Hepatoid adenocarcinoma of the renal pelvis in a 59-year-old male with nephrolithiasis: Case report and review of the literature.

BACKGROUND: Hepatoid adenocarcinoma arising from urological system is extremely rare, and the pathogenesis and therapeutic regimen have been poorly understood. CASE REPORT: we report a unique case of ɑ-fetaprotein (AFP)-producing neoplasm of renal pelvis associated with nephrolithiasis. A 59-year-old male patient was diagnosed with right renal tumor and nephrolithiasis with no evidence of lesions in his digestive or reproductive system. He was successfully treated with right laparoscopic radical nephroureterectomy and lymph node dissection. Pathology analysis showed moderately or poorly hepatocellular differentiation and adenocarcinoma differentiation with lymph node reactive hyperplasia. Immunohistochemical analysis demonstrated that the cancer cells were positive for AFP, HepPar-1, GPC3, CK7, and PLAP. The patient's recovery was on schedule and no sign of recurrence was observed for 3 months. We recently reviewed AFP-producing nongerm cell tumors in upper urinary tract and discussed the clinical aspect, morphology features, pathogenesis, and therapeutic regimen for a better understanding of this rare entity. CONCLUSION: The present case is the first documented of hepatoid adenocarcinoma of renal pelvis complicated with nephrolithiasis, which was treated with laparoscopic approach. The prognosis of the hepatoid adenocarcinomas arising from renal pelvis and ureter seems good.

[Single-port laparoscopic surgery for radical nephrectomy: report of 22 cases].

OBJECTIVE: [corrected] To evaluate the method and technique of single-port laparoscopic radical nephrectomy. METHODS: Form January 2009 to September 2011, 22 patients with renal carcinoma were treated with single-port laparoscopic radical nephrectomy. An incision about 5 cm in length was made through the umbilicus or in the postaxillary line under the 12th rib to establish the peritoneal or retroperitoneal working space. A single-port cannulation was deployed and the operation was carried out using standard and crooked laparoscopic equipment. RESULTS: The operations were completed successfully in all the 22 cases without conversion to open surgery, but additional trocar was needed in 5 cases. The mean operative time of radical nephrectomy was 150 min (90-240 min). The mean postoperative hospital stay was 7.6 days (3-15 days). The operation left a roughly 5-cm-long scar in all the cases. CONCLUSION: Single-port laparoscopic radical nephrectomy is safe and feasible with good cosmetic effect and shows much potential in radical resection of renal carcinoma.

[Percutaneous nephrolithotomy through the upper pole calix access for complicated renal calculi: report of 581 cases].

OBJECTIVE: To discuss the optimal approach of percutaneous nephrolithotomy (PCNL) for treatment of complicated renal calculi. METHODS: A total of 581 patients with complicated renal calculus were treated by PCNL through the upper pole calix access. Of the 581 patients, 55 had multiple upper pole calculi, 136 had staghorn stones, 145 had partial staghorn stones, and 245 had multiple renal calculi. RESULTS: PCNL through the upper pole calix access was completed successfully in all the cases. Of these patients, 90.3% (525/581) were stone-free after a single access, with a total stone-free rate of 94.6% (550/581). Thirty-five patients needed two accesses, 10 needed 3 accesses, 2 required 4 accesses, and 1 patients had 5 accesses. The operative time ranged from 30 to 150 min (mean 45 min). The successful rate of puncture was 100% without occurrence of severe injury of the pleura, intestine, peritoneum or other adjacent organs. CONCLUSIONS: Percutaneous nephrolithotomy through the upper pole calix access allows greater stone clearance rate due to its easy access into the intrarenal collecting system and can be an ideal approach for PCNL for complicated renal calculi.