Crouching carcinoma, hidden ureter: A blind ending burnt out cancerous moiety

2021 ◽  
pp. 205141582110564
Author(s):  
Benjamin Storey ◽  
Vaisnavi Thirugnanasundralingam ◽  
Avi Raman
Keyword(s):  
Urothelial Carcinoma ◽  
Bladder Tumour ◽  
Distal Portion ◽  
Upper Tract Urothelial Carcinoma ◽  
Level Of Evidence ◽  
Tissue Mass ◽  
Duplex Kidney ◽  
Pelvic Mri ◽  
Upper Tract ◽  
The Right

Background: A 76-year-old male presenting with macroscopic haematuria was found to have a lobulated mass infiltrating along the urothelium at the site of insertion of the upper moiety of a complete duplex right kidney. Suspected of being upper tract urothelial carcinoma, cystoscopy, bilateral retrograde pyelograms and transurethral resection of bladder tumour were attempted. Intra-operative findings revealed no tumour burden in the bladder or left ureter. The insertion of the upper pole moiety of the right ureter was not identified intra-operatively. Pelvic MRI demonstrated a markedly dilated upper pole moiety of the right ureter with a soft tissue mass in its distal aspect. Interestingly, the distal portion of the ectopic upper pole moiety was found to insert into the bladder neck. Objective and Methods: We report on an unusual case of upper tract urothelial carcinoma arising from the upper moiety of a complete duplex kidney. Our aim was to demonstrate the importance of thorough investigation of suspected urothelial carcinomas occurring in association with variant upper tract anatomy. Results and Conclusion: This case demonstrates the importance of thorough radiological and endourological investigation of suspected upper tract urothelial carcinoma and the various congenital abnormalities that may complicate the surgical management of this common malignancy. Level of evidence: 4 (case report)

scholarly journals Survival Benefits Based on the Number of Lymph Nodes Removed during Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: Systematic Review and Meta-Analysis

2020 ◽  
Vol 9 (6) ◽  
pp. 1933 ◽  
Author(s):  
Min Soo Choo ◽  
Sangjun Yoo ◽  
Hyeong Dong Yuk ◽  
Chang Wook Jeong ◽  
Min Chul Cho ◽  
...  
Keyword(s):  
Systematic Review ◽  
Overall Survival ◽  
Lymph Node ◽  
Urothelial Carcinoma ◽  
Meta Analysis ◽  
Upper Tract Urothelial Carcinoma ◽  
Radical Nephroureterectomy ◽  
Case Control Studies ◽  
Level Of Evidence ◽  
Upper Tract

The role of lymph node dissection (LND) is still controversial for upper tract urothelial carcinoma (UTUC), and there are no guidelines regarding its use. This study was conducted to find a higher level of evidence for the survival benefits based on the number of LNs removed during radical nephroureterectomy (RNUx) through a systematic review and meta-analysis. We included studies comparing patients who underwent LND during RNUx for UTUC. We searched the major electronic databases (Pubmed, Embase®, and Scopus®) and conducted manual searches of the electronically available abstracts of the major international urology cancer meetings [American Society of Clinical Oncology (ASCO), American Urological Association (AUA), and Eropean Association of Urology (EAU)] prior to April 2019 using grouped terms of nephroureterectomy (nephroureterectom*) and lymph node excision (lymphadenectomy; lymph + node*; lymph* + metasta*) with variations in the terms. Study selection, data collection, and risk of bias assessment were performed by two independent authors (A and B). Six retrospective case-control studies included a total of 33,944 patients who underwent RNUx for UTUC, 5071 of whom underwent LND and were finally included in the meta-analysis. The pooled hazard ratio (HR) in these studies revealed that an increased number of LNs removed during RNUx was associated with improved cancer-specific survival (CSS) in patients with UTUC (HR = 0.95, 95% CI: 0.91–0.99; p = 0.07). In addition, increased numbers of LNs removed were associated with improved overall survival (OS) in pN0 patients. However, in pN+ patients, the number of LNs removed showed no survival benefit on CSS, overall survival (OS), or progression-free survival (PFS). Higher numbers of LNs removed during RNUx were associated with improved survival outcomes in patients with UTUC. This study confirmed that LND also has oncological benefits in UTUC patients. Although still a controversial topic, meticulous LND must be considered, and efforts should be made to eliminate as many LNs as possible when administering RNUx for UTUC, especially in patients without clear evidence of LN metastasis.

