■原发性肾盂腺癌是一种罕见且独特的恶性肿瘤,代表一小部分肾癌,由于其不寻常的表现以及与更常见的排泄道疾病的症状相似,因此构成了重大的诊断挑战。该病例强调了将这种病理与起源于消化道的其他肾肿瘤和转移性腺癌区分开的重要性。
方法:我们报告了一例34岁无明显病史的男性患者,该患者表现出持续性下背部疼痛,但无血尿,这对肾脏病变是不典型的。初始成像确定右肾盂有30×14mm的增强肿块。通过右肾输尿管切除术进行手术干预,包括切除膀胱袖口.组织病理学检查证实诊断为原发性肠型肾盂腺癌,以坏死性癌增殖为特征,具有不同的结构模式和偶尔的印戒细胞。
■原发性肾盂腺癌的诊断因其非特异性症状和误诊为更常见的尿路上皮癌或转移性消化道来源腺癌而复杂化。免疫组织化学染色支持原发性而非转移性消化道起源。这一案例强调了全面诊断方法的必要性,包括先进的成像和细致的组织病理学分析,有效区分这种罕见的实体从其他肿瘤。
结论:该病例强调了诊断的复杂性和临床医生对罕见肾癌如原发性肾盂腺癌的认识的迫切需要。它还强调了跨学科合作在此类罕见病例的诊断和管理中的重要性,提高我们的认识,并要求及时和准确的治疗。
UNASSIGNED: Primary adenocarcinoma of the renal pelvis is a rare and unique malignancy, representing a small fraction of renal cancers and posing significant diagnostic challenges due to its unusual presentation and similarity in symptoms to more common excretory tract disorders. This
case emphasizes the importance of distinguishing this pathology from other renal neoplasms and metastatic adenocarcinomas that originate in the digestive tract.
METHODS: We report the
case of a 34-year-old man with no significant medical history who presented persistent lower back pain but no hematuria, which is atypical for renal pathologies. Initial imaging identified a 30 × 14 mm enhancement mass in the right renal pelvis. Surgical intervention was performed through right nephroureterectomy, including excision of the bladder cuff. Histopathological examination confirmed the diagnosis of primary intestinal-type adenocarcinoma of the renal pelvis, characterized by necrotic carcinomatous proliferation with varying architectural patterns and occasional signet ring cells.
UNASSIGNED: The diagnosis of primary renal pelvis adenocarcinoma is complicated by its nonspecific symptomatology and the potential for misdiagnosis as a more common urothelial carcinoma or a metastatic digestive-origin adenocarcinoma. Immunohistochemical staining supported a primary rather than metastatic digestive tract origin. This
case underscores the need for a comprehensive diagnostic approach, including advanced imaging and meticulous histopathological analysis, to effectively differentiate this rare entity from other neoplasms.
CONCLUSIONS: This
case highlights the diagnostic complexities and the critical need to be aware among clinicians about rare renal cancers such as primary adenocarcinoma of the renal pelvis. It also stresses the importance of interdisciplinary collaboration in the diagnosis and management of such rare cases, improving our understanding and requiring timely and accurate treatment.