Primary-multiple synchronous malignant neoplasms renal pelvis and both ureters

Introduction. Urothelial carcinoma of the upper urinary tract in Western countries of Erope and USA occurs in 1-2 cases per 100,000 populations. Nephroretrectomy remains the main method of treatment of this pathology, however, the role of organ-sparing surgeries increases with the bilateral localization of the tumor process. Due to the rarity of bilateral upper urinary tract lesions with urothelial cancer and the lack of data evaluating the results of organ-sparing surgeries in such situations, each clinical case is of interest. Materials and methods. The article describes a case of surgical treatment of a patient with non-invasive papillary urothelial carcinomas of both ureters and the pelvis of the right kidney, which were manifested by macrohematuria. Results. The diagnosis was confirmed by computer tomography (CT) and ureteroscopy with tumor biopsy, which revealed a neoplasm of the right kidney pelvis, multiple tumors of the distal part of the right ureter and a solitary neoplasm of the middle part of left ureter. The patient underwent laparoscopic nephrureterectomy on the right with transurethral resection of the bladder wall in the area of the mouth of the right ureter and endoscopic removal of the neoplasm in the middle third of the left ureter using laser energy. At the control examination 1,5 months after the surgical treatment, according to the results of CT, cystoscopy with biopsy of the bladder and ureteroscopy, as well as histological examination of the biopsies, no data for tumor growth were found. At CT 6 months after the surgery, no data for the recurrence of cancer were obtained. Сonclusions. This clinical observation demonstrates the technical feasibility and oncological feasibility of using organ-preserving surgical treatment for bilateral localization of low-grade urothelial carcinoma.

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Higher Cancer Mortality in Rural Upper Urinary Tract Urothelial Carcinoma Patients

Urologia Internationalis ◽

10.1159/000513361 ◽

2021 ◽

pp. 1-7

Author(s):

Claudia Collà Ruvolo ◽

Lara F. Stolzenbach ◽

Luigi Nocera ◽

Marina Deuker ◽

Mike Wenzel ◽

...

Keyword(s):

Urinary Tract ◽

Surgical Treatment ◽

Urothelial Carcinoma ◽

Tumor Grade ◽

Tumor Location ◽

Upper Urinary Tract ◽

Low Grade ◽

Exact Matching ◽

T Stage ◽

Urinary Tract Urothelial Carcinoma

Objective: The aim of the study was to investigate differences in the stage at presentation and cancer-specific mortality (CSM) between rural area (RA) and urban area (UA) residence status in nonmetastatic upper urinary tract urothelial carcinoma (UTUC) patients. Methods: Newly diagnosed T1–3N0M0 UTUC patients with available residence status were abstracted from the Surveillance, Epidemiology, and End Results database (2004–2016). Propensity score (PS) matching (1 RA vs. 3 UA) accounted for age (interval ≤2 years), T stage (exact matching: T1, T2, and T3), and tumor grade (exact matching: high grade, low grade/unknown). Cumulative incidence plots and multivariable competing risk regression models focused on CSM, after adjustment for other-cause mortality. Results: Of 6,012 patients, 125 (2.1%) resided in RAs and 5,887 (97.9%) in UAs. RA patients were younger than UA patients (median age 72 vs. 75 years, p = 0.03). No differences were recorded in tumor location, T stage, tumor grade, or surgical treatment between RA and UA patients. After 1:3 PS matching, 125 RA patients and 375 UA patients were assessable. At 5 years of follow-up, CSM rates were 26.7 versus 15.7% according to RA versus UA, respectively. After additional multivariable adjustment for age, sex, tumor location, and surgical treatment, RA remained an independent predictor of higher CSM (hazard ratio 1.75, p = 0.02). Conclusions: Despite no differences in cancer characteristics, UTUC patients in RA are at higher risk of CSM than their UA counterparts. This suggests suboptimal care delivery and compliance as possible causes. Complex and/or rare disease should be centralized to expert centers, which are often in UAs.

