Patient history
Past medical history is notable for hematuria, hypertension, non-insulin dependent diabetes mellitus, Warthin’s tumor of left parotid, pleomorphic adenoma of right parotid, tubular adenoma and adenomatous polyps of the colon, thyroid disorder, tonsillectomy, pilonidal cyst and arthritis.
Hospital course
A 79 year old male presented with gross hematuria and palpable right kidney hydronephrosis. Ureteroscopy found blockage of the right ureter by a mass and biopsy revealed features consistent with papillary urothelial carcinoma favoring high grade. A radical nephroureterectomy was performed.
Gross description
The right kidney and portion of ureter was surgically resected. Opening the ureter revealed two discrete tan-gray papillary lesions. One was 4.0 cm in length and 2.0 cm in open circumference and located 4.0 cm from the ureteropelvic junction and occluded the lumen. The other was 0.8 cm in length and 0.5 cm in open circumference, did not occlude the lumen and was located 2 cm from the ureteric margin. The remaining ureteric and renal pelvic mucosa was unremarkable. The kidney revealed markedly dilated renal pelvis and calyces.
Diagnosis
Microscopic examination of the larger occluding lesion is consistent with high grade papillary urothelial carcinoma which invades the muscularis propria (Fig. 1). The additional focus revealed high-grade papillary urothelial carcinoma with no invasion of the lamina propria or muscularis propria (Fig. 2). Also noted in random sampling of ureter and renal pelvic walls is focal urothelial carcinoma in situ (Fig. 3.)
Discussion
Urothelial carcinomas most commonly occur in the urinary bladder but can occur at any site which contains urothelium including the upper urinary tract from the ureteral orifice to the renal calyces. Cancers of the upper urinary tract account for 5-10% of all renal tumors and 5-7% of all urothelial tumors [1]. The types of urothelial tumors in the upper urinary tract mirror those that originate in the bladder. The four morphological patterns of growth include papilloma-papillary, invasive papillary, flat noninvasive carcinoma and flat invasive carcinoma [2]. Papillomas are benign, exophytic structures with finger-like papillae, central fibrovascular core with epithelium which resembles typical urothelium. Inverted papillomas can occur which are benign lesions, but extend into the lamina propria. Papillary urothelial neoplasms of low malignant potential (PUNLMPs) show thicker urothelium or diffuse nuclear enlargement with rare mitotic figures. Low grade papillary urothelial carcinomas are cohesive and maintain polarity with some nuclear atypia and infrequent mitotic figures. High grade papillary urothelial cancers have discohesive cells with large hyperchromatic nuclei, frank anaplasia and frequent mitotic figures.
Anne Morell is a seventy-four year old female with a past medical history of hyperlidemia, hypertension, osteoarthritis, osteoporosis, diabetes mellitus type 2, renal insufficiency, Charcot foot, and osteomosteomyeltits. Anne has a history of osteosarcoma treated in 1996 with surgery, chemotherapy and radiation. Anne also has a history of breast cancer, diagnosis in 2003 treated with radiation therapy. Anne past surgical history includes tonsillectomy in 1962, removal if osteosarcoma of left thigh in 1996 and lumpectomy of left breast in 2003.
The kidneys are located in the posterior section of the retroperitoneal cavity and are small, dark red kidney-bean shaped organs in the lower part of the rib cage (Marieb, The Urinary System, 2015). They are undervalued organs considering how essential they are for the body’s ability to maintain homeostasis. The kidneys filter about 120-150 quarts of blood to produce about 1-2 quarts of urine each day (NIH, 2014). Blood initially enters the kidneys through the renal artery. It then flows into the segmental artery before moving into the interlobar artery. From the interlobar artery the filtrate enters the arcuate artery before branching into the cortical radiate artery, which feeds into the afferent arteriole, before passing into the glomerulus where it begins to filter out waste. The filtered waste is then collected by renal tubule. The tubules drain to collecting ducts and all of these components together makes up a small unit called a nephron. Each kidney has over a million nephrons (Marieb, Blood Supply/ Nephrons, 2015). They filter out wastes that run through different body systems via blood; the majority of that waste is nitrogenous wastes, toxins, excess fluids, electrolytes, and drugs. These waste products are eliminated as urine. While waste are removed vital enzymes, hormones, and water are returned
Nephrolithiasis, more commonly known as kidney stones, is a common renal disease characterized by crystal depositions in the kidney as a result of urinary supersaturation. There are several types of stones, such as uric acid, cystine, and struvite stones, but calcium stones are the most common.
Urinary Tract Infection, also known as UTI, occurs in two common locations, the bladder and kidneys. The kidneys are important organs that aid in filtering out waste products from blood and maintaining water distribution throughout the body. The waste products are filtered out via bladder, which is the reason of the bladder being the second site for the infection. A normal human being has two kidneys, one on left and right side, a bean shaped organ, and is located at the back of the abdomen. “Each kidney is about 11.5 cm long, 5-7.5 cm broad, 5 cm thick, and weight about 150 grams” (HealthInfoNet, Paragraph 2). Furthermore, a bacterium named Escherichia coli lives in both the kidneys and the GI tract. E. coli is part of the human body and produces
Urolithiasis is the process of forming stones in the kidney, bladder, and/or urinary tract.1 1,200 to 1,400 per 100,000 people will develop a urinary stone each year. Urinary stones are formed when there is a decrease in urine volume or an excess of stone forming substances are present. The use of diagnostic imaging plays a vital role in the diagnostic and treatment processes of a stone in the urinary track. This paper will discuss the signs, symptoms, diagnosis, treatment, and prognosis of Urolithiasis.
