Martínez JA, Camarena-Reynoso HR, Leos-Acosta CA, Shuck-Bello CE, Saavedra-Briones DV, Hernández-Castellanos VA, Merayo-Chalico C, Santana-Ríos ZA, Pérez-Becerra R, Sánchez-Turati JG, Fulda-Graue SD, Urdiales-Ortiz A, Ahumada-Tamayo S, Fernandez-Noyola G, Pacheco-Gahbler C, Morales-Montor JG, Cantellano-Orozco M, Calderón-Ferro F

Language: Spanish
References: 6
Page: 257-260
PDF size: 4243.07 Kb.

ABSTRACT

Background: There are many reports of tumors in ileal conduits, colonic conduits, augmentation cystoplasty, neobladders, and ileal substitutions of the ureter. Histologically the tumors include adenocarcinomas (the most common), adenomatous polyps, and urothelial carcinoma. Other less frequent tumors include sarcomas, carcinoids, squamous cell carcinoma and nephrogenic adenoma. Among the etiological theories of this entity are: 1) carcinogenic effect of urine, 2) carcinogen activation in feces 3) nitrosamines reduced by urinary nitrite and 4) proliferative instability in anastomosis due to inflammatory substance release.
Objective: To report a case of intramucosal adenocarcinoma in an Indiana pouch in a patient at the Hospital General Dr. Manuel Gea González.
Clinical case: Patient is a 31-year-old woman with medical history of lumbar myelomeningocele repair at birth associated with urinary and fecal incontinence for which she received medical management at the age of 9 years due to repetitive urinary tract infections and sacral eschars. At 26 years of age (2004) patient presented with abdominal pain, fever, and pyuria. Pouch lithiasis was diagnosed and neocystolithotomy was carried out. In 2009 patient presented new symptoms of fever, fetid urine with abundant sediment and hematuria during catheterization. Recurrent pouch stone measuring 6 cm x 9 cm x 12 cm was identified and polyp measuring 1cm x 1cm x1cm in the depth of the pouch adjacent to the ureteral junction was found and totally resected. Histopathological study reported intramucosal adenocarcinoma (advanced adenomatous polyp of apparent tubular origin). Three months later abdominal computed axial tomography and colonoscopy were carried out with no evidence of tumor in the neobladder or in the digestive tract. Presently, at 7-month follow-up, patient shows no signs of recurrence.
Discussion: Seven cases of adenocarcinoma localized in Indiana pouches have been reported in the literature. Their clinical manifestations included recurrent urinary tract infections, hematuria, neobladder lithiasis, and catheterization difficulty in one of the cases. The patient presented here was treated solely with local resection because no invasion of muscle plane was found.

REFERENCES

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