Neoplasia in analgesic nephropathy A urothelial field change

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Abstract
The association between analgesic nephropathy and urothelial cancer, usually in the renal pelvis, is well established. Two such patients are presented in whom careful morphologic study of nephrectomy specimens demonstrated severe and extensive urothelial dysplasia, with focal carcinoma in situ and grossly invisible invasive tumors. In 1 patient, no gross lesion was apparent in the urothelium. These findings support the development of invasive carcinoma through a phase of carcinoma in situ caused by the action of carcinogenic analgesic metabolites in the urine. Caution is needed in the assessment of urinary cytologic atypia and in the examination of excised urothelium in those patients.