Extensive Intestinal Metaplasia in Renal Pelvis

Sarrah Al sumahi, Hiba Al-Zou'bi, Suhaib Al khatib, Najla AlDaoud


A case report of intestinal metaplasia of the renal pelvis which is a rare metaplastic change with fewer than 15 cases reported in the literature.
A 40 year old male patient, presented with chronic left flank pain. Kidney-Ureter-bladder (KUB) plain abdominal X-ray and Computed tomography (CT) scan showed multiple large left kidney stones.
A left sided nephrectomy was performed, and gross examination revealed a shrunken kidney measuring 5.0x5.0x3.0 cm. Cut surface showed dilated pelvicalyceal system and thinning of the cortex. Large yellow stone is seen obstructing part of the pelvicalyceal system. Light microscopic examination revealed features of chronic pyelonephritis. The epithelial lining of the renal pelvis showed extensive intestinal metaplasia replacing the whole renal pelvis with abundant goblet cells. Immunohistochemical studies showed that few intestinal metaplastic cells are immunoreactive for ki67 and P53 immunostains.
Extensive intestinal metaplasia in renal pelvis reported in the literature showed strong association with pyelonephritis and kidney calculi.
Intestinal metaplasia in renal pelvis is a potentially premalignant condition for renal pelvic adenocarcinoma, and the criteria for classification of dysplasia in these lesions are not well identified in the literature and need further clarification with more molecular studies.

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