scholarly journals Two Different Upper Tract Urological Malignancies on Either Side

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
W. S. L. De Silva ◽  
S. R. De Almeida ◽  
G. D. B. J. Karunarathne ◽  
A. A. S. Samarathunga ◽  
K. M. C. S. Gannoruwa ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Urothelial Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Renal Mass ◽  
Transitional Cell ◽  
Upper Tract Urothelial Carcinoma ◽  
Malignant Neoplasms ◽  
Upper Tract ◽  
The Right

Introduction. The genitourinary system is a recognized site for multiple primary malignant neoplasms even without syndromic anomalies. However, to the best of our knowledge, a case of upper tract urothelial carcinoma (UTUC) with contralateral renal cell carcinoma (RCC) is not reported in surgical literature so far. Case Presentation. A 52-year-old Sri Lankan male patient was found to have a right lower ureteric tumour and a left renal mass together upon investigating for painless visible hematuria. The right ureteric tumour measured 32 × 22   mm resulting in moderate hydronephrosis and cortical thinning of the right kidney, and the left renal mass measured 43 × 38   mm involving the lower pole. The biopsy of the right ureteric lesion revealed a high-grade transitional cell carcinoma with focal nested pattern and that of the left renal mass revealed a clear cell carcinoma. Right nephroureterectomy followed by a left partial nephrectomy was performed in six weeks’ interval. The histology of both the resected specimens confirmed the biopsy findings. Discussion. A high-risk upper tract urothelial carcinoma such as the right ureteric tumour of this patient required a nephroureterectomy which makes the management of the contralateral renal cell carcinoma more complex. An adequate functional renal remnant was ensured after offering oncologically sound surgical treatment for both the malignancies of this patient. Conclusion. A UTUC when associated with a contralateral RCC poses challenges in patient management. The preservation of renal excretory function has to be considered as an important determinant in addition to oncologically sound surgical resection when managing complex cases of genitourinary malignancies involving both sides of the upper urinary tract.

Robotic nephroureterectomy in a horseshoe kidney for upper tract urothelial carcinoma

2021 ◽  
Vol 14 (6) ◽  
pp. e234901
Author(s):  
Edward Ramez Latif ◽  
Issam Ahmed ◽  
Milan Thomas ◽  
Ben Eddy
Keyword(s):  
Urothelial Carcinoma ◽  
Gold Standard ◽  
Incidental Finding ◽  
Horseshoe Kidney ◽  
Upper Tract Urothelial Carcinoma ◽  
Management Options ◽  
Upper Tract ◽  
The Right ◽  
Endoscopic Assessment ◽  
Robotic Nephroureterectomy

Upper tract urothelial carcinoma represents a small proportion (5%–10%) of all urothelial cancers. Although there are several management options, in undifferentiated or high-risk cases, surgery in the form of nephroureterectomy is the gold standard. Horseshoe kidney is the most common congenital renal fusion anomaly affecting 1 in 400–600 patients. We present the case of a smoker in her mid-50s with an incidental finding of a papillary lesion in the right renal pelvis of her horseshoe kidney on CT scan. She went on to have endoscopic assessment confirming no other foci of disease. She was definitively managed with a robotic nephroureterectomy.

Developing a nomogram for predicting intravesical recurrence after radical nephroureterectomy: a retrospective cohort study of mainland Chinese patients

2021 ◽  
Author(s):  
Shicong Lai ◽  
Xingbo Long ◽  
Pengjie Wu ◽  
Jianyong Liu ◽  
Samuel Seery ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Cox Regression ◽  
Upper Tract Urothelial Carcinoma ◽  
Chinese Patients ◽  
Clinicopathological Parameters ◽  
Radical Nephroureterectomy ◽  
Ki 67 ◽  
Data Set ◽  
Mainland Chinese ◽  
Upper Tract

