Prachi

Abstract

Primary Squamous cell carcinoma of the renal pelvis is rare and accounts to only 0.5- 0.8 % of malignant renal tumours having poor prognosis. Chronic irritation, inflammation and infection induce the pathogenesis of this malignancy. A 53 year old male patient, presented with left flank pain since one month. On radiological investigation, his CT revealed atrophic shrunken left kidney measuring 7.9x5.2cms showing significant parenchymal thinning and complete loss of corticomedullary differentiation. A left upper ureteric calculus is seen measuring 7.5 mm with significant left renal hydronephrosis.Clinically, it was diagnosed as Xanthogranulomatous Pyelonephritis. Grossly the radical nephrectomy specimen measures 10.5x5.5x3.5cm. External surface is irregular & bosselated. On Cut surface renal architecture is effaced by necrotic mass measuring 9.5x5.0x3.0 cm involving pelvic ureter and most of renal parenchyma.Hematoxylin and eosin stained tissue revealed characteristic feature such as keratin pearls and intracellular bridges seen, rendering the diagnosis of well-differentiated keratinising squmaous cell carcinoma seen with 40% tumour necrosis associated with Keratinizing Squamous Dysplasia. In the present case, obstructive uropathy has triggered the event of malignancy. The radiologic differential diagnosis includes primary and secondary renal neoplasms and xanthogranulomatous pyelonephritis associated with renal calculi. XGP is commonly associated with lithiasis however, rarely causes keratinizing squamous metaplasia and its manifestations closely mimic renal neoplasm, leading to misdiagnosis of malignancy.The prognosis is dismal with a 5-year survival rate of Keywords: Squamous cell carcinoma, kidney, Xanthogranulomatous Pyelonephritis

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Abstract

The incidence of double malignancy reported are between 0.3% and 4.3%. The second primary lesion is identified either simultaneously with the primary lesion (synchronous) or after a period of time (metachronous). We report a case in a 63-year-old male presenting with double malignancy with adenocarcinoma of the ascending colon and a pre- sacral Chordoma of which the latter was detected accidentally on imaging. The patient underwent surgical excision of the pre-sacral mass and an exploratory laparotomy with Right Hemicolectomy. The increasing incidence of multiple malignant tumors is a real challenge to both clinicians and pathologists and close attention should be paid to imaging and histologic findings to avoid a misdiagnosis. In addition an early diagnosis is essential to achieve optimal treatment. We believe that the treatment modalities should be carefully tailored for each individual patient diagnosed with a double malignancy. Keywords: Double malignancy, Ascending colon, Chordoma.

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Abstract

Urethral Clear cell adenocarcinoma is a very rare variant of lower urinary tract malignancy. We present a 62-year old lady who complained of hematuria, obstructive urinary symptoms and pain abdomen. Her MRI pelvis revealed a mass in the posterior urethra measuring 30x20x15mm. Further she underwent total urethrectomy with regional lymph node dissection. Histology demonstrated features consistent with clear cell adenocarcinoma with 8/29 positive lymph nodes. Immunohistochemically cells were positive for CK7(+4), CD10(+4), HMWCK(+2) and PAX-8(+3). Whilst it was non- immunoreactive for GATA3, CK20, uroplakin and p-63. Subsequent PET scans have demonstrated lymphatic disease progression, and later on, the patient succumbed to disease after one year of diagnosis.   Keywords: Uretheral clear cell adenocarcinoma, Urethrectomy, Immunohistochemistry, Histology

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