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Laparoscopic Nephroureterectomy in the Upper Urinary Tract Urothelial Carcinoma with Transvaginal Extraction

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2020.3888 ◽

2020 ◽

Vol 8 (C) ◽

pp. 40-43

Author(s):

Ahmad Zulfan Hendri ◽

Prahara Yuri ◽

Andy Zulfiqqar ◽

Azwar Hashfi ◽

Indrawarman Soerohardjo

Keyword(s):

Urinary Tract ◽

Urothelial Carcinoma ◽

Upper Urinary Tract ◽

Healing Time ◽

Karnofsky Performance Scale ◽

Specimen Extraction ◽

Transvaginal Specimen Extraction ◽

The Right ◽

Urinary Tract Urothelial Carcinoma ◽

Laparoscopic Nephroureterectomy

BACKGROUND: The upper urinary tract urothelial carcinoma (UTUC) is a rare urological malignancy. Laparoscopic nephroureterectomy (LNU) is one of the options for minimally invasive surgery for UTUC. It has similar oncological outcomes compared to open nephroureterectomy. One of the techniques developed for specimen extraction is the transvaginal route. Transvaginal specimen extraction has advantages in the reduced risk of complications, faster recovery time, and better end result. CASE PRESENTATION: A 37-year-old woman complained of intermittent pain in her right flank for the past 2 months, with significant weight loss. No other significant symptoms occurred. Her general condition was good with a Karnofsky Performance scale index is 90. In the right periumbilical area, there was a mobile, smooth mass palpated with the size of 10 × 12 cm. There was no tenderness. The patient underwent URS and biopsy of the right ureteral mass with pathological analysis resulting in UTUC. Then, the patient underwent laparoscopic radical nephroureterectomy. CONCLUSION: Although the surgical procedure was safe for the patient and more effective in terms of less morbidity, faster healing time, and better cosmetic appearance, transvaginal extraction of the kidney needs to be further studied, particularly relating to the little experience of this new technique.

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Impact of Ki-67 and E-cadherin expression on lymphovascular invasion in upper urinary tract urothelial carcinoma

Vojnosanitetski pregled ◽

10.2298/vsp140605101s ◽

2015 ◽

Vol 72 (11) ◽

pp. 982-988

Author(s):

Slavica Stojnev ◽

Miljan Krstic ◽

Ljubinka Jankovic-Velickovic ◽

Ana Ristic-Petrovic ◽

Maja Milojkovic ◽

...

Keyword(s):

Urinary Tract ◽

Urothelial Carcinoma ◽

Tumor Stage ◽

Upper Urinary Tract ◽

Transitional Epithelium ◽

Malignant Neoplasms ◽

Ki 67 ◽

Invasion Pattern ◽

Urinary Tract Urothelial Carcinoma ◽

E Cadherin

Bacground/Aim. Upper urinary tract urothelial carcinoma (UUT-UC) constitutes 5% of malignant neoplasms arising from transitional epithelium, but is more invasive than bladder cancer. Lzmphovascular invasion (LVI) is associated with biologically aggressive carcinoma and with occult metastases. The aim of this study was to investigate the correlation between LVI and immunohistochemical expression of two frequently routinely applied immunohistochemical biomarkers, Ki-67 and E-cadherin, in UUT-UC. Methods. The specimens from 106 patients with UUT-UC who had undergone nephroureterectomy were analyzed for pathologic parameters and LVI, while Ki-67 and E-cadherin expression were assessed by immunohistochemistry. Results. Ki-67 was overexpressed in 38% of the cases, while 45% of tumors demonstrated aberrant E-cadherin staining. The presence of LVI was significantly associated with tumor stage, grade, non-papillary growth, nodular invasion pattern, high Ki-67 labeling index and altered E-cadherin expression. Analyzing logistic regression models, we have shown that tumor properties such as stage, grade, growth and invasion pattern (p < 0.001), as well as the expression of Ki-67 and E-cadherin (p < 0.001) significantly predicted the presence of LVI. In the first model, only solid tumor architecture (p < 0.05) and nodular invasion pattern (p < 0.05) were significant predictors of LVI. In the second model, Ki-67 expression was found to improve the prediction of LVI (p < 0.05). Conslusion. Our results suggest that Ki-67 overexpression is an independent predictor of LVI in UUTUC, indicating the progression of the disease. E-cadherin staining adds no valuable information to LVI probability assessment. This emphasizes the importance of Ki-67 staining of UUT-UC sections in routine pathological practice. Patients with Ki-67 overexpression, especially in solid tumors with nodular invasion, should be monitored more closely after surgery.

