case report E513Cite as: Can Urol Assoc J 2013;7(7-8):e513-6. http://dx.doi.org/10.5489/cuaj.414 Published online on July 2, 2013. AbstractAn asymptomatic 1-cm large papillary renal cell carcinoma (RCC) embedded in a 3.5-cm large oncocytoma was diagnosed and removed by right nephrectomy in a 68-year-old male investigated for the abdominal symptoms associated with cholelithiasis. The papillary RCC displayed positive immunohistochemical stainings with cytokeratin 7, alpha-methylacyl-CoA racemase and vimentin and was negative for the E-cadherin and CD117 immunostains, whereas the oncocytoma part showed opposite staining patterns. No gains of chromosomes 7 and 17 or loss of chromosome Y was detected in the papillary carcinoma by fluorescent in situ hybridization with centromeric enumeration probes. This finding is in keeping with the morphologic diagnosis of type 2 papillary RCC reported to have lower rates of these characteristic chromosomal changes. The combination of papillary RCC and oncocytoma, two tumours of different postulated origin, is extremely rare. It may represent a simple coincidence, but 2 previous cases and our current one share a few features, including the intimate embedment of the papillary RCC in the oncocytoma, the small size of the RCC and the old age of the patients. This case raises the point that renal oncocytomas can contain a hidden malignant tumour. IntroductionRenal cell neoplasms are supposed to derive from or show differentiation toward different parts of the renal epithelium, as highlighted by immunohistochemical staining patterns and differential expression of some marker proteins.1-3 There are reports on renal tumours with hybrid features between chromophobe renal cell carcinoma (RCC) and oncocytoma, both thought to arise from the distal tubular epithelium. 4 Sometimes RCC arises within an oncocytoma. 5 However, the combination of oncocytoma and papillary RCC, 2 renal neoplasms of different origin, is very rare. 6,7 We present a case of an unusual combination of these 2 tumours, a papillary RCC buried in an oncocytoma. Case reportA 68-year-old male with long-standing hypertension was admitted to our hospital because of right upper abdominal pain. Abdominal ultrasound and computerized tomography (CT) revealed a thick-walled gallbladder with common bile duct stones and a 4-cm mass in the upper pole of the right kidney (Fig. 1). The clinical diagnosis of choledocholithiasis associated with acute cholecystitis and a renal tumour were established. After endoscopic sphincterotomy, the symptoms related to the common bile duct stone vanished and the patient underwent right nephrectomy.The nephrectomy specimen was fixed in 10% neutral buffered formalin for 36 hours. We embedded 3-mm-thick representative tissue sections in paraffin wax and sections of 4 to 5 µm were cut and stained with hematoxylin and eosin (H&E) for light microscopy. The primary antibodies used for immunohistochemistry are shown in Table 1. ResultsThe parenchymal tumour in the nephrectomy specimen was circumscribed, homoge...
Összefoglaló. Az urachus tumorai és egyéb betegségei ritkák. A 67 éves férfi anamnézisében ismétlődő húgyúti fertőzés szerepelt ciprofloxacinterápiával. Cisztoszkópia során a húgyhólyag felső részének másodlagos érintettségére utaló bullosus nyálkahártya képe mutatkozott. Az ezt követő CT-felvételek alapján az alsó medián hasfallal, húgyhólyaggal, belekkel összefüggő tumor iránydiagnózisát állították fel. A kivizsgálás során kialakuló ileus miatt Hartmann-műtétet végeztek, a tumoros jellegű elváltozás teljes és az érintett szervek részleges eltávolításával. A kórszövettani vizsgálat daganatos elváltozást nem talált, hasi, vélhetően urachuseredetű actinomycosist igazolt: erre az eredetre a lokalizáció és a tünetek közt szereplő köldökváladékozás alapján lehetett gondolni, annak ellenére, hogy urachusmaradványt szövettanilag nem sikerült igazolni a mikroabszcedáló gyulladás által érintett szövetekben. A betegnél amoxicillinterápia indult. Átmeneti, hólyag melletti vizeletcsorgást követően a beteg tünet- és panaszmentesen távozott a kórházból, de 13 nappal később a hasfali seb sterilnek véleményezett szétválása miatt ismét hospitalizálni kellett. Negatív nyomású sebkezelést követően sikerült a hasat ismét zárni. A beteg ismét tünetmentessé vált, és fenntartott antibiotikumkezelés mellett hagyta el a kórházat. Az urachuskörnyéki tumorszerű elváltozások között az actinomycosis lehetőségét is szem előtt kell tartani a differenciáldiagnosztikában. Orv Hetil. 2022; 163(4): 157–160. Summary. Tumours and other diseases of the urachus are rare. A 67-year-old male presented with a history of recurrent urinary tract infection and ciprofloxacin therapy. Cystoscopy suggested secondary involvement of the bullous upper bladder wall. The subsequent CT-based diagnosis was of a tumour infiltrating the lower median abdominal wall, the urinary bladder and bowels. Bowel obstruction developed and this led to partial resection of the involved organs along with a Hartmann’s procedure. Histology revealed no neoplastic conditions, but proved abdominal actinomycosis of probable urachal origin based on the location of the tumour-like lesion and umbilical discharge among the symptoms. Urachal remnants were not identified in the perivesical tissues involved by the microabscess forming inflammation. Amoxicillin therapy was initiated. After a temporary urine leakage from the bladder, the patient became symptomless and was emitted from hospital. After 13 days, he was readmitted because of abdominal wound disruption, which was treated with negative-pressure wound therapy before the abdomen could be closed. At the time of reporting, he is still on amoxicillin, and has become symptomless again. Actinomycosis should be considered in the differential diagnosis of mass lesions of the urachal region. Orv Hetil. 2022; 163(4): 157–160.
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