Lesion In Renal Pelvis Research Articles

Perirenal capsule and scrotal involvement in immunoglobulin G4-related kidney disease: case-based review

Immunoglobulin G4-related disease (IgG4-RD) is a chronic, immune-mediated-, systemic disease that is characterized by IgG4 plasma cell infiltration with fibrotic changes in various organs. The most affected organs are pancreas and salivary glands. Kidney can be rarely involved, and is usually represented as a renal mass and organomegaly. Usually, elevated levels of serum IgG4 more than 135mg/dl with organ-specific features and biopsy results showing enriched infiltration of IgG4-positive plasma cells are needed to diagnose the disease. However, we experienced two unusual cases of IgG4-RD involving kidney. IgG4-related kidney disease (IgG4-RKD) was first reported as an extra pancreatic feature of autoimmune pancreatitis(AIP) in 2004. Herein, we describe two cases of such unique presentation of IgG4RKD and a literature review focusing on clinicopathologic features of IgG4RKD. Our cases are distinct in the fact that IgG4RD invades unusual organs such as perinephric capsule or scrotum. We reported the patient who showed extinct perirenal capsule invasion with multi-organ involvement including exocrine glands in comparison to previous IgG4RKD that often involved in renal parenchyma and renal pelvis lesions. And the other patient had scrotal invasion with multifocal renal parenchymes. Referring to the features observed in these two cases, we could propose that as every organ can be related to IgG4RD, we propose clinicians to confirm the disease using imaging, serologic, and pathologic studies. We also reviewed previous reports of IgG4-RKD and summarized diverse imaging findings and pathologic features.

Comparative Diagnostic Performance of Contrast-Enhanced ultrasound versus Baseline Ultrasound for Renal Pelvis Lesions

The aim of this study was to assess the relative efficacy of contrast-enhanced ultrasound (CEUS) and baseline ultrasound (B-US) in diagnosing renal pelvic lesions. B-US findings on 58 suspected renal pelvis lesions were examined. The B-US and CEUS results were classified into five grades. Receiver operating characteristic curve analysis was used to compare the diagnostic efficacy of the two imaging modalities. CEUS characteristics of renal pelvis malignancies at different tumor stages and pathologic grades were examined. In the final diagnosis, 29 patients had malignant lesions (27 transitional cell carcinomas, 1 squamous cell carcinoma and 1 renal cell carcinoma) and 29 had benign lesions. On B-US, echogenicity and renal pelvis separation pattern in patients with malignant renal lesions overlapped those of patients with benign lesions. CEUS significantly increased the diagnostic grade of malignant lesions and decreased the grade of benign lesions (p = 0.000). The area under the receiver operating characteristic curve of CEUS was larger than that of B-US (p = 0.030). Enhancement shape and intensity in the wash-in phase markedly differed in lesions of higher tumor stage and higher pathologic grade, compared with lesions of lower stage and grade. In this study, compared with B-US, CEUS had significantly higher diagnostic efficacy in patients with renal pelvis lesions.

Delayed Ureterectomy after Incomplete Nephroureterectomy for Upper Tract Urothelial Carcinoma: Pathologic Findings and Outcomes

To evaluate the pathologic findings and outcomes after distal ureterectomy for a retained ureteral segment following incomplete nephroureterectomy for urothelial carcinoma of the renal pelvis or ureter. After IRB approval, an institutional database identified patients who underwent distal ureterectomy for a retained ureteral segment after assumed complete nephroureterectomy for urothelial carcinoma of the upper ureter or renal pelvis. Clinical and pathologic variables were analyzed. From January 1993 to July 2007, 12 patients were identified with median age at the time of ureterectomy of 60.5 years (41-85 years). Initial approach to surgery was open in 9 patients and laparoscopic in 3 patients. The median time from nephroureterectomy to distal ureterectomy was 23.5 months (range 2-66). At the time of initial surgery, pathologic stage was Ta, T1, T2, and T3 in 3,4,1, and 4 patients respectively. Initial pathology was urothelial carcinoma; grade 2 in 6 patients and grade 3 in six patients. Pathology from the subsequent surgery demonstrated urothelial carcinoma in the retained ureteral segment in 8 patients, dysplasia or atypia in 3 patients, and 1 patient with chronic inflammation. Local recurrence in 2 patients was present in a segment of ureter discontinuous with the bladder after laparoscopic nephroureterectomy. Three patients (25%), all with initial grade 3 renal pelvis lesions, developed metastatic disease. Tumor recurrence in a retained ureteral segment after incomplete nephroureterectomy is a significant problem and may contribute to intravesical recurrence or metastatic disease. Complete, en bloc resection is imperative to minimize these risks.

Hydroflotation Magnetic-Aided Endolumenal Navigation—Preliminary Platform in Ex-Vivo Setting for the Next Paradigm in Minimally Invasive Urologic Surgery

Navigation of endolumenal devices, such as image rendering capsules, have been described for diagnostic purposes in the animal, and more recently, human models. In urology, the ureter is a prime lumenal structure that often needs to be explored for diagnostic and therapeutic purposes. A novel device using a flotation mechanism in a water-filled environment was developed and its navigation achieved with magnetic-aided guidance. The device was tested for propulsion and real-time control in the ex-vivo setting. An endolumenal bionic worm (EBW) with a magnetic core was developed and introduced into synthetic lumens (SL) and supermarket chicken lumenal structures. The latter involved the gastrointestinal lumenal tissue of supermarket chickens; ie, the ex-vivo equivalent of a ureteral substitute lumen (USL). Navigation was graded by achievement of the EBW in propulsion to premarked sites, ability to remain static when necessary, and trauma to the USL. The structures were observed under the microscope for breech after the exercises. Navigation was observed in 10 SLs and 10 USLs. The EBW was successfully steered using the magnetic guidance system with hydroflotation. Observation of endolumenal surfaces did not reveal evidence of trauma in either model. Hydroflotation magnetic-aided endolumenal navigation (HMAEN) of a microdevice was achieved endolumenally with targeted real-time control and with no observed trauma to the structures. HMAEN could potentially be used to guide devices like the EBW to permit diagnostic and therapeutic ureteroscopy including biopsy of ureteral and renal pelvis lesions, thus ushering in the platform for the next paradigm in endolumenal urologic procedures.

Extranodal Rosai-Dorfman disease of the kidney

Extranodal Rosai-Dorfman disease of the kidney

Nódulo fusocelular post-quirúrgico en pelvis renal

IntroductionThe postoperative spindle cell nodule of the urinary tract is a bening proliferative lesion similar to sarcoma in the microscopic exam. We present a case of nodulein renal pelvis location CaseA woman presenting a stag horn lithiasis in left kidney was treated by LOC and percutaneous nephroscopy. Because of the large size of the stone a second intervention was required four weeks later. Then we discovered a 2 cm exophytic lesion in renal pelvis and removed it easily with a forceps DiscussionThis kind lesion belong to the group of iatrogenic inflamamtory pseudotumours, wich are secondary to an injury that leads to a tissular repairing response. Differential diagnostic includes sarcomas ConclusionsIt is important that Urology and pathology specialist think of this tumour in patients having a recent surgical intervention. A mistake in the diagnosis would lead us to an unnecessary radical surgery