J.P., a 58 year old female, presents to the Emergency Room on March 18th. She has a past medical history of cervical cancer, atheroembolism of the left lower extremity, fistula of the vagina, peripheral vascular disease, neuropathy, glaucoma, GERD, depression, hypertension, chronic kidney disease, and sickle cell anemia. She complains of right lower extremity pain accompanied by fatigue, a decreased appetite, increased work of breathing, burning urination, and decreased urine output for three days. Upon admission, a complete physical assessment was performed along with a blood and metabolic panel. The assessment revealed many positive and negative findings.
Prostate cancer has been the number one diagnosed cancer today. According to the World Health Organization, approximately one in every ten American men will develop prostate cancer during his lifespan. This cancer has been very common in the last few years. American Cancer Society reported over 200,000 new cases of prostate cancer. Huge number of population suffered severely. The prostate is significant for reproduction. It helps the substances that are involved in fertilization and transporting of sperm as well as survival. Prostate tumor is developed in the prostate gland, which is found in the men’s reproductive system. Prostate is the size of a walnut, which is located inferiorly in the penis and anterior to the rectum. It contains the connective tissue, which includes the glandular and fibrous tissues. This tumor starts to develop during their adolescent year due to the control of the male reproductive hormones. When the tumor starts to develop, it begins at the urethra, which is a tube that releases the urine from the bladder. The tumor is a slow development yet it is contagious to the other parts of the body, such as it does affect the pelvic bones, lungs, liver, and the lower vertebrae (Zenka, 2009).
As for the kidney’s, they consist of a renal cortex with arcuate vessels surrounds the renal medulla of the kidney. The renal papilla at the end of the renal medulla connects to the renal pelvis. Finally, a ureter descends form the kidney to the urinary bladder in both the mink and human.
Papillary Carcinoma a lot of times grows very slowly. Typically mature in only one of the lobes of the thyroid gland, in patients under the age of forty-five. Cancer often spreads to the lymph nodes in the neck, still resulting in treatment which is usually successful and is rarely fatal. Papillary carcinoma is most likely to affect women that are in their childbearing stages in life. According to MedicineNet.com, “About eight of ten thyro...
up on the inner surfaces of the kidney. A kidney stone that does not pass on out
Genitourinary system: He doesn’t have pain during urinating and no increase of passing urine and he doesn’t need to get up in the middle of the night to pass urine. There is no blood in the urine.
From the results of the numerous tests carried out according to the patient history of frothy urine with a significant oedema over a maximum period of 5 days, the patient was diagnosed with Nephrotic Syndrome. This is condition that occurs due to leakage in the kidney filtration part leading to a large amount of protein leaking from the blood into the urine. This is mainly due to fluid retention known as oedema which is as a result of low protein level in the blood. It occurs due to abnormal functioning or a part of the kidney is affected (glomeruli). This syndrome can be caused by numerous diseases coming together to cause or form one particular disease; these causes range from minimal change disease, membranous nephropathy, focal segmental glomerulosclerosis (FSGS) and other conditions, disorders of the glomeruli. The membranous nephropathy also known as the membranous nephritis or membranous glomerulonephritis, only causes diseases in adults and very uncommon in children. Leakage occurs from this due to the thickening of the membranous in the glomeruli which is the filter of the glomeruli. Focal segmental glomerulosclerosis is a causative due to the formation of small scars (sclerosis) on some of the kidney glomeruli. Another form of cause of nephrotic is minimal change which is due to lack of virtual change detected in the glomeruli when examined under the microscope. This causes the syndrome in 9 out of a total of 10 children under the age of 5 years.
A urinary tract infection is a very common infection that can happen to anybody. A urinary tract infection usually occurs when bacteria enters the urethra and multiples in the urinary system. The Urinary tract includes the kidneys, the thin tubes that carry urine from the kidneys to the bladder (ureters), and the main tube that carries the urine from the bladder (urethra). Women, men, and children are all immune to this infection. Women have the highest chances of getting it. In the Urinary tract, the main links of the ureters help get rid of any bacteria that tries to enter the urine, and the bladder helps prevent urine from backing up into the kidneys.
The purpose of this paper is to analyze, diagnose, and to determine a proper treatment plan to work toward the beneficial prognosis for the individual indicated within the case study.
Mr. GB is a 78 year old white male admitted to Bay Pines VAMC on 6/18/96. for " atypical chest pain and hemoptysis". V/S BP 114/51, P 84, R 24, T 97.4. He seems alert and oriented x 3 and cheerful. Bowel sounds present x 4. Pt. has a red area on his coccyx. Silvadene treatments have been started. Pt. Has a fungal lung infection with a pleural suction drainage tube inserted in his chest . Pt is extremely thin with poor skin turgor with a diagnosis of cachexia ( wasting) secondary to malnutrition and infection. Patient is no known allergies to drugs but is allergic to aerosol sprays disinfectants and dust.. Advanced directives on chart. Code status DNR. Primary physician Dr. R, Thoracic surgeon Dr. L. Psychology Dr.W. There is PT, OT Dietary and Infectious Disease consults when necessary. He lives with his wife who he has been married to for 56 years. His son and his daughter come to visit him. He does not smoke. He wears dentures but did not bring them. He dose not use a hearing aid but he does have a hearing deficit.