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Wang KY, Hu JS, Fang L, Zhang DX, Li Q, Ng DM, Haleem M, Xie GH, Ma Q. Advantages of retrograde flexible ureteroscopy in determining the etiology of painless hematuria originating from the upper urinary tract. Exp Ther Med 2020; 19:2627-2631. [PMID: 32256743 PMCID: PMC7086279 DOI: 10.3892/etm.2020.8482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 11/29/2019] [Indexed: 01/07/2023] Open
Abstract
The present study investigated the use of retrograde flexible ureteroscopy (RFU) in the discrimination of the etiology of hematuria that originates from the upper urinary tract (UUT). The present study collected retrospective data for patients who presented with hematuria and cystoscopy-detected bleeding from the UUT between June 2006 and August 2018 in Ningbo First Hospital. All patients accepted RFU to determine the etiology of hematuria. Data regarding imaging examinations, surgery, pathology and complications were also collected and analyzed. In total, 65 patients (males, 38; females, 27) with a mean age of 63 years underwent RFU to determine the etiology of hematuria originating from the UUT. Using RFU, UUT tumors were found in 29 cases. Stones, polyps and atypical hyperplasia were found in two cases, and a definite diagnosis was not found in three cases. There were 17 cases without obvious abnormalities and nine cases were unable to undergo RFU due to ureteral stenosis. In patients who could not be diagnosed by imaging examination, 34.4% (11/32) were diagnosed with urothelial carcinoma by RFU, and these results were also confirmed by postoperative pathology. In the present study, no patient had severe complications after RFU. The present results suggested RFU may be used as a sensitive method to diagnose UUT tumors (78.4%; 29/37) and has strong specificity. RFU could be performed as a routine examination for patients with hematuria from the UUT.
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Affiliation(s)
- Kai-Yun Wang
- Translational Research Laboratory for Urology, The Key Laboratory of Ningbo City, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, Zhejiang 315010, P.R. China.,School of Medicine, Ningbo University, Ningbo, Zhejiang 315000, P.R. China
| | - Jia-Sheng Hu
- Department of Urology, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, Zhejiang 315010, P.R. China
| | - Li Fang
- Department of Urology, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, Zhejiang 315010, P.R. China
| | - Dong-Xu Zhang
- Department of Urology, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, Zhejiang 315010, P.R. China
| | - Qiang Li
- Department of Urology, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, Zhejiang 315010, P.R. China
| | - Derry Minyao Ng
- School of Medicine, Ningbo University, Ningbo, Zhejiang 315000, P.R. China
| | - Maria Haleem
- School of Medicine, Ningbo University, Ningbo, Zhejiang 315000, P.R. China
| | - Guo-Hai Xie
- Department of Urology, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, Zhejiang 315010, P.R. China
| | - Qi Ma
- Translational Research Laboratory for Urology, The Key Laboratory of Ningbo City, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, Zhejiang 315010, P.R. China.,Comprehensive Urogenital Cancer Center, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, Zhejiang 315010, P.R. China
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Arora HC, Fascelli M, Zhang JH, Isharwal S, Campbell SC. Kidney, Ureteral, and Bladder Cancer: A Primer for the Internist. Med Clin North Am 2018; 102:231-249. [PMID: 29406055 DOI: 10.1016/j.mcna.2017.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Malignancies of the urinary tract (kidney, ureter, and bladder) are distinct clinical entities. Hematuria is a unifying common presenting symptom for these malignancies. Surgical management of localized disease continues to be the mainstay of treatment, and early detection is important in the prognosis of disease. Patients often require life-long follow-up and assessment for recurrence.
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Affiliation(s)
- Hans C Arora
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10-1, Cleveland, OH 44195, USA
| | - Michele Fascelli
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10-1, Cleveland, OH 44195, USA
| | - Jj H Zhang
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10-1, Cleveland, OH 44195, USA
| | - Sudhir Isharwal
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10-1, Cleveland, OH 44195, USA
| | - Steven C Campbell
- Center for Urologic Oncology, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10-1, Cleveland, OH 44195, USA.
