Primary Mucinous Adenocarcinoma of Renal Pelvis- A Diagnostic Dilemma

Tewani Vipin *

Wenlock District Hospital, Mangalore, Karnataka, India.

Sadanand Poojary

Department of Urology, Wenlock District Hospital, Mangalore, Karnataka, India.

Mohan Chandra Suvarna

Department of Urology, Wenlock District Hospital, Mangalore, Karnataka, India.

Ranjith Shetty

Department of Urology, KMC, Mangalore, Karnataka, India.

S. A. Deepa Adiga

Department of Pathology, Kasturba Medical College, Mangalore, Karnataka, India.

Abhishek Gawri

Wenlock District Hospital, Mangalore, Karnataka, India.

*Author to whom correspondence should be addressed.


Abstract

Introduction: Primary mucinous adenocarcinoma of the renal pelvis is extremely rare, with only ~100 cases reported till now. Its pathophysiology is thought to comprise glandular metaplasia of the urothelium of the calyces and pelvis, as well as malignant transformation of the metaplasia. Unfortunately, there are no distinguishing symptoms or radiological characteristics.

Case Presentation: A 75-year-old man presented with pain in his left flank and intermittent fever. A physical examination showed swelling in left flank on inspection which was soft, non-tender, and ballotable with no local rise of temperature. The results of most laboratory tests were within normal limits. Plain radiography of the kidneys, ureter, and urinary bladder showed a large radio-opaque mass in the left kidney. Abdominal computed tomography showed left kidney measuring 24.8 x 12.4 cm with gross hydronephrosis with severe cortical thinning with large calculus of 2.7 X 3.1 x3.6cm in left pelviureteric junction. Diuretic- enhanced 99mTc DTPA renal scanning showed that the relative function of the left versus the right kidney was 11.19 versus 88.81 %. On the basis of the imaging findings, kidney dysfunction due to ureteropelvic junction stenosis with a large stone was initially diagnosed.

Although the cytopathology of gelatinous material was negative for malignancy, we could not rule out other disease, such as hidden malignancies of the kidney. As a result, we did a radical nephrectomy, and pathological investigation of the kidney revealed a mucinous adenocarcinoma in the renal pelvis. A bone scan and positron emission tomography revealed no additional malignancies, metastases, or remnant cancer.

Conclusions: Primary mucinous adenocarcinomas of the renal pelvis are extremely rare, and the majority are discovered by post-operative examination of resected specimens. Despite the difficulty of preoperative diagnosis, urologists should evaluate the possibility of primary mucinous adenocarcinoma in patients with severe hydronephrosis, renal stones, and chronic inflammation.

Keywords: Mucinous adenocarcinoma, metaplasia, pathophysiology


How to Cite

Vipin , Tewani, Sadanand Poojary, Mohan Chandra Suvarna, Ranjith Shetty, S. A. Deepa Adiga, and Abhishek Gawri. 2023. “Primary Mucinous Adenocarcinoma of Renal Pelvis- A Diagnostic Dilemma”. Asian Journal of Research and Reports in Urology 6 (1):76-81. https://journalajrru.com/index.php/AJRRU/article/view/95.

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References

Han DS, Yuk SM, Youn CS, Park G, Sul HJ, Jang H. Primary mucinous cystadenocarcinoma of the renal pelvis misdiagnosed as ureteropelvic junction stenosis with renal pelvis stone: A case report and literature review. World Journal of Surgical Oncology. 2015;13(1):1-5.

Julian W, Kana A, Lee W. Primary mucinous adenocarcinoma of renal pelvis in Solitary pelvic kidney. Urology 1993; 41:292e4.

Joshi K, Jain K, Mathur S, Mehrotra G. Mucinous adenocarcinoma of the renal Pelvis. Postgrad Med J. 1980;56:442e4.

Chen CC, Kuo CL, Lin MS, Hsieh HL, Lin TC, Wu JCH. Mucinous adenocarcinoma of the renal pelvis: An analysis of 5 cases. JTUA. 2007;18:219e24.

Huang KH, Lee WC, Chang SC, Lin BH, Chi HS. Primary mucinous adenocarcinoma of the renal pelvis: A case report. JTUA. 2004;15:75e7.

Mehdi F, Afshin M, Kazem M. Primary mucinous cystadenocarcinoma of renal pelvis: A case report. Cases J. 2009;2:93e5.

Harlan A, Thomas D, William T. Mucinous adenocarcinoma of renal pelvis. Urology. 1982;20:94e5.

Vinaya BS, Gayathri PA, Jaya RD, Hemant B. Mucinous adenocarcinoma of the renal pelvis with pseudomyxoma peritonei. Indian J Pathol Microbiol. 2008;51: 536e7.

Kaur G, Naik VR, Rahman MNG. Mucinous adenocarcinoma of the renal pelvis associated with lithiasis and chronic gout. Singapore Med J. 2004;45:125e6.

Kathryn JW, Margaret MS, Barry IS, Isaac RF. Squamous cell carcinoma of renal pelvis: Case report emphasizing sonographic and CT appearance. Urol Radiol. 1983;5:267e9.

Xu X, Shen W, Wang D, Li N, Huang Z, Sheng J, Rucker AJ, Mao W, Xu H, Cheng G. Clinical features and prognosis of resectable pulmonary primary invasive mucinous adenocarcinoma. Translational Lung Cancer Research. 2022;11(3):420.

Zeng H, Zhang M, Xie Y, Wang M, Dai J, Zhu X, Zeng Y, Xu N, Huang P, Zhao J, Sun G. Primary renal mucinous adenocarcinoma masquerading as a giant renal cyst: A case report. Frontiers in Oncology. 2023;13:1129680.