The patient was a 63-year-old women who visited our hospital with the chief complaints of swelling, chills, fever and right lumbago. Fifteen years ago, she received surgical exploration for right renal stones at another department of urology. A large, soft and round kidney was palpable from the right upper quadrant of abdomen to the right lower abdomen. The parenchyma of the right kidney was thinned and inside the kidney there was a huge amount of yellowish mucin. The histological diagnosis was mucin-producing cyst-adenoma (borderline malignancy) of the renal pelvis and ureter. Mucin-producing cystadenoma of the renal pelvis and ureter origin was very rare, and only 4 similar cases to our patient were so far reported.
A total of 419 calculi in the upper urinary tract of 402 patients were treated by SWL with the EDAP LT-01 lithotripter from July 1988 to September 1989. Subcapsular hematomas resulted in 17 kidneys of 16 patients, an incidence of 4.1%. On CT scan, fractures with subcapsular hematomas were observed in nine kidneys, and a retroperitoneal hematoma was observed in one patient. There was no significant difference in stone location and size, grade of hydronephrosis, number of shock waves, applied energy, or post-treatment fever between the groups with and without hematomas. However, the hematoma group revealed significantly (P < 0.01) higher incidences of pretreatment hypertension (> 160/95 mm Hg) and use of antiplatelet agents. It is difficult to detect some disorders of blood coagulation in ordinary laboratory studies in patients receiving low dosages of antiplatelet agents; and many drugs including analgesic and anti-inflammatory agents, calcium antagonists, coronary vasodilators, antiplatelet agents, beta-blockers, and lipid-regulating agents have antiplatelet actions. Therefore, particular care should be taken in SWL when a patient is using those drugs.
A new renal cell carcinoma (RCC) cell line (KRC/Y) has been established from a surgical specimen of a 41-yr-old Japanese female patient with RCC composed of both clear cells and granular cells. This cell line has been maintained for more than 15 mo. through 45 passages with a stable growth. KRC/Y cells have clear or eosinophilic polygonal cytoplasm and round to oval nuclei with one or two nucleoli, and proliferate in a pavementlike cell arrangement with a lack of contact inhibition. By electron microscopy, these cells contain abundant fat droplets and glycogen granules or well-developed organelles or both, which were also observed in the original tumor. The doubling time of these cells at the 15th passage was 73 h. The chromosome number was from 37 to 45 with a hypodiploid modal number of 42. Tumorigenicity was identified by tumor formation after subcutaneous injections of KRC/Y cells in nude mice, which showed close resemblance to the original tumor by light and electron microscope observations.
Summay: Histopathological examination of pyeloureteritis cystica and cystitis cystica revealed the mechanisms for the cystic formation of the urothelium. Chronic stimulation with inflammation or physical stimulation with crystals or calculi causes the urothelium to form an inflammatory crypt. The crypt is isolated as a result of an adhesive occlusion of the urothelium at the orifice of the crypt. This crypt is an immature cyst that cannot be clinically detected. A von Brunn's cell nest represents a cut surface of the immature cyst. The inflammatory cyst isolated from the urinary tract, i, e., the immature cyst, gradually grows into a complete cyst, i, e., a clinically visible mature cyst, because of a hydrodynamic flow between the surrounding tissue and neogenetic capillaries, and inflammation.These findings indicate that von Brunn's cell nest, and glandular and cystic formation, occur during development from an inflammatory crypt to an immature cyst and then, a mature cyst.
A case of a foreign body stone which formed on an indwelling catheter that was left in the urinary bladder for a long time is described. Foreign body stones are composed primarily of a mixture of struvite and carbonate apatite, which are components of infection stones. The foreign body can be iatrogenic, accidentally or self-induced, or endogenous, suggesting that a variety of materials can serve as the nucleus for the stone.
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