Atypical Recurrent Renal Cell Carcinoma of the Ipsilateral Ureter Showing Typical Symptoms of Upper Urinary Tract Urothelial Carcinoma: A Case Report and Literature Review.

ABSTRACT

BACKGROUND: Ureteral metastasis is a rare phenomenon. Synchronous recurrence in both the pelvis and ureter with symptoms that are typical of upper urinary tract urothelial carcinoma (UTUC) has not been reported previously. METHODS: We present a case of metastasis of clear cell renal cell carcinoma (ccRCC) to the ipsilateral pelvis and ureter in a 37-year-old man who underwent open partial nephrectomy (PN) after laparoscopic exploration 20 months after surgery. We suspected painless hematuria with clots and upper UTUC based on the imagological diagnosis. We performed complete transperitoneal laparoscopic nephroureterectomy in a single position. We also searched PubMed for studies with the keywords "renal cell carcinoma" and "ureteral metastasis" that had been published since 2000. RESULTS: Postoperative pathology demonstrated ccRCC in the left pelvis that had spread along the ureter. The patient was discharged 1 week after surgery, without a drainage tube, and free to eat and perform normal activities. We identified 10 cases from nine studies that had been published since 2000. Nephrectomy was performed in all 10 cases, and nine of the patients had hematuria. Open ureterectomy was performed on two patients who had ipsilateral ureteral metastasis. CONCLUSIONS: Recurrent ccRCC in the ureter is rare. Due to the difficulty in distinguishing it from ipsilateral upper UTUC, complete transperitoneal laparoscopic nephroureterectomy in a single position is a safe and feasible treatment option in this situation.