ACWe eft krec eou20
Idemeexshhetinninsorenal pelvis, which was removed using a percuta-neous approach. Histologic examination of thefrapethhetimheblo
Bdarecmeforing the malignant potential and recurrence rate.However, no malignant potential3 or any associa-
ALLgments revealed a cholesteatoma of the renallvis. The follow-up was uneventful, and no fur-er treatment was necessary. In December 2003,r flank pain and hematuria recurred. At thate, urine examination confirmed keratin sheets,
r serum creatinine was 1.5 mg/dL, and the otherod tests were normal.rography showed a large solid mass in the leftal pelvis. Computed tomography and magnetic
tion with squamous carcinomas has been de-scribed. In published studies, different nephron-sparing procedures have been described, includingwait and see strategies, pyelolithotomy,4 extracor-poral workbench surgery,5 partial nephrectomy,and endourological approaches.6
Important diagnostic features are keratin sheetsin urine cytology,7 the absence of malignant cells,and radiologic defects on urography. The differen-tial diagnosis includes renal stones, tumors, in-flammatory and necrotic processes, and bloodclots, which must be excluded. The etiology of re-nal cholesteatomas is unclear. Chronic infection,obstruction, and stones have been considered. In
m the Departments of Urology and Radiology, Ruhr Univer-t Bochum, Marienhospital Herne, Herne, Germanyddress for correspondence: Jens Knig, M.D., Department ofLATE RECURRENCE OF RENA15 YE
JENS KNIG, JRGEN PANNEK, RALP
ABSTRreport a late recurrence of a cholesteatoma of the lurrence were treated by endourologic and percutan04. 2004 Elsevier Inc.
holesteatoma of the urinary tract, first re-ported by Rosina1 in 1953 is an extremely un-
mmon disease. Only 90 cases have been reportedpublished studies. Histologically, keratinizing
squamative squamous metaplasia of the urothe-l cell layer is found.2 The most common site ofnifestation is the renal pelvis, but manifesta-ns in the ureter have been reported as well.3
n 1989, a 50-year-old woman presented to ourpartment with left flank pain and hematuria. Herdical history was uneventful, and the physical
amination was normal. Urine examinationowed no signs of acute infection but significantmaturia; the urine culture was sterile. Her rou-e blood tests were normal, with a serum creati-e of 1.3 mg/dL. Urography and renal ultra-
nography led to the diagnosis of a stone in theouT
ology, Ruhr Universitt Bochum, Marienhospital Herne, Wi-er Strasse 8, Herne 44627, Germanyubmitted: March 1, 2004, accepted (with revisions): May 6,4
2004 ELSEVIER INC.RIGHTS RESERVEDCHOLESTEATOMA AFTERRS
ICKUTH, AND JOACHIM NOLDUS
Tidney after 15 years. Both the initial case and thes approaches. UROLOGY 64: 808.e19808.e20,
onance imaging (Fig. 1) revealed a noninvasiveocess. Retrograde ureteropyelography (Fig. 2)nfirmed the diagnosis. Cystoscopy revealed armal lower urinary tract, and left ureteropyelog-hy did not show any other pathologic findings.r therapy, a percutaneous approach was used,d a nephrostomy tube was inserted (Fig. 3). An-rade pyeloureterography revealed no residualratin material, and the tube was removed after 2ys. The histopathologic examination confirmede recurrence of the cholesteatoma.
ecause renal cholesteatomas are rare, the stan-rd treatment has not been well defined. Untilently, nephrectomy was reported as the treat-nt of choice. This aggressive procedure was per-med because of the lack of information regard-r case, none of these factors were evaluated.he exact data regarding the recurrence rate of
is entity are very rare in published studies owing
FIGURE 1. Magnetic resonance imaging scan showinghe
80the small number of cases worldwide. It seemsvious that cholesteatoma recurrence can occurickly if the keratin matrix has not been com-tely removed.4 Taguchi et al.5 reported a case ofurrence 7 years after pyeloscopic treatment.povitch et al.8 described a case with a long-termurrence-free follow-up of more than 56 years.table in that long-term case was that supportiveamin A therapy led to stabilization of the kera-izing lesion. After discontinuing the therapy,
e symptoms recurred. It is known that vitamin Applementation has significant value in other dis-ses such as oral leukoplakia.
terogeneous mass in left renal pelvis.
FIGURE 2. Retrograde ureteropyelography.8.e20n our patient, the cholesteatoma recurred afteryears, although no supportive therapy had been
ed, and a percutaneous approach led to quickd satisfactory results.
. Rosina G: Two rare forms of chronic pyelitis: leukopla-with cholesteatoma and wide, isolated calcification of theal pelvis. Osp Maggiore 41: 431437, 1953.. Hertle L, and Androulakakis P: Keratinizing desquama-
e squamous metaplasia of the upper urinary tractleukopla-cholesteatoma. J Urol 127: 631635, 1982.. Weitzner S: Cholesteatoma of the calix. J Urol 108: 365, 1972.. Willis JS, Pollack H, and Curtis JA: Cholesteatoma of the
per urinary tract. AJR Am J Roentgenol 136: 941944,1.. Taguchi Y, Kotha V, Tomka B, et al: Conservinghrons in cholesteatoma. J Urol 123: 258260, 1980.. Neerhut G, Politis G, Alpert L, et al: Cholesteatoma ofrenal pelvis: endoscopic management. J Urol 139: 10324, 1988.. Gale GL, and Kerr WK: Cholesteatoma of the urinary
ct. J Urol 104(1): 7172, 1970.. Lupovitch A, Domzalski H, and Tippins R: Cholestea-a of the renal pelvisa case with long term follow up.
rol 140: 360361, 1988.
FIGURE 3. Percutaneous approach.UROLOGY 64 (4), 2004
LATE RECURRENCE OF RENAL CHOLESTEATOMA AFTER 15 YEARSCASE REPORTCOMMENTREFERENCES