ABSTRACT
INTRODUCTION: Metastasis of malignant melanoma to urinary tract is reported to be rare. According to retrospective analysis of a single center study, improvement of overall survival was observed in patients with metastasis to the gastrointestinal tract that had undergone metastasectomy with curative intent. However, there is no significant evidence regarding resection for metastasis to urinary tract. CASE PRESENTATION: Case 1: an 86-year-old Japanese man was diagnosed with a small bladder tumor by computed tomography scan during post operative follow-up of malignant melanoma in the choroid of the left eye. Cystoscopy revealed black, nonpapillary tumors, suggesting metastatic malignant melanoma. Because no apparent invasive growth to muscle layer was observed by magnetic resonance imaging, transurethral resection was performed. Pathological appearance was compatible with metastatic malignant melanoma. No recurrence in urinary tract was observed; however, multiple liver metastasis was diagnosed at 3 months after surgery. Case 2: a 57-year-old Japanese man was diagnosed with right hydronephrosis due to ureteral tumor. He had a past history of subungual malignant melanoma to the left thumb 2 years prior to his visit. Right nephroureterectomy was performed, and pathological evaluation revealed metastatic malignant melanoma. He revisited 2 years later due to dysuria, and a large bladder tumor was revealed by ultrasound. Cystoscopy showed black-colored nonpapillary tumor, suggesting malignant melanoma. Total cystectomy was recommended; however, the patient withheld consent. Therefore, we performed transurethral resection. The resulting pathological finding was compatible with metastatic malignant melanoma without invasion to muscle layer. He remained free from local recurrence and metastasis for 22 years after surgery. CONCLUSION: We successfully performed metastasectomy for bladder and ureteral metastases without recurrence in the urinary tract. Long recurrence-free survival was observed in case 2. Complete resection for metastasis of malignant melanoma may have the potential to improve survival.
Subject(s)
Melanoma , Humans , Male , Melanoma/surgery , Melanoma/secondary , Melanoma/pathology , Middle Aged , Aged, 80 and over , Urinary Bladder Neoplasms/pathology , Urinary Bladder Neoplasms/surgery , Ureteral Neoplasms/pathology , Ureteral Neoplasms/surgery , Ureteral Neoplasms/secondary , Liver Neoplasms/secondary , Liver Neoplasms/surgery , Tomography, X-Ray Computed , Choroid Neoplasms/secondary , Choroid Neoplasms/surgeryABSTRACT
ABSTRACT: Hematogenous or lymphatic intraureteral metastasis from distant primary cancer is very rare. We present contrast-enhanced CT and FDG PET/CT findings in a case of intraureteral metastasis from colonic adenocarcinoma 3 years after colectomy. The intraureteral showed moderate enhancement on contrast-enhanced CT and increased FDG uptake on PET/CT mimicking a primary ureteral carcinoma. This case suggests that metastatic tumor of the ureter should be considered in the differential diagnosis in patients with hypermetabolic ureteral lesion and known malignancy.
