219
CASE REPORTS
noid variants of prostatic carcinoma (Jelbart et al., 1988). However, only 50% of the patients with small cell undifferentiated carcinoma of the prostate (SCUCP) were associated with syndromes suggestive of ectopic ACTH. SCUCP has been reported to occur in 1 to 10% of prostatic carcinomas (Jelbart et al., 1988; Turbatt-Herrera et al., 1988) and closely resembles the morphological pattern seen in bronchogenic small cell undifferentiated carcinoma. However, not all of these tumours stain positively for the neuroendocrine markers (Ro et al., 1987). The initial presentation of SCUCP may be similar to that of prostatic adenocarcinoma. Unlike prostatic adenocarcinoma, it tends to metastasise early to liver, spleen and lung and to unusual sites such as omentum, vocal cord, axillary lymph nodes and periadrenal soft tissue (Tetu et al., 1987; Jelbart et al., 1988). In patients with this variant the clinical course has been aggressive, with a reported median survival of only 5 months (Tetu et al., 1987). SCUCP tends to respond well to chemotherapy (Hindson et al., 1985; Tetu et al., 1987) and therefore its recognition as a histopathological entity is of considerable importance. This condition is almost certainly underdiagnosed and in patients with rapidly progressive disease, or biochemical abnormalities consistent with hormone secretion, the possibility of SCUCP should be considered even if recent biopsies show adenocarcinoma only.
Spontaneous Rupture of Hydronephrotic Kidney during Pregnancy D. A. R. EL HALABI, M. S. HUMAYUN and J. M. SHARHAAN, Departments of Surgery and Obstetrics and Gynaecology, AlAdan Hospital, Kuwait
Rupture of the urinary tract during pregnancy is uncommon. Pyelonephritis, painful overdistension and rupture are occasional effects of pregnancy on the urinary tract. We present a case of spontaneous rupture of a hydronephrotic kidney in a pregnant woman.
Case Report
A 30-year-old Kuwaiti woman, mother of 8 children, was admitted to the Maternity Department on 5 December 1988 complaining of right flank pain, frequency of micturition and dysuria. Her general condition was satisfactory and she was 28 weeks pregnant. Examination revealed a tender mass in the right lumbar region and hypochondrium. Ultrasound showed hydronephrosis of the right kidney and a normal left kidney. Urine culture revealed Escherichiu coli and appropriate antibiotics were given. On 9 December the pain in the right hypochondrium suddenly intensified, spread over the abdomen and was associated with vomiting. On examination the BP was 80/50mmHg. The abdomen was distended with guarding and rebound tenderness. Bowel sounds were sluggish. The right flank mass could not be felt and no fetal heart sounds were elicited. Catheterisation showed frank haematuria. A provisional References diagnosis of internal bleeding was made. Hb was 104 g/ Hindson, D. A., Knight, L. L. and Ocker, J. M. (1985).Small cell 1; urea, creatinine and electrolytes were normal. Ultracarcinoma of the prostate. Transient complete remission with sound confirmed the intrauterine fetal death and showed chemotherapy. Urology, 26,182-184. a distorted right kidney with free fluid in the peritoneal Jelbart, M. E., Russell, P. J., Russell,P. e r d (1988).The biology and management of small cell undifferentiated carcinoma of cavity (Fig.). Artificial rupture of the membranes revealed clear fluid the prostate. In Textbook of Uncommon Cancer, ed. Williams, C. J., Krikorian, J. G . , Green M. R. et 01. Pp. 249-262. and laparotomy was performed. The peritoneal cavity Chichester : Wiley. contained about 300 ml of blood and there was a huge Ro, J. Y., Tetu, B., Ayala,A. G . e t d (1987).Small cell carcinoma retroperitoneal haematoma around the right kidney. A of the prostate. 11. Immunohistochemical and electron lower segment Caesarean section was done with delivery microscopic studies of 18 cases. Cancer, 59,977-982. of a dead fetus. Exploration of the right kidney showed Tetu, B., Ro, J. Y., Ayala, A. G. e t d (1987).Small cell carcinoma of the prostate part 1. A clinicopathologic study of 20 cases. rupture of the renal parenchyma at the upper pole, the pelvis being full of blood clots. Right nephrectomy was Cancer, 59,1803-1 809. Turbatt-Herrera, E. A., Herrera, G. A., Gore, I. er d (1988). performed. The patient made a good recovery. IntraNeuroendocrinedifferentiation in prostatic carcinomas. Arch. venous urography confirmed a normal left kidney. Pathol. Lab. Med., 112, llO(r1105. WHO (1982). The World Health Organisation histological Comment typing of lung tumors. Am. J. Clin. Pathol., 77, 123-136. Requests for reprints to: I. E. Smith, Department of Medicine, Royal Marsden Hospital, Fulham Road, London SW3 655.
Spontaneous rupture of the kidney is uncommon and until 1985 only 13 cases had been reported
220
BRITISH JOURNAL OF UROLOGY
Urethral Adenocarcinoma with High Levels of C A I 9-9 in Serum and Tumour Specimen N. M0RIYAMA.A. OKAZAWA, K.TOYAMA,T. KITAMURA, I. MURAHASHI, Y. A S 0 and K. MORIGUCHI, Departments of Urology. Branch Hospital. University of Tokyo and Nerima General Hospital, Tokyo, Japan
Case Report
Fig.
