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Squamous Cell Carcinoma and Calculi in Ureteral Stump: 12 Years Post-Nephrectomy
Vol. 99, lliar. Printed in U.8.A..
THE JOURNAL OF l;ROLOGY
Copyright © 1968 by The Williams & Wilkins Co.
SQUAMOUS CELL CARCINOMA AND CALCULI IN URETERAL STUMP: 12 YEARS POST-NEPHRECTOJ'vIY IBRAHIM T. SOZER From the Department of Urology, S.S. K. Nishantashi Hospital, Istanbul, Turkey
Tumors of the ureter were formerly regarded as rare but are now reported in increasing numbers. In 1930 Rousselot and Lamon found only 50 reported cases of ureteral tumors,1 but, within the next 20 years, more than 200 cases were reported. 2 This increase in case reports is explained by the development of more adequate methods in modern urology. In the case herein reported, squamous cell carcinoma of the ureter originated in the proximal end of a 7-inch long ureteral stump which contained 2 calculi. Previously, two similar cases were reported, but neither patient had a stone. 3 • 4
utes and 64 mm. in 1 hour. The urine showed a specific gravity of 1.020 and many red blood cells. A culture of urine grew Escherichia coli and Aerobacter aerogenes. A Papanicolaou study of the urine was positive.
CASE REPORT
:Mrs. S. D., No. 346, aged 46, had had persistent pyuria for several years, and painless hematuria for a week. Approximately 12 years prior to the current hospitalization, the patient had undergone a left nephrectomy for calculous pyelonephritis and hydronephrosis. Postoperatively, she was asymptomatic except for the pyuria. The patient was in good general condition; her blood pressure was 142/80 and her pulse rate was 80 per minute. On examination, the right kidney was not palpated. A well-healed operative scar was seen on the left lmnbar region. The ureteral point on the left lower quadrant was fairly tender. Blood urea nitrogen was 20 mg. per 100 ml.; blood sugar, 90 mg. per 100 ml.; hemoglobin level, 12 mg. per 100 ml. and the white blood count was 7,600 cu. mm. with a normal differential. The serum electrolytes were in normal limits. The sedimentation rate was 25 mm. in 30 min-
Fm. 1. Excretory mogram shows normal functioning right kidney and 2 opacities on left lumbar area.
Accepted for publication July 21, 1967. 1 Rousselot, L. M. and Lamon, J. D.: Primary carcinoma of the ureter: Report of a case and review of the literature. Surg., Gynec. & Obst., 50: 17, 1930. 2 Baron, A. and Green, J. A. S.: Primary carcinoma of the ureter. Brit. J. Surg., 41: 576, 1954. 3 Amar, A. D.: Squamous cell carcinoma of ureteral stump 40 years after nephrectomy. J. Urol., 91: 337, 1964. 4 Loef, J. A. and Casella, P. A.: Squamous cell carcinoma occurring in the stump of a chronically infected ureter many years after nephrectomy. J. Urol., 67: 159, 1952.
An excretory urogram showed a normal functioning right kidney with 2 opacities in the left lumbar area (fig. 1). Cystoscopically, the right ureteral orifice appeared normal; the left ureteral orifice was enlarged and surrounded by an area of marked edema. Pressure on the left lower quadrant revea.led oozing blood from the left ureteral orifice. Operative exploration of the left lumbar region 264
CAHC'INOJJA AND CALCULI l)f URETEHAL STU'\H"
Fw. 2. Photomicrographs. A, XlOO. B, X450
revealed a. slightly adherent 7-inch-long ureteral stmnp which contained 2 calculi in its proximal portion . Under great care, the ureteral stump and the left side of the trigone were excised. The upper portion of the ureter was moderately hard in conOn dissection 2 8mall ~tones were seen beside the firm, whitish-grey tumoral area of the proximal portion of the ureteral stump. examination revealed that the Lumoral area ,vas composed of polygonal epithelial cells, often with abundant cytoplasm and intercellular The nuclei were usually pleomorphic and often vesicular, with nucleoli (fig. 2). Keratinization and formation were seen in most areas of the well-differentiated tumor. The diagnosis was squamous cell carcinoma of the ureter. Convalescence was satisfactory and the patient was discharged from the hospital 3 weeks postopera. A ccnuse of radiotherapy was started.
