Colonic adenocarcinoma associated with dysplastic lesions in an indiana pouch.

Abstract

The risk of adenocarcinoma in intestinal segments used for urinary reconstruction is well known. We report a case of colonic adenocarcinoma in an Indiana pouch near the ureteral anastomosis. CASE REPORT A 71-year-old Japanese man had undergone cystectomy and an Indiana pouch continent diversion for grade 2 pT1aN0M0 transitional cell carcinoma 9.5 years previously. There was no family history of colon cancer. The patient failed to catheterize the pouch and an 18Fr balloon catheter was left indwelling for 9 years. At presentation he reported 2 episodes of macrohematuria from the pouch. Computerized tomography showed an obstructed right kidney and a 4 2.5 cm. mass in the pouch (fig. 1). Serum carcinoembryonic antigen was 15.5 ng./ml. (normal less than 4.0). Flexible fiberscopy of the pouch revealed a tumor on the posterior wall near the right ureteral anastomosis, biopsies of which demonstrated moderately differentiated colonic adenocarcinoma. Cytokeratin staining pattern (cytokeratin negative and cytokeratin 20 positive) was compatible with colonic origin.1 The patient underwent excision of the Indiana pouch with ileal conduit and right nephrectomy. Pathological examination showed moderately differentiated colonic adenocarcinoma invading the subserosa, which was contiguous with mucosal dysplastic lesions, and a remote submucosal metastatic lesion with negative surgical margins and right hydronephrosis with mild chronic pyelonephritis and ureteritis (fig. 2). At 5-month followup there was no evidence of disease recurrence and serum carcinoembryonic antigen had decreased to 3.8 ng./ml.