Mucus-secreting adenomatous polyp at the site of ureterosigmoidostomy. A case report and review of the literature

Polyps at the Site of Ureterosigmoidostomy

Anatomoclinical findings in 6 patients under long-term control of ureterosigmoidostomy, performed 5 to 26 years previously for nonneoplastic bladder pathology, are reported. Four histologically confirmed polyps are described and histopathogenetic theories are discussed. The authors suggest that these polyps arise from the ureter via glandular metaplasia due to external contact surgically created in urinary diversion.

Ureterosigmoidostomy associated signet ring colon cancer presenting as hip pain

PURPOSE

We present a case of a young male with a history of ureterosigmoidostomy who presented with hip pain, the subsequent workup of which revealed metastatic bone lesions from a primary sigmoid signet ring cell adenocarcinoma.

METHODS

Review of literature was conducted using databases PubMed Medline (1966-current), PubMed Central (1970-current), and EMBASE (1988-2009) to explore previous studies on the topic; used the Surveillance, Epidemiology and End Results Program for epidemiological data; and used the National Comprehensive Cancer Network guidelines for management recommendations.

RESULTS

Ureterosigmoidostomy is well-documented risk factor for colonic neoplasms, the reported incidence being 2-41% with a latent period of 10 to 30 years and a risk of occurrence 80-7,000 times higher than in the general population. The most common histological type of colon cancer seen after ureterosigmoidostomy is adenocarcinoma, but cases of signet-ring cell carcinoma have also been described. Signet-ring cell adenocarcinoma occurs predominantly in stomach but may infrequently arise from other organs such as breast, urinary bladder, and small and large bowel.

CONCLUSIONS

This case underscores the importance of prolonged screening in patients with ureterosigmoidostomies and also calls for heightened awareness among primary care physicians regarding long-term risks associated with this unique entity.

Colon carcinoma associated with ureterosigmoidostomy

A patient developing a colonic adenoma 38 years following ureterosigmoidostomy is presented. The mechanisms of neoplastic transformation associated with ureterosigmoidostomy is now better understood. This knowledge is being applied to develop modifications both of the surgical technique and the management of patients with this form of urinary diversion, and is a subject of discussion.

An investigation of colon cancer associated with urinary diversion

The mechanism by which ureterocolic anastomoses promote cancer of the colon is uncertain. To investigate the role of anastomotic healing, rats were exposed to the colon carcinogen azoxymethane after which they had either 1) a sham operation, 2) colotomy with suture, or 3) colovesical anastomosis, performed randomly. The first two groups had an equally low frequency of colon cancers, whereas rats with colovesical fistulas had a significantly higher frequency, and cancers were concentrated at the anastomotic site. It was concluded that prompt healing does not promote cancer in this model. It is probably not responsible for suture-line recurrences seen clinically, nor for the increased frequency of cancer at the site of urinary diversion into the colon.

Rectosigmoid carcinoma occurring after ureterosigmoidostomy

Reported are two patients with adenocarcinoma of the large bowel following ureterosigmoidostomy by 40 and 53 years. The interval of 53 years is the longest yet recorded in the literature. Long-term surveillance with endoscopy and urine cytology is advocated.

Multiple benign colonic polypi at the site of ureterosigmoidostomy

Nine benign retention (juvenile) large bowel polyps with an unusual histologic appearance, developed in a 23-year-old man at the site of anastomosis 7 years after ureterosigmoidostomy. Benign tumor occurring as a complication of this operation are very uncommon, and no previously reported case has had more than two lesions. The literature is reviewed, with emphasis on the characteristic histological appearance of benign postureterosigmoidostomy polyps.

Changes in the mucosa of colon conduits with particular reference to the risk of malignant change

Intestinal suction biopsies were obtained in 15 infants and children with cutaneous colo-ureterostomies. The patients were subdivided into groups according to the length of time the conduit had been established, i.e. less than 5 years, 5 to 10 years, 10 to 15 years and over 15 years. The histological changes found were chronic inflammation with a dense infiltration of plasma cells and eosinophils. The changes were progressive and correlated with the length of time the conduit had been established. As persistent chronic inflammation is a precursor of malignancy, it seems likely that there is a risk of malignant change in these conduits. Regular follow-up of such patients is recommended and should include flexible fibreoptic endoscopy of the conduit.