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Incidence and prognostic significance of second primary cancers in renal cell carcinoma. Am J Clin Oncol 2013; 36:132-42. [PMID: 22441339 DOI: 10.1097/coc.0b013e3182438ddf] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The survival of patients with renal cell carcinoma (RCC) has improved in recent years. However, data on the risk of developing a second cancer after a diagnosis of RCC is limited. We used the data available in the Surveillance Epidemiology and End Results (SEER) database to estimate the risk of second metachronous primary cancers in patients diagnosed with RCC between 1973 and 2006. Furthermore, we also investigated the effect of the second primary cancers (SPCs) on the survival of RCC patients. RESULTS A total of 3795 cases of SPCs were registered in the SEER between 1973 and 2006. The ratio of observed/expected number of SPCs in RCC was 1.18, which was significantly greater than expected. Solid tumors comprised 90% of all second malignancies in RCC patients, with the most second cancers reported in the prostate gland and the digestive and respiratory systems. The overall risk of second primaries was highest in patients aged over 30 years at the time of diagnosis. The site-specific risk of second cancers varied with the age at diagnosis, sex, race of the patient, size of the primary renal tumor, and history of radiation therapy. Patients with second primaries had a significantly longer overall survival than those without second malignancies. An interval of <1 year between the diagnosis of RCC and the second primary was the strongest predictor of poor overall survival in RCC patients with a second malignancy. CONCLUSIONS Patients with RCC are at a significantly higher risk of developing a second malignancy, suggesting the need for careful surveillance for their early detection and management.
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Konala P, Schaefer TK, Iranpour F, Friederich NF, Hirschmann MT. An unusual case of persistent groin pain after total hip arthroplasty: a case report. J Med Case Rep 2011; 5:67. [PMID: 21324110 PMCID: PMC3049745 DOI: 10.1186/1752-1947-5-67] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Accepted: 02/15/2011] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Arthroplasty is a well-established routine elective surgical procedure in orthopaedics. To a great extent, diagnosis, treatment and post-operative rehabilitation in these patients is standardised. In a busy clinic, surgeons from time to time tend to focus their attention on common causes of joint pain, but it may lead them to overlook sinister but less common pathologies. Here we report a case of a patient with groin pain due to pre-operatively undetected pelvic metastases from a pyeloureteral carcinoma who underwent total hip arthroplasty. There are several case reports which deal with primary or secondary tumours which were either discovered at the time of replacement surgery or developed at the site of prosthesis years after total hip or knee replacement. To the best of our knowledge, this is the first case report in which a metastatic cancer was missed pre-operatively and intra-operatively both by the radiologist and by the orthopaedic surgeon and should be reported so that surgeons are reminded to be careful when dealing with seemingly routine cases. CASE PRESENTATION A 79-year-old Caucasian woman presented to the arthroplasty clinic with groin pain. Initial radiographs showed subtle bilateral abnormalities in the pelvis. Neither the radiologist nor the orthopaedic surgeon recognized it. A diagnosis of osteoarthritis of the hip was established, and she underwent total hip arthroplasty. Despite initial improvement, the patient came back with worsening hip pain three months later. Further radiological examination revealed multiple metastatic lesions throughout the pelvis due to a pyeloureteral carcinoma. CONCLUSIONS This case report emphasizes the importance of meticulous, unbiased pre-operative assessment of patients and their radiographs, even in so-called routine clinical cases. Often subtle radiological changes are classed as normal, especially if they are bilateral. Further radiological imaging should be recommended in all cases where unexplained clinical features or radiological findings are present.
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Affiliation(s)
- Praveen Konala
- Musculoskeletal Surgery Department, Imperial College, London, UK.
