title: Primary mucinous cystadenocarcinoma of the renal pelvis misdiagnosed as ureteropelvic junction stenosis with renal pelvis stone: a case report and literature review.
abstract: BACKGROUND
  Primary mucinous adenocarcinoma of the renal pelvis is extremely rare, with only ~100 cases reported till now. Its presumed pathogenesis includes glandular metaplasia of the urothelium of the calyces and the pelvis and malignant transformation of the metaplasia. Unfortunately, it has no characteristic symptoms or radiological features. We report a case of primary mucinous adenocarcinoma of the renal pelvis misdiagnosed as ureteropelvic junction stenosis with a renal pelvis stone.
  
  
  METHODS
  A 50-year-old man presented with discomfort in his right flank after a fall. A physical examination was normal except mild costovertebral angle tenderness on the right side. The results of most laboratory tests were within normal limits. Plain radiography of the kidneys, ureter, and urinary bladder showed a large radio-opaque mass in the right kidney. Abdominal computed tomography showed a hyperdense mass with 2.62 × 5.70 cm size in the right renal pelvis and severe hydronephrosis and cortical thinning. Diuretic-enhanced 99mTc DTPA renal scanning showed that the relative function of the right versus the left kidney was 20 versus 80 %. On the basis of the imaging findings, kidney dysfunction due to ureteropelvic junction stenosis with a large stone was initially diagnosed. However, the drained urine volume was almost zero, and gelatinous material was aspirated when percutaneous nephrostomy was performed for decompression of hydronephrosis. Although the cytopathology of gelatinous material was negative for malignancy, we could not rule out other disease, such as hidden malignancies of the kidney. We therefore performed radical nephrectomy, and pathological examination of the kidney uncovered a mucinous cystadenocarcinoma in the renal pelvis. A bone scan and positron emission tomography showed no evidence of other malignancies, metastasis, or remnant cancer. The patient has been well, without evidence of tumour recurrence or metastasis, for 20 months after surgery.
  
  
  CONCLUSIONS
  Primary mucinous adenocarcinomas of the renal pelvis are extremely rare, and most are diagnosed via post-operative analysis of resected specimens. Although preoperative diagnosis is difficult, urologists should consider the possibility of primary mucinous adenocarcinoma in patients with severe hydronephrosis accompanied by renal stones and chronic inflammation.
authors.affiliation: Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. hds@dreamwiz.com.
authors.forename: Dong Seok
authors.initials: DS
authors.lastname: Han
authors.affiliation: Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. doctor6@hanmail.net.
authors.forename: Seung Mo
authors.initials: SM
authors.lastname: Yuk
authors.affiliation: Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. singen80@daum.net.
authors.forename: Chang Shik
authors.initials: CS
authors.lastname: Youn
authors.affiliation: Department of Radiology, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea. greempark@gmail.com.
authors.forename: Geon
authors.initials: G
authors.lastname: Park
authors.affiliation: Department of Pathology, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea. hjsul2000@daum.net.
authors.forename: Hae Joung
authors.initials: HJ
authors.lastname: Sul
authors.affiliation: Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. urjang@gmail.com.|Department of Urology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea 64, Daeheung-ro, Jung-gu, Daejeon, 34643, Republic of Korea. urjang@gmail.com.
authors.forename: Hoon
authors.initials: H
authors.lastname: Jang
mesh_terms: D018282:Cystadenocarcinoma, Mucinous / Q000175:diagnosis* / Q000601:surgery; D003951:Diagnostic Errors; D006801:Humans; D007669:Kidney Calculi / Q000473:pathology* / Q000601:surgery; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000601:surgery; D007682:Kidney Pelvis / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D014057:Tomography, X-Ray Computed; D014515:Ureteral Diseases / Q000175:diagnosis* / Q000601:surgery