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Year : 2010  |  Volume : 2  |  Issue : 1  |  Page : 42-43 Table of Contents     

Primary adenocarcinoma of ureter mimicking pyelonephritis

Government Medical College & Hospital, Chandigarh, India

Date of Submission25-Jun-2009
Date of Acceptance05-Aug-2009
Date of Web Publication30-Apr-2010

Correspondence Address:
Irneet Mundi
Department of Pathology, Government Medical College, Sarai Building, Sector-32A, Chandigarh - 160 030
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DOI: 10.4103/0974-7796.62914

PMID: 20842259

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Tumors of the ureter are rare. We present a case of primary mucinous adenocarcinoma of the ureter diagnosed as chronic pyelonephritis preoperatively. This tumor is postulated to arise from metaplastic glandular mucosa in response to chronic irritation of the urothelium.

Keywords: Adenocarcinoma, pyelonephritis, ureter

How to cite this article:
Punia R, Mundi I, Arora K, Dalal A, Mohan H. Primary adenocarcinoma of ureter mimicking pyelonephritis. Urol Ann 2010;2:42-3

How to cite this URL:
Punia R, Mundi I, Arora K, Dalal A, Mohan H. Primary adenocarcinoma of ureter mimicking pyelonephritis. Urol Ann [serial online] 2010 [cited 2021 Sep 22];2:42-3. Available from: https://www.urologyannals.com/text.asp?2010/2/1/42/62914

   Introduction Top

Primary adenocarcinoma of the renal pelvis and ureter is an extremely rare tumor, representing less than one per cent of all renal tumors. [1] A preoperative diagnosis is rarely made because the tumor is uncommon. We report a case of primary mucinous adenocarcinoma of the ureter.

   Case Report Top

A 40-year-old female presented to our hospital with a history of abdominal discomfort and right flank pain for one month. Physical examination was unremarkable. Results of routine hematological investigations were within normal limits. Urine examination showed presence of RBCs and pus cells. Ultrasonography revealed a contracted kidney and no mass was identified. Renal scan showed the kidney as non-functioning; a right nephrectomy was performed with a preoperative diagnosis of chronic pyelonephritis.

   Pathological Findings Top

On gross examination the kidney weighed 195 g and measured 11.5 Χ 6.8 Χ 6.5 cm. The capsule was intact and there was increase in perinephric fat. On cut section the pelvicalyceal system was dilated and renal parenchyma thinned out. No calculus was identified. The ureter measured 2.6 cm long with maximum diameter two cm. On cut section the lumen of the ureter was obliterated [Figure 1].

Microscopic examination showed a tumor arising from the ureter and extending into the renal pelvis [Figure 2]. The tumor was composed of mucin secreting tumor cells. Pools of mucin with floating tumor cells were noted [Figure 3]. Invasion was identified consisting of dissecting mucin containing malignant glandular epithelium. Mucin was highlighted by mucicarmine. The kidney showed changes of chronic pyelonephritis and a focal area showed presence of acute inflammatory exudate and yeast forms of candida.

   Discussion Top

Malignancies originating within the renal pelvis and ureter are uncommon. Most of them are transitional cell carcino­mas accounting for approximately 90% cases. Less common are squamous cell carcinomas accounting for less than 10% and rarest are primary adeno­carcinomas comprising only one percent. [1]

The postulated pathogenesis of adenocarcinoma is related to its frequent association with chronic irritation, inflammation, infection, hydronephrosis and urinary calculi. Glandular metaplasia of the urothelium that develops as a response to injury may progress to dysplasia and adenocarcinoma. [2] These tumors are subdivided into tubulovillous, mucinous, and papillary non-intestinal categories. The first two groups representing intestinal adenocarcinoma constitute 93% of cases. Mucinous adenocarcinoma has a bet­ter prognosis and occurs in elder patients, but the papillary non-intestinal variety occurs in younger individuals and is not necessarily associated with infection. [3]

Primary mucinous adenocarcinoma of the renal pelvis and ureter occurs in patients who are beyond middle age. [4] Patients are often asymptomatic. Hematuria is the most common presenting sign while loin pain and palpable abdominal mass signifies a late stage. Radiological studies may not be able to identify a malignant tumor. [2] Literature review reveals a high frequency of reporting this otherwise rare tumor in India and Japan and suggests an inflammatory, environmental or dietary etiology. [5],[6] A case of primary mucinous adenocarcinoma of the renal pelvis has been reported in our institution. The tumor had masqueraded as pyonephrosis clinically and was diagnosed on histopathologic examination. [7]

A preoperative diagnosis of ureteric adenocarcinoma is difficult to achieve. Most cases are diagnosed from the resected specimen postoperatively. The treatment is nephrectomy with ureterectomy. Although it is uncommon, the possibility of this tumor should be kept in mind, especially in patients with a renal stone accompanied by hydronephrosis and chronic inflammation. Japan (12) and India (10) have reported the highest number of cases of primary adenocarcinoma of ureter and pelvis while other parts of the world have reported occasional cases. There is need for further research to understand why this carcinoma is more common in these countries than other parts of the world.

   References Top

1.Spires SE, Banks ER, Cibull ML, Munch L, Delworth M, Alexander NJ. Adenocarcinoma of renal pelvis. Arch Pathol Lab Med 1993;117:1156-60.  Back to cited text no. 1  [PUBMED]    
2.Kaur G, Naik VR, Rahman MN. Mucinous adenocarcinoma of the renal pelvis associated with lithiasis and chronic gout. Singapore Med J 2004;45:125-6.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]  
3.Kundu AK, Giri A, Kaviraj SP. Primary adenocarcinoma of renal pelvis and ureter: report of three cases. Indian J Urol 2002;18:160-3.  Back to cited text no. 3    Medknow Journal  
4.Huang KH, Lee WC, Chang SC, Lin BH, Chi HS. Primary mucinous adenocarcinoma of the renal pelvis: A case report. JTUA 2004;15:75-8.  Back to cited text no. 4      
5.Terris MK, Anderson RU. Mucinous adenocarcinoma of the renal pelvis in natives of India. Urol Int 1997;58:121-3.   Back to cited text no. 5  [PUBMED]    
6.Zennami K, Yamada Y, Nakamura K, Katuda R, Tobiume M, Naruse K, et al. Primary adenocarcinoma of the ureter: Report of a case. (Hinyokika Kiyo) Acta urologica Japonica 2007;53:645-8.  Back to cited text no. 6  [PUBMED]    
7.Bal A, Aulakh R, Mohan H, Bawa AS. Mucinous adenocarcinoma of the renal pelvis presenting as pyonephrosis: A case report. Indian J Pathol Microbiol 2007;50:336-7.  Back to cited text no. 7  [PUBMED]    


  [Figure 1], [Figure 2], [Figure 3]

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Urology. 2013; 81(6): e40
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