Subject(s)
Colonic Neoplasms , Fluorodeoxyglucose F18 , Positron Emission Tomography Computed Tomography , Ureteral Neoplasms , Humans , Colonic Neoplasms/diagnostic imaging , Colonic Neoplasms/pathology , Ureteral Neoplasms/diagnostic imaging , Ureteral Neoplasms/secondary , Diagnosis, Differential , Male , Tomography, X-Ray Computed , Multimodal Imaging , Aged , Middle AgedABSTRACT
BACKGROUND: Bone metastasis (BM) carries a poor prognosis for patients with upper-tract urothelial carcinoma (UTUC). This study aims to identify survival predictors and develop a prognostic nomogram for overall survival (OS) in UTUC patients with BM. METHODS: The Surveillance, Epidemiology, and End Results database was used to select patients with UTUC between 2010 and 2019. The chi-square test was used to assess the baseline differences between the groups. Kaplan-Meier analysis was employed to assess OS. Univariate and multivariate analyses were conducted to identify prognostic factors for nomogram establishment. An independent cohort was used for external validation of the nomogram. The discrimination and calibration of the nomogram were evaluated using concordance index (C-index), area under receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis (DCA). All statistical analyses were performed using SPSS 23.0 and R software 4.2.2. RESULTS: The mean OS for UTUC patients with BM was 10 months (95% CI: 8.17 to 11.84), with 6-month OS, 1-year OS, and 3-year OS rates of 41%, 21%, and 3%, respectively. Multi-organ metastases (HR = 2.21, 95% CI: 1.66 to 2.95, P < 0.001), surgery (HR = 0.72, 95% CI: 0.56 to 0.91, P = 0.007), and chemotherapy (HR = 0.37, 95% CI: 0.3 to 0.46, P < 0.001) were identified as independent prognostic factors. The C-index was 0.725 for the training cohort and 0.854 for the validation cohort, and all AUC values were > 0.679. The calibration curve and DCA curve showed the accuracy and practicality of the nomogram. CONCLUSIONS: The OS of UTUC patients with BM was poor. Multi-organ metastases was a risk factor for OS, while surgery and chemotherapy were protective factors. Our nomogram was developed and validated to assist clinicians in evaluating the OS of UTUC patients with BM.
Subject(s)
Bone Neoplasms , Carcinoma, Transitional Cell , Nomograms , Ureteral Neoplasms , Humans , Bone Neoplasms/secondary , Bone Neoplasms/mortality , Male , Female , Aged , Middle Aged , Carcinoma, Transitional Cell/secondary , Carcinoma, Transitional Cell/mortality , Ureteral Neoplasms/mortality , Ureteral Neoplasms/pathology , Ureteral Neoplasms/secondary , Survival Rate , Kidney Neoplasms/pathology , Kidney Neoplasms/mortality , Prognosis , Retrospective Studies , SEER Program , Aged, 80 and overABSTRACT
The occurrence of ureteral metastasis from distant primary tumors is uncommon, and appears to be especially rare when it originates from the lungs. In the case presented here, a patient with lumbago and left hydronephrosis was diagnosed with left ureteral metastasis of pulmonary adenocarcinoma after a CT-guided percutaneous transthoracic needle biopsy of the lung and retroperitoneal laparoscopic left nephroureterectomy. He accepted the targeted therapy because the lung tumor epidermal growth factor receptor mutation (exon19 deletion) was positive, and preoperative staging of lung adenocarcinoma was stage IVA. After an 8-month follow-up, he is still alive and well, with no local recurrence or distant metastases. The therapy outcome assessment is stable disease. Although rare, our case has demonstrated that pulmonary adenocarcinoma has the possibility of metastasizing to the ureter, a risk that should be considered in some lung cancer patients.
Subject(s)
Adenocarcinoma of Lung/drug therapy , Adenocarcinoma of Lung/pathology , Lung Neoplasms/drug therapy , Lung Neoplasms/pathology , Nephroureterectomy/methods , Ureteral Neoplasms/secondary , Ureteral Neoplasms/surgery , Acrylamides/therapeutic use , Adult , Aniline Compounds/therapeutic use , Humans , Male , Protein Kinase Inhibitors/therapeutic useABSTRACT
AIM: To compare the patency and safety of covered metallic stents (CMS) and the double-J stent (DJS) for treating malignant ureteral obstruction (MUO) in advanced gastric cancer (AGC). MATERIALS AND METHODS: Between 2016 and 2018, the medical records of 61 patients (84 ureters; CMS, 39 patients, 54 ureters; DJS, 22 patients, 30 ureters) with MUO caused by AGC were reviewed retrospectively. The Kaplan-Meier method and log-rank test were used to evaluate differences of primary or assisted primary patency between groups. Cox regression was conducted separately for early (within 7 days) and late (after 7 days) primary patency. RESULTS: Technical success of CMS placement was 100% (54/54) and 96.8% (29/30) for DJS (p=0.357). The cumulative stent patency rates at 1, 3, 6, and 12 months were 77%, 74%, 70%, and 70%, in the CMS group and 72%, 60%, 53%, and 26%, in the DJS group. Apart from the period within 7 days (p=0.784), primary patency was consistently higher in the CMS group when compared to the DJS group over the entire follow-up period (p=0.034). Assisted primary patency was consistently higher in the CMS group than in the DJS group over the entire follow-up period (p=0.001). The CMS group was more likely to have complications than the DJS group (48.1% versus 16.7%, p=0.004). Complications were minor, self-limiting events such as haematuria/haematoma. CONCLUSION: CMS had better late patency and assisted primary patency than DJS. Procedure-related minor complications more frequently occurred with CMS.
