Clear cell papillary renal cell carcinoma (CCP-RCC) is a recently described, relatively uncommon variant of renal cell carcinoma (RCC) with a reported incidence of 4.1%. Thought to only arise in those with end stage renal disease, CCP-RCC is increasingly identified in those without renal impairment. CCP-RCCs have unique morphologic, genetic, and immunohistochemical features distinguishing them from both conventional clear cell renal cell carcinomas and papillary renal cell carcinomas. Immunohistochemically, these tumors are positive for CK7 and negative for CD10 and racemase. This is in contrast to conventional cell renal cell carcinomas (CK7 negative, CD10 positive) and papillary cell carcinomas (CK7, CD10, and racemase positive). These tumours appear to be indolent in nature, with no current documented cases of metastatic spread. We present the case of a 42-year-old female who presented with an incidental finding of a renal mass that on a core biopsy was reported as clear cell carcinoma, Fuhrman grade 1. She subsequently underwent a radical nephrectomy and further histological examination revealed the tumor to be a clear cell papillary renal cell carcinoma, Fuhrman grade 1.

Epithelioid angiomyolipoma is a rare mesenchymal derived neoplasm of the kidney. Thought to be a variant of classical angiomyolipoma, a benign tumour, its malignant potential has been highlighted by case reports of loco-regional and distant metastasis. Given the potentially adverse clinical course associated with epithelioid angiomyolipoma compared to classical angiomyolipoma, the distinction and comprehensive histological characterisation of this rare entity is essential.

Ectopic ureteric insertion to a seminal vesicle cyst associated with renal dysplasia is a rare anomaly. [1][2][3] We present the case of a patient with urosepsis on a background of right-sided renal dysplasia, ectopic megaureter with insertion into an ipsilateral seminal vesicle cyst with subsequent spontaneous ureterovesical fistula formation that required a semi-elective laparotomy. This case serves to highlight the embryology and anatomy of ectopic ureteric insertion to a seminal vesicle cyst, its complications and the benefits of T3MRI in defining the abnormal anatomy.A 62-year-old male Caucasian was transferred from a regional hospital with urosepsis following office-based transrectal aspiration of a pelvic cyst identified on trans-rectal ultrasound examination. The patient was immunosuppressed with etanercept for treatment of ankylosing spondylitis.Physical examination revealed the patient having a large, asymmetric and tender pelvic cystic mass in the region of the right prostate lobe. Initial CT scan suggested a right ectopic megaureter with seminal vesicle insertion and associated renal dysplasia.It was noted that the patient also developed spontaneous purulent discharge into his indwelling catheter with corresponding improvement in his symptoms, suggesting a spontaneous drainage, decompression and fistula formation of the infected right upper urinary tract to the bladder.The patient improved further with broad-spectrum intravenous antibiotics and catheter drainage. He subsequently underwent T3MRI of his urinary tract which confirmed the diagnosis of right-sided renal dysplasia, ectopic megaureter inserting into an ipsilateral seminal vesicle cyst with spontaneous uretero-vesical fistula formation (Figs 1,2).Unfortunately the patient's infection was difficult to control due to his immunosuppressant use and the decision was made to proceed to semi-elective laparotomy and open right nephro-ureterovesicalectomy and fistula repair once the local infection and inflammation completely resolved.Cystoscopy performed prior to the laparotomy showed absence of the native right ureteric orifice. A fistulous opening was demonstrated to lead to the ectopic right ureter on retrograde pyelogram. The existing local pelvic inflammation and adhesions made positive identification of the seminal vesicle cyst difficult intraoperatively.The histology of the resected specimen revealed a completely atrophic right kidney with fibrosis, thyroidisation of tubules, cystic change and haemosiderin laden macrophages with no glomeruli identified. The ureter measured 15 mm across with generalized inflammatory changes. The distal ureteric margin had dense fibrosis with large numbers of haemosiderin laden macrophages and denuded, haemorrhagic urothelium -features consistent with a fistulous tract. The seminal vesicle cyst could not be identified in the submitted specimen (Fig. 3).Embryological development of the ureter starts as an outgrowth of the distal mesonephric duct towards the end of the fourth week of gestation. This ureteric bud d...

No abstract

No abstract