Cases reported "Kidney Neoplasms"

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1/57. Double cancers of the kidney and ureter complicated with emphysematous pyelonephritis within the parenchyma of the renal tumour.

    Emphysematous pyelonephritis and double cancers of the kidney and urinary tract are rare. We describe here a case of a diabetic man who had simultaneous renal cell carcinoma of the right kidney and transitional cell carcinoma of the right ureter complicated with emphysematous pyelonephritis within the tumour parenchyma of renal cell carcinoma. Imaging and pathology are demonstrated.
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2/57. Lymphoepithelioma-like carcinoma of the renal pelvis.

    We report the first documented case of undifferentiated carcinoma of the renal pelvis with a prominent lymphoid stroma (lymphoepithelioma-like carcinoma [LELC]). LELCs are morphologically identical to nasopharyngeal carcinoma and are rarely seen in the urinary tract, with only isolated cases involving the urinary bladder and ureter. The tumor was composed entirely of large pale staining malignant epithelial cells with ill-defined borders arranged in syncytial sheets separated by mainly reactive lymphocytes, occasional plasma cells and histiocytes. Tumor cells were immunoreactive to cytokeratin and were negative for leukocyte common antigen. awareness of LELC is important, as it should be distinguished from lymphoma or inflammatory lesions including, xanthogranulomatous pyelonephritis.
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3/57. Primary adenosquamous and squamous cell carcinoma of the upper urinary tract. Report on three cases.

    Three cases of adenosquamous cell carcinoma and squamous cell carcinoma of the upper urinary tract are presented. The fact that the urothelium normally has no glandular or squamous structures renders the pathogenesis of these tumours interesting. The process is assumed to begin with an urothelial metaplasia resulting from a reaction to chronic irritation, leading to dedifferentiation, dysplasias and, in the end, to a squamous cell carcinoma or adenocarcinoma. The relevant medical histories include chronic episodes of pyelonephritis or nephrolithiasis. diagnosis, therapeutic approaches and prognosis of these rare tumours are discussed.
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4/57. Xanthogranulomatous pyelonephritis presenting as a pseudotumor in a 2-month-old boy.

    The authors report on a 2-month-old boy presenting with a right renal mass. Investigations including ultrasound scan and computed tomogram were suggestive of a renal tumor. A right nephrectomy was performed with great difficulty because of dense adhesions to the adjacent structures. Cut section of the specimen showed the entire kidney to be replaced by cheesy-yellow areas. Histological examination was suggestive of xanthogranulomatous pyelonephritis. Although rare at this age, xanthogranulomatous pyelonephritis should be considered in the differential diagnosis of a renal mass in children. The lesion is unique among the inflammatory conditions in closely mimicking renal tumours clinically. A thorough histological examination also is suggested because the features can get confused easily with those of renal tumors.
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5/57. Renal scars masquerading as complex masses in a patient with vesicoureteral reflux nephropathy.

    Vesicoureteral reflux can lead to chronic pyelonephritis, renal scarring, and renal failure. We present a case of renal scarring masquerading as bilateral, complex renal masses. A 35-year old woman who was diagnosed with vesicoureteral reflux as a child presented for evaluation of recently developed hypertension and an abnormal renal ultrasound. Her serum creatinine level was 2.5 mg/dL and she had subnephrotic-range proteinuria. A renal sonogram showed small, echogenic kidneys and bilateral complex renal masses of 3.8 (right) and 4.4 (left) cm in greatest dimensions. CT scan of the kidneys revealed slightly contrast-enhancing masses with irregular walls. Renal angiogram showed decreased blood supply to the areas coinciding with the masses consistent with renal scarring. There was no increased vascularity. This case demonstrates that renal scarring may masquerade as renal masses. A step-wise, comprehensive approach is necessary to rule out potentially malignant lesions in these patients.
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6/57. Xanthogranulomatous pyelonephritis--the "great imitator" justifies its name.

    A case of focal xanthogranulomatous pyelonephritis (XGP) clearly imitating renal tumour is presented. The authors underline the need to include focal XGP in the preoperative differential diagnosis of a renal mass even in the absence of typical characteristics.
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7/57. Muconephrosis.

    We report a case of a mucus-filled kidney (muconephrosis) encountered during laparoscopic nephrectomy for presumed xanthogranulomatous pyelonephritis. Conversion to open nephrectomy and en-bloc right hemicolectomy were necessary because of severe perinephric fibrosis and suspected renal-enteral fistula. Pathologic examination revealed a renal pelvic villous adenoma and diffuse intestinal metaplasia of the urothelium; no enteral communication or gastrointestinal pathologic features were found. Urothelial villous adenoma is extremely rare, and one should consider neoplastic etiologies, including appendiceal mucinous cystadenocarcinoma and mucus-secreting adenocarcinoma of the renal pelvis, in directing the appropriate management of muconephrosis.
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8/57. Renal cell carcinoma complicated by emphysematous pyelonephritis in a non-diabetic patient with renal failure.

    A 72-year-old non-diabetic uremic woman underwent right nephrectomy for urolithiasis at the age of 50. Because pyuria, fever, chilliness and left flank pain developed during preparing for arteriovenous fistula, she was admitted to National Cheng Kung University Hospital. Renal cell carcinoma (RCC) complicated with emphysematous pyelonephritis (EPN) was diagnosed and immediately treated with antibiotics and CT-guided percutaneous catheter drainage. Cultures of pus and blood yielded escherichia coli. She received left radical nephrectomy later for the control of persistent sepsis and removal of left renal tumor. The pathology of the tumor was composed of a glandular arrangement of granular cells with the occasional atypism, and renal parenchyma had been totally replaced by RCC. The non-tumor part of the kidney showed chronic pyelonephritis. Five months later, multiple metastases developed. We reported this first uremic case with EPN and RCC, but without diabetes mellitus and urinary tract obstruction. The gas formation may be due to large RCC, which caused impaired tissue perfusion and E. coli infection.
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9/57. Urinary extravasation from the kidney of recurrent renal cell carcinoma.

    A man presented with recurrent renal cell carcinoma, complicated with acute pyelonephritis, 3 months status post partial nephrectomy. He underwent cystourethroscopy and a bilateral retrograde pyelogram, then was referred for a Tc-99m DTPA renal study; the images showed an initial photon-deficient area of the right kidney being gradually filled-in by radiotracer with further extension laterally, indicating urinary extravasation. 16 days later this area was aspirated, yielding 5 ml of yellowish fluid with clots consistent with necrotic tumor and pus.
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10/57. Coexisting renal cell carcinoma and xanthogranulomatous pyelonephritis in a chronic calculous disease.

    association of renal cell carcinoma (RCC) with renal calculi is very rare. Herein we report a case of RCC developing in a non-functioning kidney containing multiple renal and ureteric calculi. Histologically, the kidney, in addition, revealed changes of xanthogranulomatous pyelonephritis (XGP). XGP can be confused clinically, grossly and microscopically with RCC. In the present case both were coexistent and thus make it interesting.
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