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Title Inverted Papilloma of the Renal Pelvis Associated with Renal Cell Inverted papilloma of the renal pelvis associated with renal cell Title carcinoma: a case report Ueda, Takeshi; Akimoto, Susumu; Shimazaki, Jun; Matsuzaki, Author(s) Masaru; Nagao, Kouichi Citation 泌尿器科紀要 (1992), 38(5): 561-563 Issue Date 1992-05 URL http://hdl.handle.net/2433/117552 Right Type Departmental Bulletin Paper Textversion publisher Kyoto University Acta Urol. Jpn. 38: 561-563, 1992 561 INVERTED PAPILLOMA OF THE RENAL PELVIS ASSOCIATED WITH RENAL CELL CARCINOMA: A CASE REPORT Takeshi U eda, Susumu Akimoto, J un Shimazaki, Masaru Matsuzaki* and Kouichi Nagao* From the Department of Urology, School of Medicine, Chiba University and Pathology, School of Medicine, Teikyo University, Ichihara Hospital Twenty-one cases of inverted papilloma of the renal pelvis have been described in the litera­ ture. A 71-year-old man was admitted to our hospital to examine a right renal mass. We diagnosed a right renal tumor on the basis of the findings from excretory urogram (IVP), computerized tomog­ raphy (CT) and magnetic resonance imaging (MRI). Surgical material revealed an inverted pap­ illoma in the renal pelvis. We report on the first case of an invested papilloma of the renal pelvis associated with renal cell carcinoma. (Acta Uro!. Jpn. 38: 561-563, 1992) Key words: Inverted papilloma, Renal pelvis, Renal cell carcinoma this was again demonstrated by MRI. Se­ INTRODUCTION lective arteriography showed a marked Since Potts!) reported the first case of an neovascularity in the identical portion of inverted papilloma of the urinary bladder, the kidney as mentioned above we diag­ more than 200 cases have been reported. nosed a right renal tumor. Mainly, inverted papilloma occurs in the Right nephrectomy was performed in region of the urinary trigone, bladder neck September, 1989. The weight of the right and prostatic urethra. They have been kidney was 530 g and the size was 15.0 x rarely found in the upper urinary tract. ro.O x 6.5 cm. There were two distinct Inverted papilloma is recognized as a be­ tumors in the upper portion of the kidney, nign tumor, because only 2 cases of recur­ which measured 4.0 x 5.0 x 3.0 cm and 3.5 x rence have been recorded2,3). However, a 4.0 x 3.0 cm. Another grey-colored solid few cases revealed malignant formation4 ,5) tumor, 4.0 x 2.5 x 1.0 cm, was observed in the and the coexistence of transitional cell renal pelvis (Fig. 1). Histological slides carcinoma2,6-S) We report a case of an with hematoxylin-eosin staining demon­ inverted papilloma of the renal pelvis asso­ strated that both renal tumors in the upper ciated with renal cell carcinoma. portion of the kidney were occupied by cells having a clear cytoplasm and small CASE REPORT nucleus. Pathological diagnosis was a re­ A 71-year-old man was admitted to our nal cell carcinoma, pT2NOMO. Pathologi­ hospital for examination of a renal mass cal diagnosis of the renal pelvic tumor was that was incidentally discovered by ultra­ an inverted papilloma demonstrating con­ sonography (US) during screening of the servation of the epithelial cells, seven or upper abdomen. The patient had no other eight layers of cells with no cellular dys­ urological symptoms. US demonstrated a plasia (Fig. 2). low echoic lesion of the right kidney. The postoperative course was without Cystoscopy showed a normal urothelium. any complications, and the patient has been IVP revealed distortion of the right renal receiving medication with anti-cancer drugs. pelvis. CT scan demonstrated a mass in Follow-up observation for 21 months has the upper portion of the right kidney, and shown no evidence of recurrence. 562 Acta Urol. jpn. Vol. 38, No.5, 1992 of the tumor5,12,13) One was found at autopsyl4) . The nature of inverted papilloma is con­ sidered to be that of a benign tumor. However, even if a pelvic tumor can be examined by biopsy under ureteroscopy, it is difficult to conclude that the tumor is an inverted papilloma. A biopsy specimen alone is not sufficient for distinguishing an inverted papilloma from an inverted type transitional cell carcinoma (Tee) or a combination of an inverted papilloma and Tee. There have been two reports of recurrent inverted papilloma2,3). In addi­ Fig. I. Gross specimen shows two yellowish tion there have been nine cases of inverted tumors of the upper portion and a grey­ papilloma with concomitant urothelial can­ colored tumor of the renal pelvis (ar­ 3 7 rows). cer - ,l5). These cases had malignant uro­ thelial lesions at sites independent from the inverted papilloma, but in four4- 6,15) of them carcinomas also occurred in the same lesion as the inverted papilloma. In the ;;.. present case, inverted papilloma of the renal pelvis seems to be associated with re­ nal cell carcinoma by coincidence. In