which encircle the ureter. Among 183 cases non-papillary ureteral tumors, including squamous cell carcinomas, approximately 17 Ji per cent were associated with calculi. 0 Xumerous theories are mentioned about the etiology of ureteral tumors: 1) local (inflamma.tion and calculi), 2) rests, 3) leukoplakia, 4) endogenous 5) exogenous chemicals, 6) The genesis of squamous cell carcinomas is similar that of transitional eell carcinomas. The role oi chronic infection in the of sciuamous cdl carcinoma of the ureteral stump was described Loef and Casella. 4 In the case herein reported, ,Ye believe that chronic infection and calculi (local irritants) were the main etiologic facton, vVhen a nephrectorny is done, we believe that much as possible of the ureter should be ,.""""'"", this could prevent late complications .
DISCUSSIOK
SUMMARY
J\Ialignant uretera.l tumors are anrnng the most malignant tumor~ of the urinary tract. The incidence of squamous cell carcinoma, when comto tra1rnitional cell carcinoma, is approxi1 to 7, 5 :VIacroscopically, squamous cell carcinomas are non-papillary infiltrating tumors 5 Lucke, B. and Schlumberger, H. G.: Tumors
Squan10us cell carcinoma developed in a ureteral stump, 12 years following nephrectorny for nephrolithiasis and hydronephrnsis. In addition to the carcinoma, 2 stones were found in the ureteral stump. vV r, could not find a similar ca-;c reported in the literature.
of the kidney, renal pelvis and ureter. In: Atlas of Tnmor Pathology. Washington: Armed Forces Institnte of Pathology sec. 1'III, fasc. :30, p. 188, 1957.
6 Lazarus .J. A. and J\farks, M. S.: carcinoma the ureter with special reference hydronephrosis. Review of literature and report of an unusual case. J. lJroL, 54: 140, Hl45,
,;f
THE JOURNAL OF l;ROLOGY
Copyright © 1968 by The Williams & Wilkins Co.
SQUAMOUS CELL CARCINOMA AND CALCULI IN URETERAL STUMP: 12 YEARS POST-NEPHRECTOJ'vIY IBRAHIM T. SOZER From the Department of Urology, S.S. K. Nishantashi Hospital, Istanbul, Turkey
Tumors of the ureter were formerly regarded as rare but are now reported in increasing numbers. In 1930 Rousselot and Lamon found only 50 reported cases of ureteral tumors,1 but, within the next 20 years, more than 200 cases were reported. 2 This increase in case reports is explained by the development of more adequate methods in modern urology. In the case herein reported, squamous cell carcinoma of the ureter originated in the proximal end of a 7-inch long ureteral stump which contained 2 calculi. Previously, two similar cases were reported, but neither patient had a stone. 3 • 4
utes and 64 mm. in 1 hour. The urine showed a specific gravity of 1.020 and many red blood cells. A culture of urine grew Escherichia coli and Aerobacter aerogenes. A Papanicolaou study of the urine was positive.
CASE REPORT
:Mrs. S. D., No. 346, aged 46, had had persistent pyuria for several years, and painless hematuria for a week. Approximately 12 years prior to the current hospitalization, the patient had undergone a left nephrectomy for calculous pyelonephritis and hydronephrosis. Postoperatively, she was asymptomatic except for the pyuria. The patient was in good general condition; her blood pressure was 142/80 and her pulse rate was 80 per minute. On examination, the right kidney was not palpated. A well-healed operative scar was seen on the left lmnbar region. The ureteral point on the left lower quadrant was fairly tender. Blood urea nitrogen was 20 mg. per 100 ml.; blood sugar, 90 mg. per 100 ml.; hemoglobin level, 12 mg. per 100 ml. and the white blood count was 7,600 cu. mm. with a normal differential. The serum electrolytes were in normal limits. The sedimentation rate was 25 mm. in 30 min-
Fm. 1. Excretory mogram shows normal functioning right kidney and 2 opacities on left lumbar area.
