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“BEHIND THE SCENE”
A RARE BORDERLINE MUCINOUS TUMOR OF RENAL PELVOCALYCEAL
AREA AND URETER PRESENTING AS PYELONEPHROSIS WITH
NEPHROLITHIASIS
More often than not, things are more than meets the eye and we need
to take a closer look.
OBJECTIVES:
• To present a rare case of tumor occurring in the pelvocalyceal area
and ureter presenting as pyelonephrosis with nephrolithiasis

• To present the classic clinical presentation, the dilemmas in radiologic


and histopathologic diagnosis and management of such case
Background of the Case

Cancer of the kidney amounts to 2% of the total human cancer


burden while tumors of the ureter and renal pelvis account for 8% of all
urinary tract neoplasms with incidence of 0.7 to 1.1 per 100,000.

World Health Organization Classification of Tumors. Pathology and Genetics of Tumours of the Urinary System and Male
Genital Organs, 9, 150. 69008 Lyon, France: International Agency for Research on Cancer (IARC) (2004).
Background of the Case
• Neoplasm in the renal pelvis and ureter
• transitional cell carcinoma of 85-90%,
• squamous cell carcinoma of 10-15 %
• adenocarcinoma of less than 1 %
• tubulovillous
• papillary non-intestinal categories
• signet ring type
• mucinous
• benign mucinous cystadenoma,
• mucinous borderline tumor and
• mucinous cystadenocarcinoma

Primary mucinous adenocarcinoma of the renal pelvis with carcinoma in situ in the ureter. Journal of the egyptian national cancer institute
(2013)
Rosai and Ackerman's Surgical Pathology, 10th Edition. Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto: Elsevier Inc.,
Volume 1, Chapter 17, 1274 (2011)
Background of the Case
• 2 published journals in 2009: 5 benign, 3 borderline and 4 – 5
malignant cases

• 2 published journals in 2015: 100 reported cases of primary mucinous


adenocarcinoma

Pseudomyxoma Peritonei Associated with Primary Mucinous Borderline Tumor of the Renal Pelvicalyceal System. Arch Pathol Lab Med, 1472-1476 (2009).
Primary Mucinous Cystadenocarcinoma of Renal Pelvis: A Case Report. BioMed Central Ltd (2009).
Primary Mucinous Cystadenocarcinoma of the renal pelvis misdiagnosed as ureteropelvic junction stenosis with renal pelvis stone: A Case Reporrt and
Literature Review. World Journal of Surgical Oncology (2015).
Primary Adenocarcinoma of the Renal Pelvis, Ureter and the Urinary Bladder: A case report and review of the literature. Oncology Letters (2015).
This paper herein presents the
only reported case of
Primary Borderline Muinous Tumor of the Renal
Pelvocalyceal Area and Ureter in Baguio General Hospital
and Medical Center
The Case
• P.B.
• 53 year old male
• Filipino, Roman Catholic
• Born on January 28, 1963 in Urdaneta City, Pangasinan
• Admitted for the first time in this institution with a chief complaint of
palpable abdominal mass on the left upper quadrant
HPI
• 5 months PTC
• Dysuria without other associated symptoms
• Treat as UTI (Co-amoxiclav and Sambong)
• Interval History
• Persistence of dysuria
• 5 days PTC
• Palpable abdominal mass on left upper quadrant
• Left flank pain radiating to the left lower quadrant
• Dysuria
• Consult to local hospital (ultrasound)
• OPD BGH-MC ----Admission
PMH
• Hypertension for 10 years
• Maintenance medication: Amlodipine 10 mg OD
• Others: unremarkable
Physical Exam
• Pertinent Abdominal Findings:
• globular abdomen, non-distended, with normoactive bowel sounds, no direct
and rebound tenderness. A palpable mass at the left upper quadrant was
noted which was firm, non-movable and dull on percussion

• Other Physical Examinations: UNREMARKABLE


Hospital Stay
• 1st hospital day: monitoring and work-up, scheduled for CT scan
• 2nd hospital day: underwent CT scan (insert CT scan result), control of blood
glucose (FBS: 128.47)
• 3rd hospital day:
• cardiopulmonary clearance
• Febrile episodes
• Abdominal pain
• Control of BP (160-250/ 100-130)
• Underwent Nephrectomy
• 4th and 5th hospital day: monitoring
• 6th: improved and discharged
CT scan Results
Results
• Gross Examination
Results
Microscopic Examination:
Histopathologic Diagnosis
CONSISTENT WITH A BORDERLINE MUCINOUS TUMOR, LEFT RENAL
PELVOCLAYCEAL AREA AND URETER;
CHRONIC PYELONEPHRITIS WITH DIFFUSE GLUMERULOSCLEROSIS,
HYDRONEPHROSIS AND NEPHROLITHIASIS, LEFT KIDNEY;
CHRONIC UTERITIS, LEFT URETER
Discussion
Conclusion and Recommendations
• Primary mucinous tumor of the pelvocalyceal area and ureter is an
exceedingly rare tumor. Borderline mucinous tumor among the three
spectrum is reported least frequent.

• As this tumor is not part of the WHO classification, guidelines are yet
to be established. This makes it prudent that all cases be reported for
future classification and establishment of guidelines.