Subject(s)
Stents , Stomach Neoplasms/pathology , Ureteral Neoplasms/secondary , Ureteral Obstruction/etiology , Ureteral Obstruction/surgery , Aged , Female , Humans , Male , Middle Aged , Retrospective Studies , Self Expandable Metallic Stents , Tomography, X-Ray Computed , Ureteral Neoplasms/diagnostic imaging , Ureteral Obstruction/diagnostic imagingABSTRACT
Xanthogranulomatous pyelonephritis is well established as a renal mass-forming inflammatory process. However, a ureteral counterpart is minimally recognized. In this article, we present a case of xanthogranulomatous ureteritis in an 81-year-old woman, mimicking ureteral involvement by cancer in a radical cystectomy specimen for invasive urothelial carcinoma. Similar to the pathogenesis of xanthogranulomatous pyelonephritis, the patient was noted to have ureteral obstruction by calculus and had urine culture positive for Klebsiella pneumoniae. To our knowledge, this is the first report of xanthogranulomatous ureteritis associated with this pathogen and the only report associated with concurrent bladder cancer. Increased pathologist and urologist awareness of xanthogranulomatous ureteritis expands the spectrum of pseudotumoral processes of the ureter.
Subject(s)
Carcinoma, Transitional Cell/surgery , Klebsiella Infections/diagnosis , Urinary Bladder Neoplasms/surgery , Urinary Tract Infections/diagnosis , Xanthomatosis/diagnosis , Aged, 80 and over , Carcinoma, Transitional Cell/pathology , Cystectomy , Diagnosis, Differential , Female , Humans , Klebsiella Infections/immunology , Klebsiella Infections/microbiology , Klebsiella pneumoniae/immunology , Klebsiella pneumoniae/isolation & purification , Ureter/immunology , Ureter/microbiology , Ureter/pathology , Ureter/surgery , Ureteral Neoplasms/diagnosis , Ureteral Neoplasms/secondary , Urinary Bladder/pathology , Urinary Bladder/surgery , Urinary Bladder Neoplasms/pathology , Urinary Tract Infections/immunology , Urinary Tract Infections/microbiology , Xanthomatosis/immunology , Xanthomatosis/microbiologyABSTRACT
OBJETIVO: Resaltar la importancia del seguimiento estrecho a largo plazo de pacientes con antecedente de carcinoma de mama. MATERIALES Y MÉTODOS: Presentación de un caso clínico. RESULTADOS: Se presenta el caso de una mujer de 55 años de edad con antecedente de carcinoma lobulillar de mama. Recibió tratamiento neoadyuvante, cirugía y quimioterapia y radioterapia posterior. En estudio de imagen de control se diagnosticó de metástasis óseas múltiples. La paciente consultó por dolor lumbar izquierdo de varios meses de evolución, en estudio de imagen se observó hidronefrosis izquierda secundaria a lesión de partes blandas en unión pieloureteral con alteración funcional renal. En biopsia realizada mediante abordaje endoscópico (ureteroscopia) se diagnosticó de metástasis de carcinoma de mama en uréter. CONCLUSIÓN: Las lesiones metastásicas en uréter son extremadamente infrecuentes siendo aún menos frecuentes las de origen mamario con alrededor de diez casos publicados mundialmente. Con el diagnóstico previo de carcinoma de mama, el probable compromiso ureteral debe ser tomado en cuenta especialmente en pacientes con síntomas clínicos y radiológicos de obstrucción de la vía urinaria. Un diagnóstico oportuno es posible que influya en el pronóstico y supervivencia posterior
