332
Fig. 1 Gross appearance of specimen as seen from the renal pelvis. Lesion outlined by arrows.
BRITISH JOURNAL OF UROLOGY
who presented with either pain or haematuria and were found to have renal pelvic filling defects on intravenous urography. All of the previously reported patients were presumed to have transitional cell tumours which were resected by nephroureterectomy. Our patient is the only one to have presented with both pain and haematuria. Since the contralateral kidney was barely functional, maximal preservation of functioning renal parenchyma was desirable. The ureteroscopic appearance of the renal pelvic lesion was reassuring, as it was considered that the tumour was unlikely to be a transitional cell carcinoma. This is the only reported case of renal pelvic leiomyoma to have been resected by partial nephrectomy. The gross, microscopic and immunohistochemical features were similar to those reported previously. However, it is the only case to have been associated with cyst formation.
References Belis, J. A., Post,G.J., Rochman,S. C. etal. (1979). Genitourinary leiomyomas. J . Urol., 13,424429. Kho, G . T. and Duggan, M. A. (1989). Bizarre leiomyoma of the renal pelvis with ultrastructural and immunohistochemical findings. J . Urol., 141,928-929. Zuckermann, 1. C., Kershner, D., Laytner, B. D. ef al. (1947). Leiomyoma of the kidney. Ann. Surg., 126,220-228. Requests for reprints to: A. O’Brien, Department of Urology, Craigavon Area Hospital, Craigavon, N . Ireland.
Ureterocolic Fistula due to Impacted Ureteric Stone Fig. 2 Section showing uniform spindle cells lying parallel and arranged in bundles which course in various directions. (H and E x 200).
believed to arise from cortical vascular smooth muscle cells. They usually give rise to flank pain or discomfort, though their diagnosis has occasionally followed the finding of an asymptomatic abdominal mass. They occur almost invariably in females, and in all age groups, including the newborn (Zuckerman et a/., 1947). Leiomyomas arising from smooth muscle of the renal pelvic wall are rare, only 5 patients having been previously reported (Kho and Duggan, 1989). All were women, aged between 24 and 50 years,
K. P. PATIL, S. D. SHETW, N. ANANDAN and A. IBRAHIM, Department of Urology, College of Medicine, King Saud University (Abha). and Asir Central Hospital, Abha. Saudi Arabia
Ureteric fistulas are usually ureterovaginal and ureterocutaneous, but ureteroarterial and ureteroarterio-enteric fistulas have been reported following aortoiliac bypass graft surgery (Kar et al., 1984). Ureteroenteric fistulas are very rare. We report a case of ureterocolic fistula caused by an impacted ureteric calculus.
Case Report A 40-year-oldSaudi male was referred with a history of
333
CASE REPORTS
and transfixed with 2/0 chromic catgut. There was no pathology in the sigmoid colon. The patient made an uneventful recovery and was free from dysuria. Histologically the kidney showed features of xanthogranulomatous pyelonephritis and the ureter showed chronic inflammatory fibrosis.
Comment
The classical symptoms of ureteroenteric fistula, such as pneumaturia, faecaluria and diarrhoea (Heney and Crooks, 1984), were not seen in our patient, probably because of the impacted ureteric calculus. References Heney, N. M. and Crooks, K. K. (1984). Ureterocolic fistula. Br. J. Urol., 56,225-226. Kar, A., Angwafo, F. F. and Jhunjhuwala, J. S. (1984). Ureteroarterial and ureterosigmoid fistula associated with polyethylene ureteral stents. J. Urol., 132,755-757. Requests for reprints to: K. P. Patil, Department of Urology, Asir Central Hospital, P.O. Box 34, Abha, Saudi Arabia.
