Korean J Transplant.  2023 Jun;37(2):118-123. 10.4285/kjt.22.0055.

Primary adenocarcinoma with yolk sac differentiation in the transplant ureter and salvage of the transplant kidney: a rare case report

• Kumar BN
• Shukla AK
• Guleria P
• Datt B
• Prakash S
• Vairam AR

• KMID: 2544116
• DOI: http://doi.org/10.4285/kjt.22.0055

Abstract

Renal transplant recipients are prone to a high risk of subsequent upper tract urothelial carcinoma, occurring in both native and transplant ureters. We report a rare case of adenocarcinoma with yolk sac differentiation of the transplant ureter, which was managed successfully with transplant ureterectomy and pyelovesicostomy, thereby salvaging the functioning transplant kidney.

Keyword

Kidney transplantation; Immunosuppression therapy; Urinary tract infections; Ureteral neoplasms; Adenocarcinoma

Figure

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  Fig. 1 Noncontrast computed tomography of the kidneys, ureters, and bladder scan showing hydronephrosis of the transplant kidney with the intrarenal pelvis and a lesion in the proximal part of the graft ureter, just below the ureteropelvic junction (red arrow).

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  Fig. 2 (A) Retrograde pyelography showing hydronephrosis of the transplant kidney with a cut-off of contrast just below the ureteropelvic junction. (B) The ureteroscope was not able to negotiate beyond the site of obstruction, and (C) ureteroscopy showing unhealthy tissue (yellow arrow).

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  Fig. 3 Intraoperative images showing (A) dissection of the transplant ureter, (B) completed pyelovesicostomy with the bladder distended with saline to check for urine leak at the anastomosis, and (C) gross photograph of the cut-open resected specimen of ureterectomy with a whitish, firm infiltrative tumor present at the proximal end (red arrow).

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  Fig. 4 H&E stained histopathological images of the tumor: (A) tumor composed of areas of villoglandular morphology infiltrating the underlying stroma along with areas of necrosis (black arrow; H&E, ×40), (B) another area of the ureteric tumor with the lining showing a well-defined villoglandular architecture (H&E, ×40), (C) tumor with areas showing a reticulocystic pattern, some of the cystic areas containing secretions within (H&E, ×40), and (D) higher-power view of another area with glandular differentiation, showing distorted glands lined by highly pleomorphic cells (H&E, ×100).

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  Fig. 5 Immunohistochemistry characterizing the lesion as a ureteric adenocarcinoma with a villoglandular pattern and areas of yolk sac differentiation: (A) tumor cells are diffusely positive for CK7 (×100), (B) GATA 3 (×100), and (C) CA 19.9 (×100). (D) The reticulocystic areas were positive for alpha-fetoprotein (×200) and (E) glypican 3 (×200). (F) The tumor had a mutated phenotype for p53 (×100).

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  Fig. 6 Postoperative magnetic resonance imaging of the abdomen, 12 months after total transplant ureterectomy and pyelovesicostomy, showing a patent anastomosis between the transplanted renal pelvis and the superolateral wall of the bladder, with no lesion in the renal pelvis or bladder and significant improvement of hydronephrosis.

Reference

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