Accepted for publication July 21, 1967. 1 Rousselot, L. M. and Lamon, J. D.: Primary carcinoma of the ureter: Report of a case and review of the literature. Surg., Gynec. & Obst., 50: 17, 1930. 2 Baron, A. and Green, J. A. S.: Primary carcinoma of the ureter. Brit. J. Surg., 41: 576, 1954. 3 Amar, A. D.: Squamous cell carcinoma of ureteral stump 40 years after nephrectomy. J. Urol., 91: 337, 1964. 4 Loef, J. A. and Casella, P. A.: Squamous cell carcinoma occurring in the stump of a chronically infected ureter many years after nephrectomy. J. Urol., 67: 159, 1952.
An excretory urogram showed a normal functioning right kidney with 2 opacities in the left lumbar area (fig. 1). Cystoscopically, the right ureteral orifice appeared normal; the left ureteral orifice was enlarged and surrounded by an area of marked edema. Pressure on the left lower quadrant revea.led oozing blood from the left ureteral orifice. Operative exploration of the left lumbar region 264
CAHC'INOJJA AND CALCULI l)f URETEHAL STU'\H"
Fw. 2. Photomicrographs. A, XlOO. B, X450
revealed a. slightly adherent 7-inch-long ureteral stmnp which contained 2 calculi in its proximal portion . Under great care, the ureteral stump and the left side of the trigone were excised. The upper portion of the ureter was moderately hard in conOn dissection 2 8mall ~tones were seen beside the firm, whitish-grey tumoral area of the proximal portion of the ureteral stump. examination revealed that the Lumoral area ,vas composed of polygonal epithelial cells, often with abundant cytoplasm and intercellular The nuclei were usually pleomorphic and often vesicular, with nucleoli (fig. 2). Keratinization and formation were seen in most areas of the well-differentiated tumor. The diagnosis was squamous cell carcinoma of the ureter. Convalescence was satisfactory and the patient was discharged from the hospital 3 weeks postopera. A ccnuse of radiotherapy was started.
which encircle the ureter. Among 183 cases non-papillary ureteral tumors, including squamous cell carcinomas, approximately 17 Ji per cent were associated with calculi. 0 Xumerous theories are mentioned about the etiology of ureteral tumors: 1) local (inflamma.tion and calculi), 2) rests, 3) leukoplakia, 4) endogenous 5) exogenous chemicals, 6) The genesis of squamous cell carcinomas is similar that of transitional eell carcinomas. The role oi chronic infection in the of sciuamous cdl carcinoma of the ureteral stump was described Loef and Casella. 4 In the case herein reported, ,Ye believe that chronic infection and calculi (local irritants) were the main etiologic facton, vVhen a nephrectorny is done, we believe that much as possible of the ureter should be ,.""""'"", this could prevent late complications .
DISCUSSIOK
SUMMARY
J\Ialignant uretera.l tumors are anrnng the most malignant tumor~ of the urinary tract. The incidence of squamous cell carcinoma, when comto tra1rnitional cell carcinoma, is approxi1 to 7, 5 :VIacroscopically, squamous cell carcinomas are non-papillary infiltrating tumors 5 Lucke, B. and Schlumberger, H. G.: Tumors
Squan10us cell carcinoma developed in a ureteral stump, 12 years following nephrectorny for nephrolithiasis and hydronephrnsis. In addition to the carcinoma, 2 stones were found in the ureteral stump. vV r, could not find a similar ca-;c reported in the literature.
of the kidney, renal pelvis and ureter. In: Atlas of Tnmor Pathology. Washington: Armed Forces Institnte of Pathology sec. 1'III, fasc. :30, p. 188, 1957.
6 Lazarus .J. A. and J\farks, M. S.: carcinoma the ureter with special reference hydronephrosis. Review of literature and report of an unusual case. J. lJroL, 54: 140, Hl45,
,;f