OBJECTIVE: To assess the importance of long-term close follow-up in patients with breast carcinoma. MATERIALS AND METHODS: To present a case report RESULTS: A case of a 55-year-old woman with history of lobular carcinoma of the breast is presented. She received neoadjuvant treatment, surgery and complementary chemotherapy and radiotherapy. In radiologic imaging studies, multiple bone metastases were diagnosed. The patient consulted for left lumbar pain. Radiologic studies revealed left hydronephrosis secondary to soft tissue lesion in pyeloureteral junction with renal functional impairment. A biopsy performed using an endoscopic approach (ureteroscopy), diagnosed a metastasis of breast carcinoma in the ureter. CONCLUSION: Metastatic lesions in the ureter are extremely rare, even less frequent the ones with breast origin with around ten cases published worldwide. With the previous diagnosis of breast carcinoma, the probable ureteral compromise should be considered especially in patients with clinical and radiological symptoms of urinary tract obstruction. A well-timed and proper diagnosis may influence in prognosis and survival
Subject(s)
Humans , Female , Middle Aged , Breast Neoplasms/pathology , Carcinoma, Lobular/secondary , Ureteral Neoplasms/secondary , Breast Neoplasms/diagnostic imaging , Carcinoma, Lobular/diagnostic imaging , Ureteral Neoplasms/diagnostic imaging , UreteroscopyABSTRACT
A 72-year-old man with a history of prostate adenocarcinoma initially managed by radical prostatectomy and salvage radiation therapy underwent resection of a left vas deferens recurrence identified on PSMA PET. Despite an initial response, PSA failed to fall below 3.5 ng/L, prompting re-evaluation with PSMA PET/CT: a left distal hydroureter with presumed physiologic urine activity remains despite diuretic administration. Upon scrutiny of the prior PSMA PET/CT and diagnostic CTs, the distal ureteral uptake matched a subtle circumferential area of enhancing mild ureteral thickening. Pathological review after left uretectomy confirmed metastatic prostate cancer.
Subject(s)
Antigens, Surface/metabolism , Glutamate Carboxypeptidase II/metabolism , Positron Emission Tomography Computed Tomography , Prostatic Neoplasms/pathology , Ureteral Neoplasms/diagnostic imaging , Ureteral Neoplasms/secondary , Aged , Humans , Male , Prostatectomy , Prostatic Neoplasms/metabolism , Prostatic Neoplasms/therapy , Salvage TherapyABSTRACT
A 70-year-old man with multiple metastasized renal cell carcinoma (RCC) presented himself in our clinic 25 years after initial diagnosis with newly developed hematuria and conspicuous right testis. The biopsy of the left ureter taken by ureterorenoscopy and the right orchiectomy show metastases of a clear cell RCC. This special case shows rare metastases in different organ systems. The individualized multimodal treatment led to a long-term survival with this metastasized disease. The presented case shows that late recurrences of RCC can occur years after initial diagnosis and should be considered at any time.
Subject(s)
Carcinoma, Renal Cell/surgery , Kidney Neoplasms/surgery , Nephrectomy , Testicular Neoplasms/secondary , Ureteral Neoplasms/secondary , Aged , Carcinoma, Renal Cell/pathology , Humans , Kidney Neoplasms/pathology , Male , Testicular Neoplasms/pathology , Ureteral Neoplasms/pathologyABSTRACT
We describe the rare case of a 61-year-old female with right ureteropelvic junction (UPJ) obstruction caused by metastatic cholangiocarcinoma. Her past medical history was notable for cholangiocarcinoma treated with neoadjuvant chemoradiation and two orthotopic liver transplants six years earlier. Urology was consulted when she presented with flank pain and urinary tract infection. Diagnostic workup demonstrated right UPJ obstruction. She was managed acutely with percutaneous nephrostomy. She subsequently underwent robotic pyeloplasty and intrinsic obstruction of the UPJ was discovered. Histological examination revealed adenocarcinoma, consistent with systemic recurrence of the patient's known cholangiocarcinoma.
