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CASE REPORT
Year : 2002  |  Volume : 18  |  Issue : 2  |  Page : 155-156
 

Asynchronous ureteral stump metasta­sis from papillary renal adenocarci­noma


Departments of Urology and Pathology, CMC, Vellore, India

Correspondence Address:
Ganesh Gopalakrishnan
Department of Urology, Christian Medical College and Hospital, Vellore (T.N.) - 632 004
India
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Source of Support: None, Conflict of Interest: None


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Keywords: Renal Cancer; Ureteral Stump.


How to cite this article:
Bobby VS, Kurien S, Gopalakrishnan G, Kekre NS. Asynchronous ureteral stump metasta­sis from papillary renal adenocarci­noma. Indian J Urol 2002;18:155-6

How to cite this URL:
Bobby VS, Kurien S, Gopalakrishnan G, Kekre NS. Asynchronous ureteral stump metasta­sis from papillary renal adenocarci­noma. Indian J Urol [serial online] 2002 [cited 2020 Apr 7];18:155-6. Available from: http://www.indianjurol.com/text.asp?2002/18/2/155/37622



   Introduction Top


Ureteral stump metastasis from nephrocarcinoma al­though rare is a well described entity in literature. Less than 25 cases of asynchronous ureteric stump metastasis from renal cell carcinoma have been reported in the lit­erature. We report an isolated case of papillary renal ad­enocarcinoma metastasizing to the ureteric stump.


   Case Report Top


A 45-year-old man presented with asymptomatic gross hematuria of one-month duration. A CT scan showed a 5 x 4 cms mixed density mass lesion in the upper pole of the right kidney with heterogeneous enhancement. As there was suspicion that this could be transitional cell carcinoma a retrograde study was done which showed a normal ureter and pelvicalyceal system. He had right radical nephrectomy. The histology was reported as papillary adenocarcinoma [Figure - 1] with the excised ureter showing no tumour.

He was on routine follow-up for last 4 years. He pre­sented again with total painless hematuria. Cystoscopy showed an emerging papillary tumour from the right ureteric orifice. He underwent excision of right ureteric stump with cuff of bladder. Biopsy showed papillary adenocarcinoma at the ureteric orifice, with no evidence of tumour in the remaining ureter. The histology was identi­cal to the previously excised renal tumour.


   Discussion Top


Papillary renal adenocarcinoma accounts for 7-15% of renal cell carcinoma. It is defined histologicai y as malig­nant epithelial tumour of the kidney with a minimum of 50% papillary architecture, and it is characterized by in­tracytoplasmic haemosiderin and foamy macrophages. [3] Unlike the clear cell carcinoma papillary renal cell carci­noma arises from the distal convoluted tubular cell and it is commonly associated with trisorny 7, 16 and 17. [4]

The present case is unusual and probably the first in the literature of asynchronous metastatic tumour in ureteral stump by papillary adenocarcinoma.

Several theories are put forth to explain ureteral metas­tasis starting from direct mucosal and submucosal exten­sion, direct implantation into the urothelium by visible tumour cells that reach the collecting system by ulcera­tion or direct extension, [5] lymphatic dissemination. But most favoured is the hematogenous spread in retrograde fashion from renal vein down to ureteral vein. [6]

Although radical nephrectomy is the standard opera­tive procedure, because of this unusual, but known pres­entation it has been suggested that nephroureterectomy should be performed.[7] This is especially true in cases where urine cytology is positive for malignant cells or there is evidence of tumour invasion to renal vessels or pelvicaly­ceal system. This case raises the issue of whether one should routinely remove the entire ureter or we follow-up these patients with 6 monthly urine cytology or annual cystoscopy and/or ureteroscopy.

 
   References Top

1.Chin KY, Ho HC, Chen JT et al. Renal cell carcinoma metastasized to the ureteral stump. Zhonghua Yi Xue Za Zhi (Taipei) 2001: 64; 68.  Back to cited text no. 1    
2.Leonard AM. Lefevre A, Lagrange W. Ureteral metastasis from renal adenocarcinoma : Case report and literature review. Acta Urol Belg 1996: 64; 23-25.  Back to cited text no. 2    
3.Granter SR. Perez-Atayde AR, Renshaw AA. Cytologic analysis of papillary renal cell carcinoma. Cancer (Cancer Cytopathology) 1998;84:305.  Back to cited text no. 3    
4.Kovacs G. Molecular differential pathology of renal cell tumours. Histopathology 1993; 22: 1-8.  Back to cited text no. 4    
5.Abeshouse BS. Metastasis to ureter and urinary bladder from renal carcinoma. J Int Coll Surg 1955; 25: 117.  Back to cited text no. 5    
6.Mitchell JE : Ureteric secondaries from hypernephroma. Br J Suva 1956:45:293.  Back to cited text no. 6    
7.Deming CC. Harvard BM. Tumours of the kidney. In: Campbell MF, Harrison JH (Eds) Urology, 3rd ed Philadelphia, Saunders 1970: 2: 885.  Back to cited text no. 7    


    Figures

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    Introduction
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    References
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