Journal of the Chinese Medical Association
Volume 73, Issue 1 , Pages 40-43, January 2010

CA125-producing Clear Cell Adenocarcinoma Arising From the Upper Ureter and Renal Pelvis

  • Chi-Min Shih

      Affiliations

    • Department of Anatomical Pathology, Yunlin, Taiwan, R.O.C.
    • ,
  • Chuan-Te Huang

      Affiliations

    • Division of Urology, Yunlin, Taiwan, R.O.C.
    • ,
  • Ching-Huang Chi

      Affiliations

    • Department of Radiology, St. Joseph's Hospital, Yunlin, Taiwan, R.O.C.
    • ,
  • Jui-Wei Lin

      Affiliations

    • Department of Pathology, Chang-Gung Memorial Hospital, Kaohsiung, Taiwan, R.O.C.
    • ,
  • Chin-Chen Pan

      Affiliations

    • Department of Pathology, Taipei Veterans General Hospital, Taiwan, R.O.C.
    • National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • Corresponding Author InformationCorrespondence to: Dr Chin-Chen Pan, Department of Pathology, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, R.O.C.

Received 13 February 2009; accepted 2 November 2009.

Article Outline

Clear cell adenocarcinomas similar to those found in the female genital organs can arise in the lower urinary tract of both women and men. Clear cell adenocarcinomas occurring in the upper urinary system are exceedingly rare. Here, we present a case of clear cell adenocarcinoma arising from the upper ureter and renal pelvis of a postmenopausal woman with a ureteral stone. The patient had elevated serum levels of cancer antigen (CA) 125 (103.80 U/mL) and CA19-9 (151.96 U/mL). The tumor showed typical features of tubulopapillary structures lined with clear-to-eosinophilic cytoplasm and frequent hobnail configuration. The tumor cells were immunoreactive for cytokeratin 7, cytokeratin 20, carcinoembryonic antigen and CA125, but negative for PAX-2 and a-methylacyl coenzyme A racemase. Given the presence of intestinal and squamous metaplasia of the adjacent urothelium, we propose that this clear cell adenocarcinoma developed through a metaplastic process. The tumor behaved so aggressively that the patient developed multiple metastases and died of the disease 5 months after radical nephroureterectomy.

Key Words:  CA125 , CA19-9 , clear cell adenocarcinoma , upper urinary tract

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PII: S1726-4901(10)70020-4

doi:10.1016/S1726-4901(10)70020-4

Journal of the Chinese Medical Association
Volume 73, Issue 1 , Pages 40-43, January 2010

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