Document Type : Case Reports
Authors
1 Department of Pathology, Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
2 Kidney Transplantation Complications Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
3 Department of Pathology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Abstract
The capability of the urinary tract to undergo metaplastic changes such as squamous, intestinal, glandular, mucinous, or ciliated epithelium in renal pelvis has been previously reported, which hypothetically is due to the mechanical irritation of the transitional epithelium. However, transitional metaplasia is a rare presentation in the collecting ducts. The aim of this paper was to report this type of extremely rare metaplasia and to inform pathologists that they may encounter this kind of metaplasia. A 25-year-old man, a known case of vesicoureteral reflux (VUR), referred to the Imam Reza Hospital; affiliated to the Mashhad University of Medical Sciences, for bilateral nephrectomy. Gross evaluation of bilateral nephrectomy specimens showed atrophic kidneys and dilated pelvicalyceal systems. The light microscopic evaluation showed transitional metaplasia in the background of chronic pyelonephritis, confirmed by GATA3 nuclear immunohistochemical stain. In this study, we presented a rare case of a renal collecting duct with transitional epithelial lining replacing the normal epithelium as a metaplastic change, with the hypothesis that previous medical history including VUR, or hemodialysis could be the trigger for the metaplastic change, which should be confirmed by further studies.
Keywords
Main Subjects
- Al Qahtani W, Sarhan O, Al Otay A, El Helaly A, Al Kawai F. Primary Bilateral High-Grade Vesicoureteral Reflux in Children: Management Perspective. Cureus. 2020;12(12):e12266. [DOI:10.7759/cureus.12266]
- Rullo E, Pecorella I, Pernazza A, Carletti R, Tornese A, Larghi Laureiro Z. Ciliated Cells in Renal Calyx mucosa: Metaplastic Change or Developmental Abnormality? Immunohistochemical Study of one Case and Review of the Literature. Int J Surg Pathol. 2022:10668969221117988. [DOI:10.1177/10668969221117988] [PMID]
- Siderits RH, Fingerman J, Hazra A, Rimmer C, Colaco M, Mikhail N, et al. Renal pelviceal keratinizing squamous metaplasia with sparing of pyramidal zones. Case Rep Urol. 2012;2012. [DOI:10.1155/2012/242780] [PMID]
- Zhang BY, Aguilar J, Yang M, Wang P, Li B. Mucinous metaplasia in urothelial tract may be the precancerous lesion of mucinous adenocarcinoma: report of two cases and review of literature. Int J Clin Exp Med. 2014;7(1):285-9.
- Zhou W, Zhong K, Wang J, Gu Y, Huang L, Jiang Z, et al. Intestinal metaplasia of the renal pelvis: A case report and literature review. Oncol Lett. 2014;8(6):2664-8. [DOI:10.3892/ol.2014.2547] [PMID]
- Shukla P, Gulwani HV. Extensive intestinal metaplasia of renal pelvis: Report of a case and literature review. Indian J Pathol Microbiol. 2015;58(4):483. [DOI:10.4103/0377-4929.168890] [PMID]
- Krag DO, Alcott DL. Glandular metaplasia of the renal pelvis: Report of a case. Am J Clin Pathol. 1957;27(6):672-80. [DOI:10.1093/ajcp/27.6.672] [PMID]
- Ogawa M, Morikawa T, Toyoshima T, Fukayama M. Squamous cell carcinoma in a duplicated renal pelvis. Int J Clin Exp Pathol. 2014;7(11):7957.
- Verma N, Yadav G, Dhawan N, Kumar A. Squamous cell carcinoma of kidney co-existing with renal calculi: a rare tumour. Case Rep. 2011;2011:bcr1020103388. [DOI:10.1136/bcr.10.2010.3388] [PMID]
- Fitzpatrick R, Reynolds LF, Watterson JD, Lavallée LT, Flood TA. Recurrent nephrolithiasis associated with keratinizing desquamative squamous metaplasia. Can J Urol. 2016;23(6): 8577-80.
- Jain P, Mishra A, Misra DS. Keratinizing squamous metaplasia of the upper urinary tract in a child with a solitary kidney. Indian Journal of Urology: J Urol Soc India. 2014;30(2):230. [DOI:10.4103/0970-1591.126916] [PMID]
- Salm R. Combined intestinal and squamous metaplasia of the renal pelvis. J Clin Pathol. 1969;22(2):187-91. [DOI:10.1136/jcp.22.2.187] [PMID]
- Verani RR. Transitional and Mucous Metaplasia of the Renal Collecting Ducts and Renal Papilla. Am J Surg Pathol. 1987;11(1):83-4. [PMID] [DOI:10.1097/00000478-198701000-00012]
- Mathur S, Singh MK, Rao SI, Seth A. Mucinous metaplasia of the renal pelvic epithelium in a case of recurrent urolithiasis and pyelonephritis. Urol Int. 2004;72(4):355-7. [DOI:10.1159/000077694] [PMID]
- Huang W-Y, Rosen S. Intrarenal urothelial transformation after obstruction: a novel metaplasia. Kidney Int. 2012;82(4):377-9. [DOI:10.1038/ki.2012.153] [PMID]
)