Indian Journal of Pathology and Microbiology

LETTER TO EDITOR
Year
: 2014  |  Volume : 57  |  Issue : 1  |  Page : 154--155

Primary small cell carcinoma of the renal pelvis with adenocarcinoma component


Shuguang Liu1, Xing Hua2, Haili Zhu1, Hong Shen1,  
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

Correspondence Address:
Hong Shen
Department of Pathology, School of Basic Medical Sciences, Southern Medical University, No. 1838, Gungzhou North Road, Guangzhou - 510 515
China




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;57:154-155


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 2021 Sep 27 ];57:154-155
Available from: https://www.ijpmonline.org/text.asp?2014/57/1/154/130935


Full Text

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}

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

1Miller 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.
2Ordonez 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.
3Kitamura 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.
4Christopher 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.
5Fetissof F, Dubois MP, Lanson Y, Jobard P. Endocrine cells in renal pelvis and ureter, an immunohistochemical analysis. J Urol 1986; 135:420-1.