|Year : 2002 | Volume
| Issue : 2 | Page : 155-156
Asynchronous ureteral stump metastasis from papillary renal adenocarcinoma
Viswaroop S Bobby, Susy Kurien, Ganesh Gopalakrishnan, Nitin S Kekre
Departments of Urology and Pathology, CMC, Vellore, India
Department of Urology, Christian Medical College and Hospital, Vellore (T.N.) - 632 004
Source of Support: None, Conflict of Interest: None
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 Jul 15];18:155-6. Available from: http://www.indianjurol.com/text.asp?2002/18/2/155/37622
| Introduction|| |
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|| |
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|| |
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.  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. 
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,  lymphatic dissemination. But most favoured is the hematogenous spread in retrograde fashion from renal vein down to ureteral vein. 
Although radical nephrectomy is the standard operative procedure, because of this unusual, but known presentation it has been suggested that nephroureterectomy should be performed. 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|| |
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[Figure - 1]