ENTERIC TYPE ADENOCARCINOMA OF THE UPPER TRACT UROTHELIUM ASSOCIATED WITH ECTOPIC URETER AND RENAL DYSPLASIA - AN ONCOLOGICAL RATIONALE FORCOMPLETE EXTIRPATION OF THIS ABERRANT DEVELOPMENTAL ANOMALY

Purpose: Intestinal metaplasia of the urothelium occurs in chronically irritated retained urinary segments and can progress to enteric adeno carcinoma. We present a unique clinical experience with a closed segme nt ureter from a dysplastic kidney draining ectopically into the semin al vesicle with malignant degeneration to enteric adenocarcinoma. The implications of this experience for management of this anomaly are dis cussed. Materials and Methods: Clinical and pathological data were ass imilated with the urological and pathological literature. Results: Pat hological examination revealed replacement of the urothelium of the re nal pelvis and ureter with intestinal type metaplasia and multifocal t ransformation to mucinous (tubular villose) poorly differentiated aden ocarcinoma. Preoperative computerized tomography failed to identify th e extensive malignancy. Conclusions: Our experience demonstrates that this anomaly is another scenario in which closed spaced nonfunctional urothelium can undergo malignant degeneration. Since monitoring such u nits for tumor progression does not seem to be possible presently, con servative treatment appears hazardous. This new recognition of the ris k of malignant metaplastic degeneration is an additional rationale to consider complete extirpation of these lesions as the most appropriate treatment in young men.