PMC4719903_01
CT urogram. (A) Noncontrast phase image illustrating left hydronephrosis with tapering at the left UPJ (arrow) on coronal section. (B) Contrast-enhanced image revealing left UPJ obstruction (arrow) with no enhancement of periureteral tissue or retroperitoneal pathology and the absence of crossing vessels. (C) Excretory phase image demonstrating delayed left nephrogram and absent opacification of the left renal pelvis and proximal ureter with concomitant tapering at the left UPJ (arrow).
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Her symptoms prompt cross-sectional imaging of the abdomen and pelvis which reveals isolated swelling of the left renal pelvis and tapering at the UPJ, findings concerning for UPJ obstruction (Fig. 1A). No enhancement of the ureteral wall or periureteral tissue around the left UPJ is identified after administration of intravenous contrast and careful inspection of the vascular architecture in the vicinity of left renal pelvis fails to reveal a crossing vessel (Fig. 1B). CT urography demonstrate a delayed left nephrogram and failed opacification of the left renal pelvis and ureter, confirming left renal obstruction (Fig. 1C). Compression of the UPJ by a moderate-sized parapelvic cyst is suspected.
PMC4719903_02
PMC4719903_03
Intraoperative appearance of L UPJ during planned laparoscopic pyeloplasty. The UPJ and adjacent proximal ureter appear encased by a desmoplastic rind compared with more distal ureteral and renal pelvis tissues which have a healthy, pinkish appearance.
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Upon isolating the renal pelvis with the intent to perform a dismembered pyeloplasty, the left UPJ and adjacent proximal ureter is noted to have a nearly circumferential desmoplastic rind (Fig. 2).
Left UPJ Tissue. (A) Invasive carcinoma infiltrating fibroconnective tissue; H&E stain, original magnification x40. (B) Invasive carcinoma is highlighted by positive staining for Estrogen Receptor (ER); ER immunostain, original magnification x40.
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Immunohistochemical stains performed as part of final pathologic assessment reveal the sampled UPJ tissue to be negative for mammoglobin and gross cystic disease fluid protein, however, strongly positive for estrogen receptor (Fig. 3).