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Lee M, Jung YW, Kim SW, Kim SH, Kim YT. Metastasis to the ovaries from transitional cell carcinoma of the bladder and renal pelvis: a report of two cases. J Gynecol Oncol 2010; 21:59-61. [PMID: 20379450 DOI: 10.3802/jgo.2010.21.1.59] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 05/14/2009] [Indexed: 11/30/2022] Open
Abstract
Ovarian metastases from a primary urinary tract carcinoma are extremely rare. This can be difficult to distinguish from transitional cell carcinomas (TCC) of ovarian origin because of histologic similarity. A 65-year-old woman who was diagnosed with renal pelvis TCC 4 months prior was referred for evaluation of a left ovarian mass. A 47-year-old woman who underwent radical cystectomy due to bladder TCC 1 year ago was referred because of a right ovarian mass. Both patients underwent a bilateral salpingo-oophorectomy. The tumor cells had morphology identical to those of the primary urinary tract tumors. Gynecologic oncologists should consider metastatic TCC of the ovary from urinary tract origin, as well as breast, and gastrointestinal tract origins.
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Affiliation(s)
- Maria Lee
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
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Wright JL, Hotaling J, Porter MP. Predictors of Upper Tract Urothelial Cell Carcinoma After Primary Bladder Cancer: A Population Based Analysis. J Urol 2009; 181:1035-9; discussion 1039. [DOI: 10.1016/j.juro.2008.10.168] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Indexed: 11/16/2022]
Affiliation(s)
- Jonathan L. Wright
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - James Hotaling
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - Michael P. Porter
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
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Minimo C, Tawfiek ER, Bagley DH, McCue PA, Bibbo M. Grading of upper urinary tract transitional cell carcinoma by computed DNA content and p53 expression. Urology 1997; 50:869-74. [PMID: 9426716 DOI: 10.1016/s0090-4295(97)00404-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Transitional cell carcinomas of upper urinary tract (uttTCC) constitute 5% to 6% of all urothelial tumors. Ureteropyeloscopy has become the standard for clinical evaluation of uutTCC. Moreover, endoscopic treatments have been advocated as a conservative approach for low grade tumors or patients with intermediate grade tumors whose renal function is compromised. Therefore, grading has become the most predictive variable in defining therapeutic approach. In addition to morphologic evaluation, a series of biologic markers may be used to increase the accuracy of grading such as DNA analysis and p53 protein expression. In this study, we have evaluated these markers by means of cell image analysis with the SAMBA 400 system. METHODS Thirteen cases of uttTCC were studied with cytologic smear, cell block, and histologic confirmation. DNA analysis was performed on cytologic smear. Immunostaining was performed on cell blocks. A grade was assigned on the basis of DNA evaluation and p53 expression quantitation. These grades were combined for each case and compared with the initial cytologic grading and the final histologic grading. RESULTS Cytology alone diagnosed TCC in all but 1 case that was diagnosed atypical. Discrepancies were found in primary grading: cytologic grading concurred with histologic grading in 6 of the 13 cases. CONCLUSIONS These results, although in a limited but selected number of cases, show the potential of computerized evaluation of biologic markers as parameters for a more objective grading of tumors.
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Affiliation(s)
- C Minimo
- Department of Pathology/Cell Biology, Thomas Jefferson University, Philadelphia 19107-5244, USA
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Catton C, Warde P, Gospodarowicz M, Panzarella T, Catton P, McLean M, Milosevic M. Transitional cell carcinoma of the renal pelvis and ureter: Outcome and patterns of relapse in patients treated with postoperative radiation. Urol Oncol 1996; 2:171-6. [DOI: 10.1016/s1078-1439(96)00095-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Terrell RB, Cheville JC, See WA, Cohen MB. Histopathological Features and p53 Nuclear Protein Staining as Predictors of Survival and Tumor Recurrence in Patients with Transitional Cell Carcinoma of Renal Pelvis. J Urol 1995. [DOI: 10.1016/s0022-5347(01)66855-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- R. Brenton Terrell
- Departments of Urology and Pathology, University of Iowa College of Medicine, Iowa City, Iowa
| | - John C. Cheville
- Departments of Urology and Pathology, University of Iowa College of Medicine, Iowa City, Iowa
| | - William A. See
- Departments of Urology and Pathology, University of Iowa College of Medicine, Iowa City, Iowa
| | - Michael B. Cohen
- Departments of Urology and Pathology, University of Iowa College of Medicine, Iowa City, Iowa
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