(Meyer et al., 1985). Non-traumatic rupture of the kidney during pregnancy may mimic a number of obstetric and surgical emergency situations. Dilatation of the urinary collecting system during pregnancy is well documented (Harrow et al., 1946) and the distended system is subject to changes in posture and increases in intra-abdominal pressure which predispose to rupture at points distorted by infection or scars. Rupture of the renal parenchyma usually tears the renal capsule; blood and urine enter the perirenal fat and produce a palpable mass in the flank. The blood and urine dissect along the fascia1 plane and produce an extensive retroperitoneal haematoma which may break through the peritoneum and lead to peritonitis. The blood may also enter the collecting system, producing haematuria.
A 61-year-old Japanese female with a 6-month history of gross haematuria was found to have diffuse urethral induration ( 5 x 3 x 3 cm) with a vaginal ulcer. The bilateral inguinal lymph nodes were swollen. Biopsies of the anterior vaginal wall and inguinal nodes showed adenocarcinoma. Computed tomography revealed tumour invasion to the bladder. Serum CA19-9 was 530 u/ml (normal level < 37 u/ml). She was referred to this hospital for pelvic exenteration and regional lymphadenectomy. The urethral surface was replaced by diffusely infiltrating tumour which had penetrated the vagina. The cervix was intact. The pathological diagnosis was well differentiated adenocarcinoma. CA19-9 was found to be diffusely expressed in the cytoplasm and on the luminal surface of glandular/tubular nests, using antibody from Toure Fuji Bionics Co., Japan (Fig.). Serum CA19-9 (maximum 743 u/ml) had returned to normal levels 2 weeks postoperatively. Eight months later, it rose to 68 u/ml as a result of pelvic metastases.
References Harrow, B., Shoane, J. A. and Solhanik, L. (1946).Etiology of hydronephrosis of pregnancy. Surg. Gynecol. Obstet., 119, 1042. Meyer,S. J.,Lee,R.V. andMunschauer,R. W. (1985).Dilatation and non-traumatic rupture of the urinary tract during pregnancy. Obstet. Gynecol., 60,809-815. Requests for reprints to: D. A. R. El Halabi, P.O. Box 51619, Rikka, 53457 Rikka, Kuwait.
Fig. Well differentiated adenocarcinoma (tubular type) cell showing positive staining to anti CA19-9 antibody. ( x 250).
CASE REPORTS
noid variants of prostatic carcinoma (Jelbart et al., 1988). However, only 50% of the patients with small cell undifferentiated carcinoma of the prostate (SCUCP) were associated with syndromes suggestive of ectopic ACTH. SCUCP has been reported to occur in 1 to 10% of prostatic carcinomas (Jelbart et al., 1988; Turbatt-Herrera et al., 1988) and closely resembles the morphological pattern seen in bronchogenic small cell undifferentiated carcinoma. However, not all of these tumours stain positively for the neuroendocrine markers (Ro et al., 1987). The initial presentation of SCUCP may be similar to that of prostatic adenocarcinoma. Unlike prostatic adenocarcinoma, it tends to metastasise early to liver, spleen and lung and to unusual sites such as omentum, vocal cord, axillary lymph nodes and periadrenal soft tissue (Tetu et al., 1987; Jelbart et al., 1988). In patients with this variant the clinical course has been aggressive, with a reported median survival of only 5 months (Tetu et al., 1987). SCUCP tends to respond well to chemotherapy (Hindson et al., 1985; Tetu et al., 1987) and therefore its recognition as a histopathological entity is of considerable importance. This condition is almost certainly underdiagnosed and in patients with rapidly progressive disease, or biochemical abnormalities consistent with hormone secretion, the possibility of SCUCP should be considered even if recent biopsies show adenocarcinoma only.
Spontaneous Rupture of Hydronephrotic Kidney during Pregnancy D. A. R. EL HALABI, M. S. HUMAYUN and J. M. SHARHAAN, Departments of Surgery and Obstetrics and Gynaecology, AlAdan Hospital, Kuwait
Rupture of the urinary tract during pregnancy is uncommon. Pyelonephritis, painful overdistension and rupture are occasional effects of pregnancy on the urinary tract. We present a case of spontaneous rupture of a hydronephrotic kidney in a pregnant woman.
