Embryonal rhabdomyosarcoma arising in the ureter

Botryoid-type of embryonal rhabdomyosarcoma of the proximal and mid ureter in an adult woman

We report a unique case of botryoid-type embryonal RMS of the proximal and mid ureter in a pregnant 29-year-old woman. The ureteral polyp consisted of a malignant small blue round cell tumor with a myxoid background and contained evidence of foci of immature cartilage and aggregates of epithelial cells reminiscent of hair follicle. Immunohistochemical stains for myogenin and desmin confirmed skeletal muscle, or rhabdomyoblastic, differentiation. The compact epithelial cell fragments reminiscent of hair follicle differentiation were positive for p40. Treatment included 6 cycles of adjuvant chemotherapy (vincristine, actinomycin and cyclophosphamide (VAC). No recurrent or metastatic disease was identified post-surgery.

Acute kidney injury due to bilateral ureteral obstruction in children

Bilateral ureteral obstruction in children is a rare condition arising from several medical or surgical pictures. It needs to be promptly suspected in order to attempt a quick renal function recovery. In this paper we concentrated on uncommon causes of obstruction, with the aim of giving a summary of such multiple, rare and heterogeneous conditions joint together by the common denominator of sudden bilateral ureteral obstruction, difficult to be suspected at times. Conversely, typical and well-known diseases have been just run over. We considered pediatric cases of ureteral obstruction presenting as bilateral, along with some cases which truly appeared as single-sided, because of their potential bilateral presentation. We performed a review of the literature by a search on PubMed, CrossRef Metadata Search, internet and reference lists of single articles updated to May 2014, with no time limits in the past. Given that we deal with rare conditions, we decided to include also papers in non-English languages, published with an English abstract. For the sake of clearness, we divided our research results into 8 categories: (1) urolithiasis; (2) congenital urinary tract malformations; (3) immuno-rheumatologic causes of ureteral obstruction; (4) ureteral localization of infections; (5) other systemic infective causes of ureteral obstructions; (6) neoplastic intrinsic ureteral obstructions; (7) extrinsic ureteral obstructions; and (8) iatrogenic trigonal obstruction or inflammation. Of course, different pathogenic mechanisms underlay those clinical pictures, partly well-known and partly not completely understood.

An antenatally diagnosed rhabdomyosarcoma of the bladder treated without extensive surgery

BACKGROUND

A female fetus was followed up from week 30 of gestation after bilateral hydroureteronephrosis and a large pelvic mass were detected on fetal imaging. At birth, the patient had high respiratory rate, a palpable bladder up to the umbilicus and a large pelvic mass, which compressed the anorectal wall.

INVESTIGATIONS

Fetal ultrasonography, fetal magnetic resonance urography, pelvic examination, full hematologic investigation, blood culture, abdominal and pelvic ultrasonography, voiding cystourethrography, abdominal and pelvic spiral CT, measurement of serum tumor marker levels, pathologic examination of the excised specimen, pelvic MRI.

DIAGNOSIS

Botryoid subtype of rhabdomyosarcoma occupying most of the bladder and protruding through the urethra, with bilateral hydroureteronephrosis.

MANAGEMENT

Catheterization on the second day of life improved the patient's renal function, but her general condition remained unstable and surgical intervention was deferred. On the fourth day, gross hematuria and decreased urinary output were observed, which rapidly progressed to anuria, and she underwent transurethral resection of the protruding part of the tumor and bilateral cutaneous ureterostomy. Subsequently, she received chemotherapy with vincristine, actinomycin D and ifosfamide, and was followed up with serial imaging. At 18 months, MRI showed no evidence of residual tumor, and cystoscopic biopsy confirmed the absence of viable tumor; chemotherapy was stopped. She had no sign of recurrence 24 months after ending chemotherapy.