Multiple urothelial cancers accompanied by acquired cystic disease of the kidney in a longterm hemodialysis patient

Abstract

A 41-year-old miller undergoing hemodialysis for 9 years presented with recurrent episodes of asymptomatic gross hematuria of a 7 years' duration and left flank pain with slight fever of a four months' duration. CT scans revealed bilateral acquired cystic disease of the kidney (ACDK) and a mass (ɸ 4 cm) in the medial portion of the left kidney, which was angiographically a hypovascular tumor. Cystoscopic examination revealed multiple papillary tumors arising from the entire bladder wall. These findings suggested that the renal mass was a renal pelvic tumor. Bilateral nephro-ureterectomy with left paraaortic lymphnodes dissection and radical cystectomy were carried out, followed by urethrectomy two weeks later. Histologically, multiple papillary transitional cell carcinomas with G2>G3 anaplasia were found in the left renal pelvis, the lower portion of the left ureter and the bladder. The tumors were predominantly superficial, although the renal pelvic one focally invaded into the muscular layer. Lymphnode metastasis and renal cell carcinoma were not recognized. Postoperative course was uneventful with normal blood pressure, though anemia was slightly progressive. He has been free of disease for six months. © 1990, THE JAPANESE UROLOGICAL ASSOCIATION. All rights reserved.