Case Report
A 30-year-old Kuwaiti woman, mother of 8 children, was admitted to the Maternity Department on 5 December 1988 complaining of right flank pain, frequency of micturition and dysuria. Her general condition was satisfactory and she was 28 weeks pregnant. Examination revealed a tender mass in the right lumbar region and hypochondrium. Ultrasound showed hydronephrosis of the right kidney and a normal left kidney. Urine culture revealed Escherichiu coli and appropriate antibiotics were given. On 9 December the pain in the right hypochondrium suddenly intensified, spread over the abdomen and was associated with vomiting. On examination the BP was 80/50mmHg. The abdomen was distended with guarding and rebound tenderness. Bowel sounds were sluggish. The right flank mass could not be felt and no fetal heart sounds were elicited. Catheterisation showed frank haematuria. A provisional References diagnosis of internal bleeding was made. Hb was 104 g/ Hindson, D. A., Knight, L. L. and Ocker, J. M. (1985).Small cell 1; urea, creatinine and electrolytes were normal. Ultracarcinoma of the prostate. Transient complete remission with sound confirmed the intrauterine fetal death and showed chemotherapy. Urology, 26,182-184. a distorted right kidney with free fluid in the peritoneal Jelbart, M. E., Russell, P. J., Russell,P. e r d (1988).The biology and management of small cell undifferentiated carcinoma of cavity (Fig.). Artificial rupture of the membranes revealed clear fluid the prostate. In Textbook of Uncommon Cancer, ed. Williams, C. J., Krikorian, J. G . , Green M. R. et 01. Pp. 249-262. and laparotomy was performed. The peritoneal cavity Chichester : Wiley. contained about 300 ml of blood and there was a huge Ro, J. Y., Tetu, B., Ayala,A. G . e t d (1987).Small cell carcinoma retroperitoneal haematoma around the right kidney. A of the prostate. 11. Immunohistochemical and electron lower segment Caesarean section was done with delivery microscopic studies of 18 cases. Cancer, 59,977-982. of a dead fetus. Exploration of the right kidney showed Tetu, B., Ro, J. Y., Ayala, A. G. e t d (1987).Small cell carcinoma of the prostate part 1. A clinicopathologic study of 20 cases. rupture of the renal parenchyma at the upper pole, the pelvis being full of blood clots. Right nephrectomy was Cancer, 59,1803-1 809. Turbatt-Herrera, E. A., Herrera, G. A., Gore, I. er d (1988). performed. The patient made a good recovery. IntraNeuroendocrinedifferentiation in prostatic carcinomas. Arch. venous urography confirmed a normal left kidney. Pathol. Lab. Med., 112, llO(r1105. WHO (1982). The World Health Organisation histological Comment typing of lung tumors. Am. J. Clin. Pathol., 77, 123-136. Requests for reprints to: I. E. Smith, Department of Medicine, Royal Marsden Hospital, Fulham Road, London SW3 655.
Spontaneous rupture of the kidney is uncommon and until 1985 only 13 cases had been reported
220
BRITISH JOURNAL OF UROLOGY
Urethral Adenocarcinoma with High Levels of C A I 9-9 in Serum and Tumour Specimen N. M0RIYAMA.A. OKAZAWA, K.TOYAMA,T. KITAMURA, I. MURAHASHI, Y. A S 0 and K. MORIGUCHI, Departments of Urology. Branch Hospital. University of Tokyo and Nerima General Hospital, Tokyo, Japan
Case Report
Fig.
(Meyer et al., 1985). Non-traumatic rupture of the kidney during pregnancy may mimic a number of obstetric and surgical emergency situations. Dilatation of the urinary collecting system during pregnancy is well documented (Harrow et al., 1946) and the distended system is subject to changes in posture and increases in intra-abdominal pressure which predispose to rupture at points distorted by infection or scars. Rupture of the renal parenchyma usually tears the renal capsule; blood and urine enter the perirenal fat and produce a palpable mass in the flank. The blood and urine dissect along the fascia1 plane and produce an extensive retroperitoneal haematoma which may break through the peritoneum and lead to peritonitis. The blood may also enter the collecting system, producing haematuria.
A 61-year-old Japanese female with a 6-month history of gross haematuria was found to have diffuse urethral induration ( 5 x 3 x 3 cm) with a vaginal ulcer. The bilateral inguinal lymph nodes were swollen. Biopsies of the anterior vaginal wall and inguinal nodes showed adenocarcinoma. Computed tomography revealed tumour invasion to the bladder. Serum CA19-9 was 530 u/ml (normal level < 37 u/ml). She was referred to this hospital for pelvic exenteration and regional lymphadenectomy. The urethral surface was replaced by diffusely infiltrating tumour which had penetrated the vagina. The cervix was intact. The pathological diagnosis was well differentiated adenocarcinoma. CA19-9 was found to be diffusely expressed in the cytoplasm and on the luminal surface of glandular/tubular nests, using antibody from Toure Fuji Bionics Co., Japan (Fig.). Serum CA19-9 (maximum 743 u/ml) had returned to normal levels 2 weeks postoperatively. Eight months later, it rose to 68 u/ml as a result of pelvic metastases.
References Harrow, B., Shoane, J. A. and Solhanik, L. (1946).Etiology of hydronephrosis of pregnancy. Surg. Gynecol. Obstet., 119, 1042. Meyer,S. J.,Lee,R.V. andMunschauer,R. W. (1985).Dilatation and non-traumatic rupture of the urinary tract during pregnancy. Obstet. Gynecol., 60,809-815. Requests for reprints to: D. A. R. El Halabi, P.O. Box 51619, Rikka, 53457 Rikka, Kuwait.
Fig. Well differentiated adenocarcinoma (tubular type) cell showing positive staining to anti CA19-9 antibody. ( x 250).