Subject(s)
Cholangiocarcinoma/complications , Pelvic Neoplasms/complications , Ureteral Neoplasms/complications , Ureteral Obstruction/etiology , Bile Duct Neoplasms/pathology , Cholangiocarcinoma/secondary , Female , Humans , Hydronephrosis/diagnostic imaging , Hydronephrosis/etiology , Middle Aged , Pelvic Neoplasms/secondary , Tomography, X-Ray Computed , Ureteral Neoplasms/secondary , Ureteral Obstruction/diagnostic imaging , Ureteral Obstruction/pathology , UrographyABSTRACT
ABSTRACT We describe the rare case of a 61-year-old female with right ureteropelvic junction (UPJ) obstruction caused by metastatic cholangiocarcinoma. Her past medical history was notable for cholangiocarcinoma treated with neoadjuvant chemoradiation and two orthotopic liver transplants six years earlier. Urology was consulted when she presented with flank pain and urinary tract infection. Diagnostic workup demonstrated right UPJ obstruction. She was managed acutely with percutaneous nephrostomy. She subsequently underwent robotic pyeloplasty and intrinsic obstruction of the UPJ was discovered. Histological examination revealed adenocarcinoma, consistent with systemic recurrence of the patient's known cholangiocarcinoma.
Subject(s)
Humans , Female , Pelvic Neoplasms/complications , Ureteral Neoplasms/complications , Ureteral Obstruction/etiology , Cholangiocarcinoma/complications , Pelvic Neoplasms/secondary , Ureteral Neoplasms/secondary , Ureteral Obstruction/pathology , Ureteral Obstruction/diagnostic imaging , Bile Duct Neoplasms/pathology , Urography , Tomography, X-Ray Computed , Cholangiocarcinoma/secondary , Hydronephrosis/etiology , Hydronephrosis/diagnostic imaging , Middle AgedABSTRACT
Enfortumab vedotin is an antibody-drug conjugate targeting nectin-4 and is being studied in the treatment of various epithelial carcinomas including urothelial carcinoma; early data suggests efficacy and tolerability. Rash has been described as an adverse event associated with treatment with enfortumab vedotin, but has not been characterized to date. We report a patient with metastatic urothelial carcinoma treated with enfortumab vedotin who developed erythematous, scaly papules and plaques on his torso and extremities with corresponding histologic features of vacuolar interface dermatitis and maturation disarray of keratinocytes. He was successfully treated with topical corticosteroids. Cutaneous toxicity appears to be a common adverse reaction in this growing class of antibody-drug conjugates.
Subject(s)
Antibodies, Monoclonal/adverse effects , Antineoplastic Agents, Immunological/adverse effects , Carcinoma, Transitional Cell/drug therapy , Drug Eruptions/etiology , Lung Neoplasms/drug therapy , Ureteral Neoplasms/drug therapy , Aged , Carcinoma, Transitional Cell/secondary , Drug Eruptions/pathology , Humans , Immunoconjugates/adverse effects , Lung Neoplasms/secondary , Lymphatic Metastasis , Male , Ureteral Neoplasms/secondaryABSTRACT
PURPOSE: We investigated the prognostic impact of concomitant carcinoma in situ in radical cystectomy specimens. MATERIALS AND METHODS: We performed a systematic review and meta-analysis using MEDLINE®, Scopus®, Web of Science™ and The Cochrane Library to identify eligible studies published until October 2017. Studies were eligible for analysis if they compared patients with concomitant carcinoma in situ in radical cystectomy specimens for bladder cancer to patients without concomitant carcinoma in situ to determine its value to prognosticate overall mortality, recurrence-free survival, cancer specific mortality and ureteral involvement using multivariable analysis. The protocol for this systematic review was registered in PROSPERO (Prospective Register of Systematic Reviews, CRD42018086539) and is available in full on the University of York website. RESULTS: Overall 23 studies published between 2006 and 2017 including a total of 20,647 patients were selected for the systematic review and meta-analysis. Concomitant carcinoma in situ was reported in 39.4% of radical cystectomy specimens. In studies analyzing all patients the presence of concomitant carcinoma in situ was not associated with overall mortality (pooled HR 0.92, 0.77-1.10), recurrence-free survival (pooled HR 1.06, 0.99-1.13) or cancer specific mortality (pooled HR 1.00, 0.93-1.07). It was associated with ureteral involvement (pooled OR 4.51, 2.59-7.84). On subanalysis of studies restricted to patients with organ confined bladder cancer at radical cystectomy concomitant carcinoma in situ was associated with worse recurrence-free survival (pooled HR 1.57, 1.12-2.21) and cancer specific mortality (pooled HR 1.51, 1.001-2.280). CONCLUSIONS: Concomitant carcinoma in situ is significantly associated with ureteral involvement in patients treated with radical cystectomy. In patients with organ confined disease concomitant carcinoma in situ in the radical cystectomy specimen is a prognosticator of recurrence-free survival and cancer specific mortality.
