IN SINGLE KIDNEY
PAUL F. SCHELLHAMMER, From the Department Norfolk, Virginia
AND RENAL CELL
and transitional - A case is presented of synchronous occurrence ofrenal adenocarcinomu cell carcinoma of the renal pelvis in the same kidney. Review of the English literature revealed this to be a unique coincidence.
Renal tumors constitute 2 per cent of all neoplasms appearing in the United States population yearly and are responsible for 2 per cent of yearly deaths from carcinoma, an incidence of 4 deaths per 100,000 popu1ation.l Approximately 85 per cent of renal tumors are renotubular adenocarcinema, 15 per cent transitional cell carcinoma, and less than 1 per cent sarcoma. Simultaneous occurrence of renal cell carcinoma and transitional cell carcinoma of the ipsilateral ureter is unusual but has been described.2’3 Synchronous discovery of renal adenocarcinoma and transitional cell carcinoma of the renal pelvis in the same kidney must also be rare since review of the English literature revealed no examples. Case Report A fifty-eight-year-old white male was seen in March, 1975, with a history of gross hematuria of one year’s duration. He had been investigated at another hospital at which time intravenous pyelogram and cystoscopy revealed no abnormality. He had passed a small calculus fifteen years prior to this episode of hematuria. Painless hematuria occurred several times over the ensuing year. On admission to our institution, results ofphysical examination and serum chemistries were within normal limits. Urine analysis revealed microhematuria. Intravenous pyelogram suggested a filling defect in the left lower pole calyx which was well demonstrated on retrograde pyelogram (Fig. 1). Cystoscopy was normal;
FIGURE 1. Large filling defect occupying lower pole calyx and portion of pelvis as demonstrated by retrograde pyelography.
cytology was inconclusive (Class III cells suspicious for malignancy). Arteriogram revealed no distinct abnormalities of the vessels other than a perfusion defect along the lateral border of the kidney (Fig. 2). This was believed to be a cyst.
FIGURE 2. (A) Left selective renal arteriogram revealing normal vascular pattern with exception of area of decreased profusion along lateral aspect of lower pole of kidney. (B) Nephrogram phase following arteriogram demonstrating perfusion defect and loss of smooth ren ,a1t:on:touw-a!lon,g later.a1 101WH PC71e. dm .
At exploration the kidney was exposed and a small pyelotomy performed to confirm the presence of a neoplasm anti to determine if a narrowbased stalk was preseni. which might allow local excision and conservation of the kidneye4 The tumor appeared broad-base and, therefore, a radical nephroureterectomy with lymphadenectomy was performed. The patient’s postoperative course was benign. Microscopic examination revealed a Grade I transitional cell carcinoma of the pelvis and lower pole calyx without evidence of invasion. The area of decreased parenchymal perfusion seen on the preoperative arteriogram proved to represent a (Fig. 3). small 1.5 by 1.5 cm. adenocarcinoma There was no evidence of tumor invasion through the renal capsule or in the lymph nodes. The patient was discharged to be followed by routine interval cystoscopy, pyelography, and cytology in anticipation that further urothelial tumors will occur.5 Norfolk, Virginia 23507 (DR. SCHELLHAMMER) References
FIG URE 3.
Sagittal section of kidney after dissection n Gerota’s fascia and perirenal fat and fixation in malin, illustrating pelvic and lower pole infundibuneoplasm adjacent to small renal cortical adenocarpma.
1. American Cancer Society, Inc., ‘75 Cancer Facts & Figures, 1974, p. 10. 2. WILENIUS, R., and MATTILA, K.: Simultaneous occurrence of renal adenocarcinoma and primary transitional cell carcinoma of the ureter, Ann. Chir. Gynaecol. Fenn. 59: 108 (1970). 3. RICHARDSON, E.J.,and WOODBURN, R. L.: Dissimilar primary tumors in the right upper urinary tract, J. Urol. 90: 253 (1963). 4. PETKOVIC, S. D.: Plea for conservative operation for ureteral tumors, ibid. 107: 220 (1972). 5. GRABSTALD, H., WHITMORE, W. F., JR., and MELAMED, M. R.: Renal pelvic tumor, J.A.M.A. 218: 845 (1971).