Renal lesions after unilateral ureterosigmoidostomy in the rabbit: preliminary results

Unilateral ureterosigmoidostomy (U.S.S.) was performed on 15 rabbits and then the animals were sacrificed after 3, 8 and 15 months. The gross appearance of the kidney and radiological investigations revealed enlargement of the pelvis and of the ureter on the operated side although the anastomosis was patent in all cases. In rabbits sacrificed 8 months after U.S.S. an adenomatous polyp was present at the site of anastomosis. Histological examination of the affected kidney showed pyelonephritis secondary to obstruction and immunopathological studies revealed in some rabbits glomerular and tubular deposition of immunoglobulins and complement. The contralateral kidney was always normal. Biochemical investigations showed only a moderate increase in blood urea nitrogen and plasma creatinine values.

Ureterosigmoidostomy and carcinoma of the colon

The etiology for development of colon carcinoma associated with ureterosigmoidostomy seems to be related to the urine. The incidence of colon carcinoma associated with ureterosigmoidostomy is 500 times greater than in the normal population, indicating about a 5% life time risk. The development time of these lesions varies from 6 to 50 years postoperatively but it is significantly less in patients more than 40 years old. The possibility exists that colon carcinoma may develop in primary sigmoid urinary diversion conduits or sigmoid internal conduits to either bladder or bowel. No reported bowel carcinoma has developed in an ileal urinary diversion. Followup examination should include stools for blood every 3 months after 2 years, an excretory urogram yearly after 5 years, sigmoid or colonoscopy every 5 years and barium enema every 5 years. If the patient has hematochezia or the excretory urogram demonstrates ureteral obstruction sigmoid or colonoscopy and a barium enema should be done.

Benign polypi at the site of uretero-rectal anastomosis

A case of benign polypi at the site of uretero-rectal anastomosis is herein reported. Nine other similar cases are reviewed. Possible aetiology and diagnosis are discussed.

Neoplasms at the site of ureterocolic anastomosis

This paper discusses one of the more uncommon sequelae of ureterocolic anastomosis, namely the formation of tumours at the site of anastomosis. This is a very rare complication and until 1971 the literature recorded only 28 cases of this phenomenon. This present communication adds 2 more cases to the literature--a unilateral tumour and bilateral tumours at the site of anastomosis.

Neoplasia at the site of ureterosigmoidostomy

An increased incidence of neoplasia at the site of ureterosigmoidostomy must be considered in patients being evaluated for or who have undergone this procedure. A case of mucinous adenocarcinoma 24 years following bilateral ureterosigmoidostomy is reported. This patient had bilateral hydroureteronephrosis, which led to left nephroureterectomy and right cutaneous ureterostomy. Mucinous adenocarcinoma was diagnosed only after the edematous, protruding and inflamed cutaneous ureterostomy stoma was biopsied. To our knowledge this is the first reported case of transfer of such a malignancy to the skin at the time of cutaneous ureterostomy. We recommend that ureterosigmoidostomy be performed only in patients with a limited life expectancy who agree to long-term followup. This followup should be frequent, complete and continue for the remainder of the patient's life. We consider the tendency for development of neoplasia at the ureterosigmoid anastomosis to be a relative contraindication to ureterosigmoidostomy. However, with proper patient selection and followup, ureterosigmoidostomy is still a remarkably satisfactory method of urinary diversion.

Colonic neoplasms following ureterosigmoidostomy

Attention is drawn to the occurrence of colonic tumors at the site of ureterosigmoidostomy. A case of carcinoma is described, the literature is reviewed and regular long-term followup is emphasized.

Colonic neoplasms complicating ureterosigmoidostomy

A benign reactive polyp developed at each ureteral implantation in the sigmoid colon following bilateral ureterosigmoidostomy for exstrophy of the bladder. The first polyp was discovered 23 years after the operation. The second polyp occurred 4 years later at the other ureteral orifice. Each polyp contained benign cystic glandular epithelium within the submucosa and the stalk. These submucosal cysts resembled colitis cystica profunda, except that they were confined to the pedunculated polyps. A complete review of the literature of neoplasms complicating ureterosigmoidostomy is presented. It is concluded that a benign or a malignant colonic tumor may develop at the site of the ureterocolic anastomosis many years later. Therefore, patients who undergo this operation should be followed for the rest of their lives.

A neonatal complication of maternal leukaemia treated with 6-mercaptopurine

A 24-year-old African mother, who had received 6-mercaptopurine for acute leukaemia from before conception and throughout her pregnancy is described. The child, born prematurely, was anaemic at birth, with many features of a micro-angiopathic haemolytic anaemia. It is suggested that the mother's disease or treatment was involved in the aetiology of this anaemia.