Fig. Retrograde ureteropyelogram showing fistulous tract and the ureteric stone.
dysuria. There were no other urinary symptoms and clinical examination was unremarkable. The urine contained significant gram-negative bacteria but no acid fast bacilli. Investigations revealed a non-functioning left kidney, with a 5-cm renal stone and a 1.5-cm ureteric stonejust below the left sacroiliac joint. The right kidney showed compensatory hypertrophy. Ultrasonography revealed a small left kidney with a dilated collecting system. At cystoscopy a 6 F ureteric catheter was passed into the left ureter and was initially held up at the 8-cm level, but subsequently could be advanced up to the kidney. The retrograde ureteropyelogram showed a dilated pelvicaliceal system with a calculus in the upper major infundibulum. The ureter was dilated up to the calculus (Fig.), just proximal to which the dye was seen passing medially into the colon. A barium enema showed that the sigmoid loop was tethered at the level of the ureteric calculus. Sigmoidoscopy was normal. On exploration, the kidney was found to be adherent to the surrounding tissue and the ureter was dilated and thickened up to the site of the calculus. A small fistulous tract was seen communicating with the sigmoid colon. Nephrectomy was performed with excision of the ureter distal to the impacted stone. The tract was disconnected
Choriocarcinoma Arising in Transitional Cell Carcinoma of the Bladder A. L. FOWLER, ELIZABETH HALL and G. REES, Departmentsof Pathology and Oncology,Royal United Hospital, Bath
Case Report A 74-year-old man was referred for radical radiotherapy for a T3 transitional cell carcinoma. After the start of radiotherapy he complained of breast tenderness and was noted to have bilateral gynaecomastia (Campo et al., 1989). The serum beta-HCG concentration was 15,000 iu/l. His gynaecomastia became more prominent and shortly after completing radiotherapy there was evidence of distant metastases and consequent rapid decline in his condition. Owing to the possibility of this being a germ cell tumour he was treated with etoposide but with no response. At this stage his beta-HCG had risen to 75,000 iu/l. At autopsy there was evidence of spread to neck nodes, thyroid, lungs and mediastinum, gut, kidney, adrenal glands and liver as well as spinal involvement, scalp, meningeal and choroidal spread. The overall tumour bulk was extremely large.
Fig. 1 Gross appearance of specimen as seen from the renal pelvis. Lesion outlined by arrows.
BRITISH JOURNAL OF UROLOGY
who presented with either pain or haematuria and were found to have renal pelvic filling defects on intravenous urography. All of the previously reported patients were presumed to have transitional cell tumours which were resected by nephroureterectomy. Our patient is the only one to have presented with both pain and haematuria. Since the contralateral kidney was barely functional, maximal preservation of functioning renal parenchyma was desirable. The ureteroscopic appearance of the renal pelvic lesion was reassuring, as it was considered that the tumour was unlikely to be a transitional cell carcinoma. This is the only reported case of renal pelvic leiomyoma to have been resected by partial nephrectomy. The gross, microscopic and immunohistochemical features were similar to those reported previously. However, it is the only case to have been associated with cyst formation.
References Belis, J. A., Post,G.J., Rochman,S. C. etal. (1979). Genitourinary leiomyomas. J . Urol., 13,424429. Kho, G . T. and Duggan, M. A. (1989). Bizarre leiomyoma of the renal pelvis with ultrastructural and immunohistochemical findings. J . Urol., 141,928-929. Zuckermann, 1. C., Kershner, D., Laytner, B. D. ef al. (1947). Leiomyoma of the kidney. Ann. Surg., 126,220-228. Requests for reprints to: A. O’Brien, Department of Urology, Craigavon Area Hospital, Craigavon, N . Ireland.
