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Year : 2014  |  Volume : 57  |  Issue : 1  |  Page : 154-155
Primary small cell carcinoma of the renal pelvis with adenocarcinoma component


1 Department of Pathology, Nanfang Hospital, Southern Medical University; Departments of Pathology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
2 Department of Pathology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China

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Date of Web Publication17-Apr-2014
 

How to cite this article:
Liu S, Hua X, Zhu H, Shen H. Primary small cell carcinoma of the renal pelvis with adenocarcinoma component. Indian J Pathol Microbiol 2014;57:154-5

How to cite this URL:
Liu S, Hua X, Zhu H, Shen H. Primary small cell carcinoma of the renal pelvis with adenocarcinoma component. Indian J Pathol Microbiol [serial online] 2014 [cited 2020 Feb 19];57:154-5. Available from: http://www.ijpmonline.org/text.asp?2014/57/1/154/130935


Sir,

Primary small cell carcinomas (SCCs) of the renal pelvis are rare, with only a few individual cases reported in the literature.[1] The majority of SCCs of the renal pelvis have a distinct feature because they are often in combination with non-neuroendocrine components, such as transitional cell carcinoma, squamous cell carcinoma and rare adenocarcinoma. We report here a case of SCC with adenocarcinoma component in the renal pelvis.

A 54-year-old male patient was admitted to Nanfang Hospital of Southern Medical University, Guangzhou, China with right flank discomfort and gross hematuria. Intravenous pyelography revealed multiple calculi in the right renal pelvis and upper segment of ureter. Emission computed tomography showed severe renal dysfunction. The patient underwent nephroureterectomy. Upon gross examination, the right kidney measured 13 cm × 8.8 cm × 5 cm, with attached ureter. The renal parenchyma was thin and renal pelvis was dilated in which there were multiple small calcified stones and a tan mass (4.0 cm × 3.5 cm × 2.3 cm).

Microscopically, only part of tumor tissue was covered by urothelium [Figure 1]a. The tumor mainly consisted of small sized, round or ovoid cells, arranged in nests or dispersed, characterized by nuclear molding, scant cytoplasm and prominent mitotic figures. Focal rosette formation and extensive necrosis were seen in some areas [Figure 1]b. Only a small number of tumor cells (approximately 15%) formed adenoid structure [Figure 1]c. Immunohistochemistry showed that the predominant component was strongly and diffusely positive for synaptophysin [Figure 1]d], CD56 [Figure 1]e] and thyroid transcription factor-1 [Figure 1f] while the adenoid component was negative for the above markers [Figure 1]e and f]. With these typical histological characteristics, a final diagnosis of SCC with adenocarcinoma component in the renal pelvis was made.
Figure 1: (a) Part of tumor tissue was covered by urothelium. H and E, 100 magnification, (b) Focal rosette formation and extensive necrosis were seen in some area. H and E, 100 magnification, (c) Some tumor cells formed adenoid structure. H and E, 100 magnification, (d) The small cell component was positive for synaptophysin. Immunohistochemistry, 400 magnification, (e) The small cell component was positive for CD56 while the adenoid component was negative. Immunohistochemistry, 400 magnification, (f) The small
cell component was positive for thyroid transcription factor-1, while the adenoid component was negative. Immunohistochemistry, 200 magnification


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SCC of the renal pelvis was described for the first time by Ordonez et al. [2] in 1986 and since then fewer than 20 cases have been published. Review of literature demonstrated that SCC originating in the renal pelvis is different from that arising in the renal parenchyma because the former is often a mixed tumor. Urothelial differentiation was the most frequent component of the renal pelvis cancer. Until date, only one case of SCC of the renal pelvis with both squamous and glandular components has been reported. [3] SCC with unique glandular component in the renal pelvis has not been described.

In the present case, clinical symptoms, imaging examination and histopathologic findings as well as follow-up data excluded pulmonary metastatic carcinoma. Although the etiology of SCC in the renal pelvis is not clearly defined, there are two hypotheses about the histogenesis of primary SCC. The first hypothesis suggests that SCC may originate from a multipotent stem cell capable of differentiation into more than one cell type. [4] The other hypothesis suggests that neuroendocrine cells are derived from the neural crest during embryogenesis. [5] In our case, admixture of SCC component and glandular component would support the former theory. Previous reports indicate that chronic irritation such as inflammation, urinary calculi and hydronephrosis may play a role in carcinogenesis of the renal pelvis neoplasms. Our patient had the above risk factors, predisposing to induce multipotent cells to a mixed carcinoma.

Owing to its rarity, there are no guidelines for follow-up and treatment of SCC of the renal pelvis. However, several reports suggest that renal pelvis SCC is an aggressive tumor with poor prognosis. Many clinicians also suggest that comprehensive therapy including surgery, radiation and chemotherapy is essential for patients. It is not clear whether the presence of adenocarcinoma component in SCC is a factor that predicts aggressive behavior or appears to be resistant to standard chemotherapy. Further studies are needed to identify the most effective therapeutic modality for this rare tumor.

 
   References Top

1.Miller RJ, Holmäng S, Johansson SL, Lele SM. Small cell carcinoma of the renal pelvis and ureter: Clinicopathologic and immunohistochemical features. Arch Pathol Lab Med 2011;135:1565-9.   Back to cited text no. 1
    
2.Ordonez NG, Khorsand J, Ayala AG, Sneige N. Oat cell carcinoma of the urinary tract: An immunohistochemical and electron microscopic study. Cancer 1986;58:2519-30.  Back to cited text no. 2
    
3.Kitamura M, Miyanaga T, Hamada M, Nakata Y, Satoh Y, Terakawa T. Small cell carcinoma of the kidney: Case report. Int J Urol 1997; 4:422-4.  Back to cited text no. 3
    
4.Christopher ME, Seftel AD, Sorenson K, Resnick MI. Small cell carcinoma of the genitourinary tract: An immunohistochemical, electron microscopic and clinicopathological study. J Urol 1991; 146:382-8.  Back to cited text no. 4
    
5.Fetissof F, Dubois MP, Lanson Y, Jobard P. Endocrine cells in renal pelvis and ureter, an immunohistochemical analysis. J Urol 1986; 135:420-1.  Back to cited text no. 5
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Correspondence Address:
Hong Shen
Department of Pathology, School of Basic Medical Sciences, Southern Medical University, No. 1838, Gungzhou North Road, Guangzhou - 510 515
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.130935

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