any event, until now there has been no report on the coexistence of an inverted papillo­ ma of the renal pel vis and renal cell car­ cinomas. Silversteinl5) previously reported a pa­ Fig. 2. Microscopic examinations show typical tient with inverted papilloma of the left features of inverted papilloma (right. ureter after right nephrectomy for right H&E, x 25), and renal cell carcinoma renal cell carcinoma. Grainger8) demon­ with clear cytoplasm and small nucleus (left. H&E, x50). strated urothelial carcinoma in a portion of the ureteral inverted papilloma coexisting with a small renal cell carcinoma. We DISCUSSION report the first case of an inverted papil­ loma of the renal pelvis associated with More than fifty cases of inverted papillo­ renal cell carcinoma. ma of the upper urinary tract have been reported previously. Since Martz9) reported REFERENCES the first case in 1974, 22 cases including 1) Potts IF and Hirst E: Inverted papilloma ours have been identified in the renal pel­ of the bladder. j Urol 90: 175-176, 1963 VIS. Most of them had gross hematuria 2) Demeester Lj, Farrow GM and Utz DC: In­ with or without flank pain. Our case had verted papillomas of the urinary bladder. no urological symptoms and the renal Cancer 36 : 505-513, 1975 pelvic tumor was incidentally discovered at 3) Schultz RE and Boyle DE: Inverted papillo­ nephrectomy. An inverted papilloma of the ma of renal pelvis associated with contrate· renal pelvis is usually diagnosed after surgi­ ral ureteral malignancy and bladder recur­ rence . .J Urol 139: 111-113, 1988 cal treatment for a renal pelvic tumor. 5) Uyama T and Moriwaki S : Inverted papil­ Therefore, 11 of the 22 the cases underwent loma with malignant change of renal pelvis. nephroureterectomy. Six of the other cases Urology 17: 200-201, 1981 had either nephrectomylo,ll) or resection 5) Lausten GS, Anagnoataki L and Thomsen Ueda, et al.: Inverted papilloma of the renal pelvis 563 OF: Inverted papilloma of the upper urina- 1981 ry tract. Eur Urol 10: 67-70, 1984 16) Cameron KM and Lupton CH: Inverted pa- 6) Lazarevic B and Garret R : Inverted papil- pilloma of the lower urinary tract. Br J loma and papillary transitional cell carcino- Urol 48: 567-577, 1976 ma of urinary bladder report of four cases 17) Palvo DHB: Inverted papilloma of the uri- of inverted papilloma, one showing papillary nary tract. Scand J Urol Nephrol 19: 299- malignant transformation and review of the 302, 1985 literature. Cancer 42: 1904-1907, 1978 18) Watters G, Grant A, Wiley S, et al.: Invert- 7) Anderstrom C, Johanson S and Pettersson ed papilloma of the upper urinary tract. Br S: Inverted papilloma of the urinary tract. J Urol 55: 176-179, 1983 J Urol 127: 1132-1134, 1982 19) Aubert J, Dore B, Villemonteix P, et al. 8) Grainger R, Gikas GP and Grossman NB: Inverted papilloma of upper urinary tract. Urothelial carcinoma occurring with an in- Eur Urol 15: 150-152, 1988 verted papilloma of the ureter. J Urol 143: 20) Bassi P, Piazza R, Aragona F, et al.w Invert- 802-804, 1990 ed papilloma of the pelvis. Urol Int 46: 9) Matz LR, Wishart VA and Goodman MA: 73-76, 1991 Inverted urothelial papilloma. Pathology 6: 21) Arrufat JM, Vera-Roman JM, Casas V, et 37-44, 1974 al.: Papilloma invertido de ureter. Acta 10) Assor D: Inverted papilloma of the renal Urol Esp 7: 225-228, 1983 pelvis. J Urol 116: 654, 1976 22) Kunze E, Schauer A and Schmitt M: Histol- 11) Theoret G, Paquin F, Schick E, et al. In- ogy and histogenesis of two different types verted papilloma of urinary tract. Urology of inverted urothelial papillomas. Cancer 16: 149-151, 1980 51: 348-358, 1983 12) Schulze S, Holm-Nielsen A and Ravn V : 23) Taylor FM and Arroyo JG: Inverted papil- Inverted papilloma of upper urinary tract. loma of the renal pelvis: Cytologic features Urology 28: 58-61, 1986 of ureteral washings. Acta Cytol 30: 166- 13) Yamaguchi K, Yanagi S, Ito H, et al. : In- 168, 1986 verted papilloma of renal pelvis associated 24) Kyriakos M and Royce RK: Multiple simul- with transitional cell carcinoma of the blad- taneous papillomas of the upper urinary der. Urol Int 43: 302-304, 1988 tract: A case report with a review and renal 14) Stower MJ, Maciver AG, Gingell JC, et al.: pelvic inverted papillomas. Cancer 63: 386- Inverted papilloma of the ureter with ma- 380, 1989 lignant change. Br J Urol 65: 13-16, 1990 (Received on August 12, 1991 15) Silverstein SV and Carlton CE: Inverted Accepted on December 11, 1991) papilloma of ureter. Urology 17: 160-162, 和文抄録 腎 細 胞 癌 に 合 併 した 腎盂Invertedpapillomaの1例 千葉大学医学部泌尿器科学教室(主 任:島 崎 淳教授) 植 田 健*,秋 元 晋,島 崎 淳 帝京大学市原病院病理学教室(主 任 ・長尾孝一教授) 松 嵜 理**,長 尾 孝 一 腎腫 瘤 の精 査 目的 に て来 院 した71歳 男性.IVP, た.病 理 所 見 は,腎 細 胞 癌 と腎 孟invertcdpapillo- CT,MRIに て右 腎 腫 瘍 と診 断 し右 腎摘 出 術施 行 し maと の 合 併 で あ っ た.腎 孟invertedpapillomaに つ い て 若 干 の 文 献 的 考 察 を 加 え て 報 告 した.
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