THE JOURNAL OF UROLOGY

Vol. 114. October

Copyright© 1975 hy The Williams & Wilkins Co.

Printed in U.S.A.

PAPILLARY (TRANSITIONAL) CARCINOMA IN AN ILEAL CONDUIT 0. G. BANIGO . ,J. WAISMA'.\/

AND

J. J. KAUFMAN*

From the Division of Urology, Departments of Surgery and Pathology, University of California S chool of Medicine, Los Angeles, California

ABSTRACT

An example of papillary carcinoma developing at the ureteroileal junction with herniation of the tumor into the lumen of an ilea! conduit is reported. This and similar tumors have occurred within 4 years of urinary diversion, emphasizing the need for continued surveillance of patients with an ileal conduit. Patients with widespread atypia of the transitional epithelium of the urinary tract, such as ours, are especially prone to recurrent carcinoma and should be watched most carefully. Surgical excision of the tumor occurring at or near the ureteroileal junction should always include a cuff of ileum, as in the standard treatment of renal pelvic and ureteral tumors. Although the development of neoplasms has been noted with the diversion of urine , the occurrence of a tumor associated with an ilea! conduit is rare. To our knowledge only 4 such instances have

papillary carcinoma developing at the site of uretera\ implantation into an ilea! conduit. CASE REPORT

A 69-year-old man with a 9-year history of recurrent neoplasms of the bladder had undergone various treatments, including topical thio-tepa,

FIG. 1. Selective right renal arteriogram shows filling defect in renal pelvis and tumor neovascularity.

been reported-a papillary carcinoma at the cutaneous stoma of an ilea! conduit, 1 2 papillary carcinomas at the ureteroileal junction 2 and , recently, a papillary carcinoma in the ilea! conduit itself. 3 We herein report another patient with Accepted for publication May 2, 1975. Supported in part by the University Medical Research Foundation and the Blalock Foundation. * Requests for reprints: Room 66-14:~ CHS, Department of Surgery/Division of Urology. University of Cali fornia School of Medicine, Los Angeles, California 90024. 626

F1G. 2. Papillary tumor at ileoureteral anastomosis with ileal mucosa on right. H & E. reduced from x 8.

PAPILLARY (TRANSITIONAL) CARCINOMA IN ILEAL CONDUIT

intravenous 5-fluorouracil and :3,500 rads of external cobalt radiation. Finally a radical cystectomy with ureteroileocutaneous urinary diversion was performed in 1971. The bladder contained multiple, well differentiated papillary carcinomas and widespread, severe atypia of the transitional epithelium, tantamount to carcinoma in situ. Similarly, atypical epithelium was noted in the urethra. Within 19 months gross hematuria prompted studied showing a right renal pelvic filling defect, which on an arteriogram was compatible with a tumor (fig. 1). A radical nephroureterectomy was performed and revealed a well differentiated papillary pelvic carcinoma. The ureter was resected to the ileum but a cuff of ileum was not excised. The transitional epithelium of the ureter was atypical. In 1974 intermittent, gross painless hematuria was observed and an ileostogram revealed a defect at the s ite of the ileoureterostomy. A papillary tumor at t he a nastomosis of the left ureter and ileum was treated by partial resection of the ilea! conduit and terminal segment of the left ureter. There was no evidence of recurrent or metastatic carcinoma 9 months later. The papillary tumor measured 2 cm. in diameter a nd was attached to the terminal segment of ureter

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at the line of anastomosis (fig. 2). The t umor had herniated through the ureteral stoma into the ilea! conduit and was continuous with ureteral transitional epithelium on a ll s ides . It was composed of well differentiated transitional cells and had delicate papillary folds on the surface without evidence of invasion of the lamina propria of the ureter. Although s ignificant atypia was not observed in the ureteral epithelium adjacent to the papillary tumor or at the proximal margin of resect ion closest to the left kidney, the mucosa of the ileum was altered. Villi were absent or severely attenuated, while the epithelium contained an abundance of goblet cells, creating an impression of large intestinal metaplasia. REFERENCES

I. Grabstald, H.: Carci noma of ilea! bladder stom a . ,J. Urol. , 112: :l32, 1974. 2 . Soloway, M. S .. Myers. G. H ., Jr .. Burd ick. ,J. F. and M a lmgren, R. A.: ll ea l conduit exfoliative cytology in the diagnosis of recurrent cancer. J. Urol. , 107: 835, 1972. 3. Wajsman, Z. , Baumgartner, G. and Merrin . C.: Tran sitional cell carcinoma of ilea! loop following cystect omy. Urology. 5: 255. 1975 .

Papillary (transitional) carcinoma in an ileal conduit.

An example of papillary carcinoma developing at the ureteroileal junction with herniation of the tumor into the lumen of an ileal conduit is reported...
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