Subject(s)
Carcinoma in Situ/pathology , Cystectomy , Neoplasm Recurrence, Local/diagnosis , Ureteral Neoplasms/diagnosis , Urinary Bladder Neoplasms/pathology , Carcinoma in Situ/diagnosis , Carcinoma in Situ/epidemiology , Carcinoma in Situ/surgery , Disease-Free Survival , Humans , Neoplasm Recurrence, Local/epidemiology , Neoplasm Recurrence, Local/pathology , Prognosis , Survival Analysis , Treatment Outcome , Ureteral Neoplasms/epidemiology , Ureteral Neoplasms/pathology , Ureteral Neoplasms/secondary , Urinary Bladder/pathology , Urinary Bladder/surgery , Urinary Bladder Neoplasms/mortality , Urinary Bladder Neoplasms/surgeryABSTRACT
In patients with prostate cancer, metastases mostly develop in bone, lung, liver, pleura and adrenal glands. Prostate carcinoma metastases to the ureter are very rare, and the peritoneum is an even rarer site of prostate metastases. We present two cases of ureteral metastases of prostate cancer, of which one patient also developed malignant ascites and peritoneal metastases. An overview of the literature on these metastatic sites is also provided. Both patients presented with hydronephrosis and a ureteral mass. Biopsies of the masses were taken, which showed the presence of prostate carcinoma metastases. The first patient was treated with chemotherapy but was diagnosed with progressive disease and died 3 years later. The second patient was diagnosed with pathology-confirmed peritoneal metastases 8 months later. He died 2 years after presentation with hydronephrosis.
Subject(s)
Peritoneal Neoplasms/secondary , Prostatic Neoplasms/pathology , Ureteral Neoplasms/secondary , Aged , Humans , Male , Peritoneal Neoplasms/diagnostic imaging , Peritoneal Neoplasms/pathology , Prostate-Specific Antigen/blood , Tomography, X-Ray Computed , Ureteral Neoplasms/diagnostic imaging , Ureteral Neoplasms/pathology , Ureteral Obstruction/etiologyABSTRACT
A 62-year-old woman underwent laparoscopic radial nephrectomy for the left renal cell carcinoma in September 2008. In July2016, the patient developed asymptomatic gross hematuria. Computed tomography (CT) revealed the enlargement of the left ureteral stump and an 11mm nodule in the superior lobe of the right lung. Since [F-18] fluoro-D-glucose-positron emission tomography-CT FDG PET-CT demonstrated a lung tumor, we decided to perform right upper lobectomybyvideo-assisted thoracoscopic surgeryin September. The patient was diagnosed with metastatic renal cell carcinoma. We then removed the left ureteral stump and performed partial cystectomy in November. A pathological examination revealed that the tumor was metastatic clear cell renal cell carcinoma invading the muscle layer. Two months later, the patient developed gross hematuria again. Cystoscopy revealed a 1cm tumor around the scar of partial cystectomy. Transurethral resection was performed, and a pathological examination revealed metastatic renal cell carcinoma. We herein report this case of renal cell carcinoma in which recurrence occurred in the ureteral stump, 8 years after radical nephrectomy.