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Therapeutic Strategies for Asymptomatic Upper Urinary Tract Urothelial Carcinoma

10.21203/rs.3.rs-927423/v1 ◽

2021 ◽

Author(s):

Deng Lin ◽

Yun Hong ◽

Zesong Yang ◽

Liefu Ye

Keyword(s):

Urinary Tract ◽

Surgical Treatment ◽

Urothelial Carcinoma ◽

Upper Urinary Tract ◽

Clinicopathological Features ◽

Clinical Staging ◽

Sleeve Resection ◽

Bladder Urothelial Carcinoma ◽

Group A ◽

Group B

Abstract A total of 136 patients with upper urinary tract epithelial carcinoma (UTUC) were recruited, of which 21 patients with asymptomatic UTUC were group A, and 115 UTUC patients with hematuria or low back pain were group B. The clinicopathological features, oncologic outcomes, and surgical methods of patients were evaluated. The full-length renal ureterectomy+bladder sleeve resection was the main surgical treatment which was included (group A 80.95%, group B 90.43%). Other patients were treated with kidney-retaining surgery. No statistically significant difference was observed in the grading between groups A and B, pathological stage (p >0.05). During a median follow-up period of 44.3 months, tumor-specific mortality of group A was 7.14%, and that of group B was 5.10%. At the same period, the clinical data of 106 patients with asymptomatic bladder tumor were collected: 31 patients of them had asymptomatic bladder urothelial carcinoma. The asymptomatic UTUC group had a higher stage and grade clinicopathological features (P = 0.00), more aggressive than the asymptomatic bladder urothelial carcinoma group. The principle of asymptomatic UTUC treatment is the same as that of symptomatic UTUC. Risk stratification should be carried out according to clinical staging and other parameters, and the corresponding surgical treatment should be selected.

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INFILTRATING UROTHELIAL CARCINOMA ALONG THE URINARY TRACT OF A YOUNG ADULT

Indonesian Journal of Urology ◽

10.32421/juri.v28i2.707 ◽

2021 ◽

Vol 28 (2) ◽

pp. 211-214

Author(s):

Sri Suryanti ◽

Yuktiana Kharisma ◽

Aaron Tigor

Keyword(s):

Dna Damage ◽

Urinary Tract ◽

Young Adult ◽

Urinary Bladder ◽

Urothelial Carcinoma ◽

Flank Pain ◽

Smoking History ◽

Low Grade ◽

Patient Consent ◽

The Right

Objective: To present a rare case of infiltrating urothelial carcinoma along the urinary tract on a young adult. Case(s) Presentation: A 39 year old Asian male patient with > 20 pack-year smoking history, came to the hospital with a chief complaint of hematuria and flank pain since two weeks ago. Physical examination revealed Eastern Cooperative Oncology Group (ECOG) Performance Status 1, the right kidney was palpated, no tenderness on fist percussion. Abdominal ultrasound (USG) revealed 1.5 cm and 0.5 cm masses located in the urinary bladder. The CT scan show mass in the bladder was exophytic, > 3 cm in size, and occupying lesion was located on the right posteroinferior and left lateral bladder wall accompanied with dilatation of pelvic calyces and right ureter. Histopathology of the specimen revealed low-grade infiltrating urothelial carcinoma of bladder and right ureter. The pathological stage was pT2NxMx, The patient refused neoadjuvant chemotherapy and surgery. Four months after TURBT, he came with weakness and right flank pain. The patient consent to surgery and underwent the right nephroureterectomy. Histopathology of the specimen showed infiltrating urothelial carcinoma of right kidney, ureter, Gerota fascia with lymphovascular invasion (pT3NxMx). Discussion: Urothelial carcinoma (UC) is commonly arising in the urinary bladder, but it can develop along the urinary tract. Cigarette smoke contains a lot of carcinogenic agents and stimulates DNA damage. Conclusion: Upper tract urothelial carcinoma (UTUCs) is subset of UC with a poor prognosis. Cigarette smoking is the main risk factor that induces DNA damage.

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