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Case Reports
. 2023 Jun 26;2023(6):omad052.
doi: 10.1093/omcr/omad052. eCollection 2023 Jun.

A rare synchronous of dual primary genitourinary carcinoma manifested with a rapidly progressive renal failure

Athar Affas  1 , Sami AlBitar  1 , Fatemah Alyyan  2 , Mohammad Nasser Affas  3
Affiliations
Case Reports

A rare synchronous of dual primary genitourinary carcinoma manifested with a rapidly progressive renal failure

Athar Affas et al. Oxf Med Case Reports. .

Abstract

Non-urothelial carcinoma accounts for <5% of urinary bladder tumors, and primary bladder adenocarcinoma accounts for 0.5-2%, but the variant primary signet-ring cell is extremely rare. We present a rare case of a synchronous of dual primary malignancy from a rare variant of urinary bladder adenocarcinoma (signet-ring cell) with indolent prostate adenocarcinoma in a 61-year-old male. The patient presented with a rapidly progressive renal failure due to a non-dilated obstructive uropathy that formed a dilemma in the course of diagnosiswhich was relieved transiently by a high-dose methylprednisolone. Primary signet-ring cell adenocarcinoma of the urinary bladder is a very rare malignancy manifests as a high-grade, high-stage lesion, which takes a vague course and has a poor prognosis. It is often managed with radical cystectomy due to its aggressive nature.

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Conflict of interest statement

The authors declare that they have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
CT scan of the abdomen and pelvis without contrast: shows normal kidneys appearance with first degree dilation in urinary system in the left kidney and mild degree in the right kidney.
Figure 2
Figure 2
(A–C) Multislice CT scan for the abdomen and pelvis with contrast injection per the nephrostomy; (A, B) coronary and sagittal sections: the right nephrostomy was well located in the renal pelvis, the contrast media reached to the lower part of the right ureter where a complete obstruction of 3 cm in length was found; the left nephrostomy was located in the fatty tissue around the left renal pelvis and was removed; (C) multislice CT (3D reconstruction) shows lower obstruction of the right ureter.
Figure 3
Figure 3
The gross appearance of the eradicated urinary bladder: the gross appearance of the eradicated urinary bladder reveals a diffuse thickening of its wall without an intraluminal mass.
Figure 4
Figure 4
Immunohistochemical stains for bladder specimen: (A) signet ring cells are diffusely scattered and infiltrated into mucosa, and muscularis propria (H& E,4×); (B) a bladder tissue-stained H& E (40×): intracellular mucin, and nuclei are pushed toward the periphery; (C and D) positive CK7 staining in urinary bladder mucosa and tumor cells; (E and F) positive CK20 staining in tumor cells; (G) Negative CDX2 staining in tumor cells and (H) negative PSA staining in tumor cells.
Figure 5
Figure 5
Immunohistochemical stains for prostate specimen: (A) prostate tissue with H&E shows anomalous split (green arrow); (B) prostate H&E 40X; (C) positive PSA staining in small malignant acini; (D) negative HMW-CK in small malignant acini, whereas positive in the periphery of acini (benign acini in the area marked by the line); this suggests a small acinar cell adenocarcinoma, but not benign hyperplasia or glandular structure of the prostate.
See this image and copyright information in PMC

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