Subject(s)
Carcinoma, Renal Cell/secondary , Kidney Neoplasms/pathology , Ureteral Neoplasms/secondary , Carcinoma, Renal Cell/diagnostic imaging , Carcinoma, Renal Cell/surgery , Female , Humans , Kidney Neoplasms/surgery , Middle Aged , Nephrectomy , Time Factors , Tomography, X-Ray Computed , Ureteral Neoplasms/diagnostic imaging , Ureteral Neoplasms/surgeryABSTRACT
Imaging features of metastases to the urinary system may closely mimic primary urinary tract tumors, and differential diagnosis by imaging alone may be problematic or even impossible in some cases. The main purpose of this article was to familiarize radiologists with imaging findings of metastasis to the urinary system on cross-sectional imaging, with an emphasis on abdominal and pelvic computed tomography and magnetic resonance imaging. In addition, we review the clinical importance and implications of metastases to the urinary tract and provide information on diagnostic work-ups.
Subject(s)
Urologic Neoplasms/diagnosis , Diagnosis, Differential , Humans , Kidney Neoplasms/diagnosis , Kidney Neoplasms/diagnostic imaging , Kidney Neoplasms/secondary , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Ureteral Neoplasms/diagnosis , Ureteral Neoplasms/diagnostic imaging , Ureteral Neoplasms/secondary , Urinary Bladder Neoplasms/diagnostic imaging , Urinary Bladder Neoplasms/secondary , Urologic Neoplasms/pathologyABSTRACT
True metastatic ureteric lesions are exceptionally rare when sourced from any primary tumour. Primary prostatic cancer metastasis to the ureter is understandably even more atypical with very few cases reported in current literature. True intramural ureteric metastatic disease deposited from prostate cancer is an even rarer occurrence. We present a case of a man in his mid-60s with left-sided hydronephrosis in the setting of biochemical recurrence of Gleason 9 prostate cancer. Initially misdiagnosed as obstruction secondary to mass effect from a large trigonal lesion, subsequent investigation revealed solid intramural metastatic deposit of prostate primary tumour in the distal ureter. We detail current hypotheses regarding the subsequent pathophysiology of the disease and its common clinical presentations. Our case highlights that prostatic metastasis should be considered as a differential in coexisting prostate cancer and ureteric obstruction despite its low incidence.
Subject(s)
Hydronephrosis/etiology , Prostatic Neoplasms/complications , Ureteral Neoplasms/secondary , Ureteral Obstruction/etiology , Humans , Hydronephrosis/pathology , Male , Middle Aged , Prostatic Neoplasms/pathologyABSTRACT
Ureteral metastasis of renal cell carcinoma (RCC) is rare and usually confined to the ipsilateral ureter. In literature, about 50 cases have been reported so far. Of these, only 14 metastasized metachronously to the contralateral ureter.A seventy-one-year-old man was hospitalized with recurrent painless severe haematuria. Seven years previously, he had undergone radical nephrectomy of the right kidney due to a clearcell renal cell carcinoma (cRCC), Fuhrman grad 2. Intravenous urography and a retrograde ureterogram revealed a filling defect (25 mm) in the left distal ureter, which we expected to be an urothelial carcinoma. Biopsy was not possible, due to ureteral stricture. Diagnostic workup revealed no other sites of metastasis. To preserve kidney function and quality of life we refrainedfrom performing nephroureterectomy and opted for an autotransplantation of the solitary left kidney with ureteral reimplantation in the bladder. We resected the ureter and histopathologicial examination showed a metastasis of cRCC, Fuhrman grade 2.Postoperatively, the patient developed an acute postrenal failure, hence a nephrostomy and a bladder catherization were performed. After this, the patient improved significantly and the drains could be removed. Currently the patient is free of complaints. The residual and contralateral ureter is a potential metastatic site after RCC. Autotransplantation is an option forsurgical treatment.
