title: Primary adenocarcinoma of the renal pelvis: histologic features of a stepwise process from intestinal hyperplasia to dysplasia in a patient with chronic renal abscess.
abstract: Pure adenocarcinomas of the urothelium are very rare and their location in the pelvis is uncommon. Although their pathogenesis is not well defined, adenocarcinomas are likely to originate from neoplastic transformation of the glandular cells of the urothelial intestinal metaplasia usually arising in response to chronic irritating stimuli, such as long-duration inflammation, urolithiasis, and hydronephrosis. We report a case of an 81-year-old woman who underwent right nephrectomy for relapsing renal abscess due to a staghorn calculus. Histological examination disclosed an infiltrating adenocarcinoma arising from a tubulovillous adenoma with the surrounding pelvic mucosa showing a sequence of intestinal metaplasia, low- and high-grade villous adenoma, and invasive adenocarcinoma, supporting the hypothesis of cancer progression due to chronic inflammation from the urothelium through the metaplasia step.
authors.affiliation: 1Department of General Surgery, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Sagnotta
authors.forename: Mario
authors.initials: M
authors.lastname: Dente
authors.forename: Fabio
authors.initials: F
authors.lastname: Socciarelli
authors.forename: Claudio
authors.initials: C
authors.lastname: Cacchi
authors.forename: Antonella
authors.initials: A
authors.lastname: Stoppacciaro
authors.forename: Genoveffa
authors.initials: G
authors.lastname: Balducci
mesh_terms: D000038:Abscess / Q000473:pathology*; D000230:Adenocarcinoma / Q000473:pathology*; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D006965:Hyperplasia; D007422:Intestines / Q000473:pathology*; D007674:Kidney Diseases / Q000473:pathology*; D007680:Kidney Neoplasms / Q000473:pathology*; D007682:Kidney Pelvis / Q000473:pathology*
keywords: adenocarcinoma of the renal pelvis; intestinal metaplasia; kidney tumor; renal abscess; urolithiasis