Abstract Objective To evaluate the role of Ki-67 in predicting subsequent intravesical recurrence following radical nephroureterectomy and to develop a predictive nomogram for upper tract urothelial carcinoma patients. Methods This retrospective analysis involved 489 upper tract urothelial carcinoma patients who underwent radical nephroureterectomy with bladder cuff excision. The data set was randomly split into a training cohort of 293 patients and a validation cohort of 196 patients. Immunohistochemical analysis was used to assess the immunoreactivity of the biomarker Ki-67 in the tumor tissues. A multivariable Cox regression model was utilized to identify independent intravesical recurrence predictors after radical nephroureterectomy before constructing a nomographic model. Predictive accuracy was quantified using time-dependent receiver operating characteristic curve. Decision curve analysis was performed to evaluate the clinical benefit of models. Results With a median follow-up of 54 months, intravesical recurrence developed in 28.2% of this sample (n = 137). Tumor location, multifocality, pathological T stage, surgical approach, bladder cancer history and Ki-67 expression levels were independently associated with intravesical recurrence (all P < 0.05). The full model, which intercalated Ki-67 with traditional clinicopathological parameters, outperformed both the basic model and Xylinas’ model in terms of discriminative capacity (all P < 0.05). Decision-making analysis suggests that the more comprehensive model can also improve patients’ net benefit. Conclusions This new model, which intercalates the Ki-67 biomarker with traditional clinicopathological factors, appears to be more sensitive than nomograms previously tested across mainland Chinese populations. The findings suggest that Ki-67 could be useful for determining risk-stratified surveillance protocols following radical nephroureterectomy and in generating an individualized strategy based around intravesical recurrence predictions.

Oncologic surveillance for surgically-treated high risk upper tract urothelial carcinoma

2021 ◽  
Vol 79 ◽  
pp. S1105-S1106
Author(s):  
A. Martini ◽  
C. Lonati ◽  
A. Necchi ◽  
A. Briganti ◽  
F. Montorsi ◽  
...  
Keyword(s):  
High Risk ◽  
Urothelial Carcinoma ◽  
Upper Tract Urothelial Carcinoma ◽  
Upper Tract

scholarly journals Tumor Necrosis with Adjunction of Preoperative Monocyte-to-Lymphocyte Ratio as a New Risk Stratification Marker Can Independently Predict Poor Outcomes in Upper Tract Urothelial Carcinoma

2021 ◽  
Vol 10 (13) ◽  
pp. 2983
Author(s):  
Kun-Che Lin ◽  
Hau-Chern Jan ◽  
Che-Yuan Hu ◽  
Yin-Chien Ou ◽  
Yao-Lin Kao ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Tumor Necrosis ◽  
Roc Analysis ◽  
Upper Tract Urothelial Carcinoma ◽  
Postoperative Treatment ◽  
Rank Test ◽  
Prognostic Impact ◽  
Lymphocyte Ratio ◽  
Upper Tract ◽  
The Impact

Objectives: This study aimed at investigating the prognostic impact of tumor necrosis and preoperative monocyte-to-lymphocyte ratio (MLR) in patients treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Methods: A total of 521 patients with UTUC treated with RNU from January 2008 to June 2019 at our institution were enrolled. Histological tumor necrosis was defined as the presence of microscopic coagulative necrosis. The optimal value of MLR was determined as 0.4 by receiver operating characteristic (ROC) analysis based on cancer-specific mortality. The Kaplan–Meier method with log-rank test and Cox proportional hazards regression models were performed to evaluate the impact of tumor necrosis and MLR on overall (OS), cancer-specific (CSS), and recurrence-free survival (RFS). Furthermore, ROC analysis was used to estimate the predictive ability of potential prognostic factors for oncological outcomes. Results: Tumor necrosis was present in 106 patients (20%), which was significantly associated with tumor location, high pathological tumor stage, lymph node metastasis, high tumor grade, lymphovascular invasion, tumor size, and increased monocyte counts. On multivariate analysis, the combination of tumor necrosis and preoperative MLR was an independent prognosticator of OS, CSS, and RFS (all p < 0.05). Moreover, ROC analyses revealed the predictive accuracy of a combination of tumor necrosis and preoperative MLR for OS, CSS, and RFS with the area under the ROC curve of 0.745, 0.810, and 0.782, respectively (all p < 0.001). Conclusions: The combination of tumor necrosis and preoperative MLR can be used as an independent prognosticator in patients with UTUC after RNU. The identification of this combination could help physicians to recognize high-risk patients with unfavorable outcomes and devise more appropriate postoperative treatment plans.

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