Acute Glomerulonephritis as a Paraneoplastic Syndrome Secondary to Urachal Adenocarcinoma: An Unknown Entity

Abstract

Urachal carcinoma is an uncommon malignancy with a peculiar biomolecular characterization and therefore a complex approach. It was incorporated by the World Health Organization in 2004 in the tumors of the urinary system classification. This neoplasm is generally diagnosed in advanced stages. The standard treatment is surgical, however, due to the rarity and relatively late clinical manifestation of urachal carcinomas, the survival data are mostly case reports, as well as information about medical-surgical treatment based on evidence. The data used were extracted from both the physical and electronic clinical records. Among atypical presentations reported in the literature, we report a case of urachal adenocarcinoma with simultaneous glomerulonephritis as a paraneoplastic syndrome of which there is no report to date. Surgery was carried out in our patient, unfortunately with lifetime morbidity from kidney function replacement secondary to kidney function damage by glomerulonephritis, despite previous immunosuppression treatment for rapidly progressive glomerulonephritis. It is worth mentioning that if the initial diagnosis represents a clinical challenge, treatment is even more complex, given the little information that currently exists about it. Urachal carcinoma is a diagnostic and treatment challenge. Up to now, surgery has been the treatment of choice in localized or locally advanced disease, however, with a high morbidity for the patient.

Keywords: glomerulonefritis; malignant glandular epithelial neoplasm; papillary variant; paraneoplastic syndrome; urachal adenocarcinoma.

Figure 1. Histological slide.

Glandular formations that infiltrate the basement membrane into the surrounding connective tissue and smooth muscle. Non-urotelial involvement.

Figure 2. Histological slide.

Atypical glandular cellularity with loss of nuclear polarity in relation to the glandular basement membrane, and, in addition, giving the appearance of an enteric morphology.

Figure 3. Histological slide.

Glandular formations with atypical cellularity that spare the basement membrane and attached structures.

Figure 4. Histological slide.

Glandular architecture lined by pseudostratified malignant epithelium (intestinal type).