Asymptomatic ureteral metastasis of chromophobe renal cell carcinoma after radical nephrectomy: A case report and review of literature.

INTRODUCTION: Standard treatment for renal cell carcinomas (RCCs) is radical/partial nephrectomy and unlike upper urothelial carcinoma, complete ureteral removal is not necessary nor is advised in RCCs as tumor recurrence in ureteral remnant has scarcely been reported. Here, we present a rare case of chromophobe RCC (ChRCC) metastasis in remnant ureter following radical nephrectomy and perform a literature review in this regard. CASE PRESENTATION: A 66-year-old man presented with a CT scan-as a surveillance protocol imaging- showing a mass in ipsilateral remnant ureter 9 months after radical nephrectomy due to ChRCC while being completely asymptomatic. Cystoscopy revealed a polypoid mass protruding from right ureterovesical junction and transurethral resection of tumor revealed it to be a ChRCC. Distal ureterectomy was performed confirming pathology without any lymph node involvement. 12 months after ureterectomy, he remained asymptomatic with no sign of metastasis or recurrence in his follow up CT scan. DISCUSSION: RCC metastasis to distal ureter after radical nephrectomy has been rarely reported and only 2 cases of them were ChRCC. Gross hematuria has been the main presentation of such disease. However, our case was completely asymptomatic, highlighting necessity of surveillance imaging. No specific treatment guideline exists for such presentation but tumor resection has been the most common treatment modality. CONCLUSION: Metachronous RCC metastasis may occur in remnant ureter which can be completely asymptomatic, highlighting necessity of surveillance imaging and reviewing them meticulously. Surgical resection of the metastasis by distal ureterectomy seems to be the best treatment option.

Enhancing bladder cancer diagnosis through transitional cell carcinoma polyp detection and segmentation: an artificial intelligence powered deep learning solution.

Background: Bladder cancer, specifically transitional cell carcinoma (TCC) polyps, presents a significant healthcare challenge worldwide. Accurate segmentation of TCC polyps in cystoscopy images is crucial for early diagnosis and urgent treatment. Deep learning models have shown promise in addressing this challenge. Methods: We evaluated deep learning architectures, including Unetplusplus_vgg19, Unet_vgg11, and FPN_resnet34, trained on a dataset of annotated cystoscopy images of low quality. Results: The models showed promise, with Unetplusplus_vgg19 and FPN_resnet34 exhibiting precision of 55.40 and 57.41%, respectively, suitable for clinical application without modifying existing treatment workflows. Conclusion: Deep learning models demonstrate potential in TCC polyp segmentation, even when trained on lower-quality images, suggesting their viability in improving timely bladder cancer diagnosis without impacting the current clinical processes.

Malignant rhabdoid tumor of kidney in an adult patient with positive family history of rhabdoid tumor: A case report and review of literature.

INTRODUCTION AND IMPORTANCE: Malignant rhabdoid tumor of kidney (MRTK) is almost exclusive to children. Only 10 cases of adult MRTK have been reported. Here, we present a case of MRTK in an adult patient and discuss its clinical findings, diagnostic challenges, and treatment outcome. We also perform literature review on this issue. CASE PRESENTATION: Our patient was a 29-year-old woman presented with fever and hematuria. She also mentioned atypical teratoid/rhabdoid tumor of cerebellum in her deceased child. Initial diagnostic work up led to left partial nephrectomy with the pathology report of high grade undifferentiated tumor. Early tumor recurrence necessitated left radical nephrectomy with extensive excision of adjacent tissues. Pathology for second specimen considering disease course and family history was MRTK. Even though chemotherapy was administered, she died few months later due to multiple metastases. CLINICAL DISCUSSION: Although diagnosis is challenging in all 11 reported cases -including our case- of adult MRTK, immunohistochemistry (i.e., negative reaction for INI-1) in conjunction with clinical and radiological findings are the main tool to reach diagnosis. Treatment options are much more diverse, ranging from surgery to immunotherapy, tyrosine kinase inhibitors, chemotherapy, and combination of these modalities. Prognosis remains dismal with the mean survival period of 7 months. CONCLUSION: Although extremely rare, MRTK might happen in adults. We report the first case of adult MRTK with positive family history of rhabdoid tumor of CNS, underscoring the importance of family history in reaching the diagnosis and highlighting the role of genetics in this rare disease.