A High Association of Upper Urinary Tract Transitional Cell Carcinoma with Nonfunctioning Kidney Caused by Stone Disease in Taiwan

Abstract

Introduction: Although many studies have reported that upper urinary tract stones in patients with nonfunctioning kidneys are associated with malignancy, the incidence and frequency of the tumor cell type remain unclear. Therefore, we aimed to investigate the percentage of malignancies present in patients with nonfunctional kidneys who underwent nephrectomy. Materials and Methods: From July 1995 to December 2005, we reviewed a total of 47 patients who underwent nephrectomy to treat a nonfunctional kidney due to urolithiasis with clinical symptoms such as complicated chronic infection. Pathology revealed malignancies in 24 patients. Relationships between clinical presentations and malignancy were analyzed. Results: Malignancy was diagnosed in 24 patients after nephrectomy. Image studies revealed possible malignancy in only 7 patients before surgery. A high incidence (17/24) of transitional cell carcinoma was noted. The remaining malignancies included 5 renal cell carcinomas, 1 squamous cell carcinoma and 1 epidermoid carcinoma. There were 5 deaths during the follow-up interval. Conclusions: There is a high incidence of malignancy associated with nonfunctional kidney caused by stone disease. We suggest careful examination of the pathological specimens from nephrectomy for nonfunctional kidney regardless of clinical manifestations.

Incidence of renal carcinoma in non-functioning kidney due to renal pelvic stone disease

“…However, this may not be the case for non-functioning kidneys. In functioning kidneys, normal blood flow may be visualized by contrast-imaging studies, unlike non-functioning kidneys (12). Therefore, tumors in non-functioning kidneys may be harder to diagnose.…”

“…In 2007, Yeh et al (12) published their series of 47 patients undergoing nephrectomy for non-functioning kidneys with concurrent stone disease/chronic infection. In that study, ~51% of the patients were diagnosed with malignancy postoperatively, although preoperative imaging studies suggested possible malignancy in only 15% of the cases.…”

Urothelial Cancer of the Renal Pelvicaliceal System: Unusual Imaging Manifestations

“…Radiologists should also keep in mind the possibility of an underlying carcinoma of the upper urinary tract in patients with a nonfunctioning kidney caused by stone disease (18). Preoperative diagnosis of urothelial cancer in these patients, particularly those with staghorn stones, is difficult to achieve due to the existing stone and inflammation.…”

“…Preoperative diagnosis of urothelial cancer in these patients, particularly those with staghorn stones, is difficult to achieve due to the existing stone and inflammation. In such situations, biopsy of the renal pelvis is mandatory, with the biopsy performed directly through the nephroscope during percutaneous stone removal with careful examination of pathologic specimens (18,19).…”

Invasive urothelial carcinoma within a calyceal diverticulum associated with renal stones: A case report

“…Cases of urothelial carcinoma associated with renal stones have been reported, however, pre-operative imaging findings of urothelial carcinoma associated with renal stones can complicate the pre-operative diagnosis further (6)(7)(8). In one previous study, although malignancy was found in ~50% of the patients who underwent nephrectomy to treat a stone disease in a non-functioning kidney, the lesion was observed on preoperative imaging in only 29% of those patients (10). As the mechanism resulting in stone-related urothelial malignancies, chronic irritation and infection may play a significant role in the development of renal pelvis/ureter or bladder cancer (11).…”