Ureterocolic Fistula due to Impacted Ureteric Stone Fig. 2 Section showing uniform spindle cells lying parallel and arranged in bundles which course in various directions. (H and E x 200).
believed to arise from cortical vascular smooth muscle cells. They usually give rise to flank pain or discomfort, though their diagnosis has occasionally followed the finding of an asymptomatic abdominal mass. They occur almost invariably in females, and in all age groups, including the newborn (Zuckerman et a/., 1947). Leiomyomas arising from smooth muscle of the renal pelvic wall are rare, only 5 patients having been previously reported (Kho and Duggan, 1989). All were women, aged between 24 and 50 years,
K. P. PATIL, S. D. SHETW, N. ANANDAN and A. IBRAHIM, Department of Urology, College of Medicine, King Saud University (Abha). and Asir Central Hospital, Abha. Saudi Arabia
Ureteric fistulas are usually ureterovaginal and ureterocutaneous, but ureteroarterial and ureteroarterio-enteric fistulas have been reported following aortoiliac bypass graft surgery (Kar et al., 1984). Ureteroenteric fistulas are very rare. We report a case of ureterocolic fistula caused by an impacted ureteric calculus.
Case Report A 40-year-oldSaudi male was referred with a history of
333
CASE REPORTS
and transfixed with 2/0 chromic catgut. There was no pathology in the sigmoid colon. The patient made an uneventful recovery and was free from dysuria. Histologically the kidney showed features of xanthogranulomatous pyelonephritis and the ureter showed chronic inflammatory fibrosis.
Comment
The classical symptoms of ureteroenteric fistula, such as pneumaturia, faecaluria and diarrhoea (Heney and Crooks, 1984), were not seen in our patient, probably because of the impacted ureteric calculus. References Heney, N. M. and Crooks, K. K. (1984). Ureterocolic fistula. Br. J. Urol., 56,225-226. Kar, A., Angwafo, F. F. and Jhunjhuwala, J. S. (1984). Ureteroarterial and ureterosigmoid fistula associated with polyethylene ureteral stents. J. Urol., 132,755-757. Requests for reprints to: K. P. Patil, Department of Urology, Asir Central Hospital, P.O. Box 34, Abha, Saudi Arabia.
Fig. Retrograde ureteropyelogram showing fistulous tract and the ureteric stone.
dysuria. There were no other urinary symptoms and clinical examination was unremarkable. The urine contained significant gram-negative bacteria but no acid fast bacilli. Investigations revealed a non-functioning left kidney, with a 5-cm renal stone and a 1.5-cm ureteric stonejust below the left sacroiliac joint. The right kidney showed compensatory hypertrophy. Ultrasonography revealed a small left kidney with a dilated collecting system. At cystoscopy a 6 F ureteric catheter was passed into the left ureter and was initially held up at the 8-cm level, but subsequently could be advanced up to the kidney. The retrograde ureteropyelogram showed a dilated pelvicaliceal system with a calculus in the upper major infundibulum. The ureter was dilated up to the calculus (Fig.), just proximal to which the dye was seen passing medially into the colon. A barium enema showed that the sigmoid loop was tethered at the level of the ureteric calculus. Sigmoidoscopy was normal. On exploration, the kidney was found to be adherent to the surrounding tissue and the ureter was dilated and thickened up to the site of the calculus. A small fistulous tract was seen communicating with the sigmoid colon. Nephrectomy was performed with excision of the ureter distal to the impacted stone. The tract was disconnected
Choriocarcinoma Arising in Transitional Cell Carcinoma of the Bladder A. L. FOWLER, ELIZABETH HALL and G. REES, Departmentsof Pathology and Oncology,Royal United Hospital, Bath
Case Report A 74-year-old man was referred for radical radiotherapy for a T3 transitional cell carcinoma. After the start of radiotherapy he complained of breast tenderness and was noted to have bilateral gynaecomastia (Campo et al., 1989). The serum beta-HCG concentration was 15,000 iu/l. His gynaecomastia became more prominent and shortly after completing radiotherapy there was evidence of distant metastases and consequent rapid decline in his condition. Owing to the possibility of this being a germ cell tumour he was treated with etoposide but with no response. At this stage his beta-HCG had risen to 75,000 iu/l. At autopsy there was evidence of spread to neck nodes, thyroid, lungs and mediastinum, gut, kidney, adrenal glands and liver as well as spinal involvement, scalp, meningeal and choroidal spread. The overall tumour bulk was extremely large.