Subject(s)
Carcinoma, Renal Cell/surgery , Kidney Neoplasms/surgery , Kidney Transplantation , Ureteral Neoplasms/surgery , Acute Kidney Injury/etiology , Aged , Carcinoma, Renal Cell/secondary , Humans , Kidney Neoplasms/pathology , Kidney Transplantation/adverse effects , Male , Nephrectomy/adverse effects , Transplantation, Autologous/adverse effects , Ureteral Neoplasms/secondaryABSTRACT
BACKGROUND: In most cases, prostate cancer metastasizes to the lymph nodes, bone, and liver. In very rare cases, it metastasizes to the ureter. Due to the difficulty in making a preoperative diagnosis, ureteral metastasis from prostate cancer is typically diagnosed after nephroureterectomy. CASE PRESENTATION: A 77-year-old Asian Japanese man with right hydronephrosis and hydroureter was referred to our hospital to undergo further examination due to the suspicion of ureteral cancer. He had been diagnosed 2 years previously with prostate cancer with a Gleason score of 4+5=9. He received radiotherapy and androgen deprivation therapy. A nephroureterectomy was performed for suspected right ureteral cancer. On the basis of a histopathological examination, poorly differentiated adenocarcinoma was suspected, and the tumor cells were positive for prostate-specific antigen immunohistochemically. CONCLUSIONS: We herein report a rare case of ureteral metastasis in castration resistant prostate cancer.
Subject(s)
Adenocarcinoma , Hydronephrosis , Nephroureterectomy/methods , Prostatic Neoplasms, Castration-Resistant/pathology , Ureter , Ureteral Neoplasms , Adenocarcinoma/diagnosis , Adenocarcinoma/pathology , Adenocarcinoma/surgery , Aged , Androgen Antagonists/therapeutic use , Diagnosis, Differential , Humans , Hydronephrosis/diagnosis , Hydronephrosis/etiology , Hydronephrosis/surgery , Male , Neoplasm Grading , Neoplasm Staging , Radiotherapy/methods , Tomography, X-Ray Computed/methods , Ureter/pathology , Ureter/surgery , Ureteral Neoplasms/diagnosis , Ureteral Neoplasms/pathology , Ureteral Neoplasms/secondary , Urography/methodsABSTRACT
PURPOSE: Patients with bladder cancer who present with hydronephrosis may require drainage of the affected kidney before receiving further cancer treatment. Drainage can be done by retrograde stenting or percutaneously. However, retrograde stenting carries the risk of tumor cell spillage to the upper urinary tract. The aim of this study was to evaluate whether patients with bladder cancer are at higher risk for upper urinary tract recurrence if retrograde stenting has been performed prior to radical cystectomy. MATERIALS AND METHODS: We retrospectively analyzed the records of 1,005 consecutive patients with bladder cancer who underwent radical cystectomy at our department between January 2000 and June 2016. Negative intraoperative ureteral margins were mandatory for study inclusion. Patients received regular followup according to our institutional protocol, including imaging of the upper urinary tract and urine cytology. RESULTS: Preoperative drainage of the upper urinary tract was performed in 114 of the 1,005 patients (11%), including in 53 (46%) by Double-J® stenting and in 61 (54%) by percutaneous nephrostomy. Recurrence developed in the upper urinary tract in 31 patients (3%) at a median of 17 months after cystectomy, including 7 of 53 (13%) in the Double-J group, 0% in the nephrostomy group and 24 of 891 (3%) in the no drainage group. Multivariate regression analysis revealed a higher risk of upper urinary tract recurrence if patients underwent Double-J stenting (HR 4.54, 95% CI 1.43-14.38, p = 0.01) and preoperative intravesical instillations (HR 2.94, 95% CI 1.40-6.16, p = 0.004). CONCLUSIONS: Patients who undergo Double-J stenting prior to radical cystectomy are at higher risk for upper urinary tract recurrence. If preoperative upper urinary tract drainage is required, percutaneous drainage might be recommended.