients with end-stage renal disease developing renal cell carcinoma, the workup focuses on a careful evaluation of the collecting system. The workup for gross hematuria in a renal transplant recipient is similar; however, the focus shifts toward a more thorough evaluation of the transplanted kidney and bladder because immunosuppression increases the overall risk for malignancy. An immunosuppressed patient also is at risk for infectious processes in the transplanted kidney manifesting as gross hematuria. Concerns for chronic rejection also should be investigated, although microscopic hematuria is more common in this scenario. If this is unrevealing, then close scrutiny of the native kidneys for possible sources of bleeding is warranted. We present an interesting and unusual cause of painless gross hematuria in a patient with end-stage renal disease and transplant nephrectomy 3 months before the onset of bleeding. ( info) |
17/77. Carcinomatous meningitis from urachal carcinoma: the first reported case. Carcinomatous meningitis (CM) occurs in less than 10% of cancer patients. Although patients frequently present with a focal complaint, multifocal signs are often found following careful neurological examination. The gold standard for diagnosis remains the demonstration of neoplastic cells in the cerebrospinal fluid. Despite the discouraging prognosis, palliative treatment may improve quality of life and lengthen lifespan. We report a patient with known primary carcinoma of the urachus who presented with headaches, nausea, vomiting and ataxia 1 week following resection of a nodular arachnoidal metastasis (indenting the cerebellum). Lumbar cerebrospinal fluid subsequently confirmed carcinomatous meningitis. This is the first reported case of carcinomatous meningitis resulting from metastatic urachal carcinoma. ( info) |
18/77. Percutaneous sequential bacillus Calmette-Guerin and mitomycin C for panurothelial carcinomatosis. A 59 year old male presented with a 4 month history of lower urinary tract symptoms. Exhaustive urological investigations revealed papillary tumors and carcinoma in situ extending from the prostatic urethra, throughout the bladder, up both ureters and into the renal pelves. Tumors were resected where possible and then bacillus Calmette-Guerin (BCG) and mitomycin C (MMC) were infused sequentially through bilateral nephrostomy tubes for a total of six BCG and three MMC instillations. Follow up 1 month post treatment demonstrated a complete response which persisted for 2 years. Then there appeared a solitary papillomatous recurrence in the bladder which was successfully resected. Side effects were the occasional fever and BCG induced granulomatous prostatitis which slowly resolved. In conclusion, sequential BCG/MMC instillations were effective treatment for widespread panurothelial carcinomatosis. ( info) |
19/77. Urothelial carcinoma with rhabdoid features: report of 6 cases. Extrarenal rhabdoid tumors have been described in a variety of primary sites with only rare case reports of urothelial carcinomas with rhabdoid features in the literature. In this report, we describe the clinicopathologic characteristics, including clinical follow-up on 6 cases of urothelial carcinoma with prominent rhabdoid features. Four cases were retrieved from the consultation files of one of the authors and 2 were retrieved from the surgical pathology files at our institution. The patients were all men, with ages ranging from 53 to 86 years (mean, 66.5 years). patients initially presented with hematuria or obstructive symptoms. The sites included bladder (n = 4) and renal pelvis (n = 2). All cases had a prominent rhabdoid component (mean, 60%), ranging from 40% to 80%. In addition to the rhabdoid component, multiple coexistent histological components were seen, including in situ urothelial carcinoma (carcinoma in situ) and high-grade papillary urothelial carcinoma (n = 2), poorly differentiated carcinoma with small-cell features (n = 1), sarcomatoid (n = 2), and a myxoid component (n = 2). All cases in this series had focal or diffuse positive staining with one or more cytokeratin markers (epithelial membrane antigen, CAM 5.2, AE1/AE3). Of the 6 patients, 4 were treated initially with surgery (radical cystoprostatectomy, n = 2; radical nephrectomy, n = 2). Of 6 patients, 2 died within 1 month, whereas a third patient died within 4 months. The remaining 3 patients were alive at 3, 3, and 9 months after diagnosis. The histological and immunohistochemical findings in this study serve to broaden the morphological spectrum of urothelial carcinomas with prominent rhabdoid features and add further evidence as to their poor prognosis. ( info) |
20/77. Unknown ESUR cases 2004. The authors present 14 cases from the film interpretation session of the 11th annual meeting of the European Society of Urogenital radiology presented in September, 2004. The cases demonstrate the imaging findings, differential diagnoses, and clinical relevance of a wide variety of genitourinary tract diseases. The cases include examples of benign and malignant urinary tract neoplasms, inflammatory processes, vascular diseases, traumatic injuries, and congenital anomalies. ( info) |