A case of sarcomatoid urothelial carcinoma of the right ureter

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)

Download Full-text

Case Report: Metachronous bilateral upper tract and bladder urothelial carcinoma: a long-term follow-up

F1000Research ◽

10.12688/f1000research.55516.1 ◽

2021 ◽

Vol 10 ◽

pp. 778

Author(s):

Agus Rizal Ardy Hariandy Hamid ◽

Fakhri Zuhdian Nasher ◽

Meilania Saraswati ◽

Sahat Matondang ◽

Chaidir Arif Mochtar

Keyword(s):

Urothelial Carcinoma ◽

Radical Cystectomy ◽

Upper Urinary Tract ◽

Urothelial Cell ◽

Laser Evaporation ◽

Ureteral Orifice ◽

Upper Tract ◽

Bladder Urothelial Carcinoma ◽

Carcinoma Of The Bladder ◽

The Right

Background: Upper tract urothelial carcinoma (UTUC) is a malignant disease of the urothelial cell lining the upper urinary tract from renal calyces, pelvises, and ureter down to the ureteral orifice. Urothelial carcinoma is a multifocal malignant tumor which tends to reoccur after treatment. Radical cystectomy shows that upper tract recurrence occurs in 0.75% to 6.4% of patients. The occurrence of contralateral UTUC after nephroureterectomy is rarer with a prevalence of 0.5%. Case presentation: The case of a 43-year-old male with metachronous bilateral UTUC was reported. The patient had undergone gemcitabine-cysplatine neoadjuvant chemotherapy followed by radical cystectomy and orthotopic neobladder for urothelial carcinoma of the bladder cT2N0M0. Left hydronephrosis was discovered three months after the procedure. The patient was diagnosed with left UTUC cT4N0M0 of renal pyelum after a series of examinations. A left open radical nephroureterectomy was conducted to remove the mass followed by adjuvant chemotherapy. This was followed up with routine ultrasound and magnetic resonance imaging (MRI) every three months with a “tumor-free” period of 26 months. Meanwhile, the patient was re-admitted with fever and an increase in creatinine value of 4.3. After further workups, the patient was diagnosed with UTUC cT2N0M0 of the right renal pyelum. A kidney sparring approach with laser evaporation of the tumor was conducted followed by eight cycles of Gemcitabine intracavity antegrade per nephrostomy. After the regimen was finished, an MRI evaluation was conducted to assess treatment results, and the mass had decreased. Conclusions: This report showed a rare case of urothelial cell carcinoma recurrences. From bladder urothelial carcinoma to left UTUC and then to contralateral UTUC. It is important to evaluate the upper tract to reduce the risk of recurrence.

Download Full-text

Pure Lymphoepithelioma-Like Carcinoma Originating from the Urinary Bladder

Case Reports in Oncology ◽

10.1159/000445049 ◽

2016 ◽

Vol 9 (1) ◽

pp. 188-194 ◽

Cited By ~ 3

Author(s):

Takashi Nagai ◽

Taku Naiki ◽

Noriyasu Kawai ◽

Keitaro Iida ◽

Toshiki Etani ◽

...

Keyword(s):

Urinary Bladder ◽

Urothelial Carcinoma ◽

Undifferentiated Carcinoma ◽

Bladder Tumors ◽

Adc Value ◽

Barr Virus ◽

Apparent Diffusion ◽

Adc Values ◽

Epstein Barr ◽

The Right

Lymphoepithelioma-like carcinoma of the urinary bladder (LELCB) is a rare variant of infiltrating urothelial carcinoma. We report a case of LELCB in a 43-year-old man. Ultrasonography and cystoscopy revealed two bladder tumors, one on the left side of the trigone and the other on the right side of the trigone. Transurethral resection of the bladder tumors was performed and pathological analysis revealed undifferentiated carcinoma. We therefore performed radical cystectomy and urinary diversion. Immunohistochemically the tumor cells were positive for cytokeratin, but negative for Epstein-Barr virus-encoded small RNA in situ hybridization as found for previous cases of LELCB. The final pathological diagnosis was a lymphoepithelioma-like variant of urothelial carcinoma with perivesical soft tissue invasion. For adjuvant systemic chemotherapy, three courses of cisplatin were administered. The patient subsequently became free of cancer 72 months postoperatively. Based on the literature, pure or predominant LELCB types show favorable prognoses due to their sensitivity to chemotherapy or radiotherapy. An analysis of the apparent diffusion coefficient (ADC) values of bladder tumors examined in our institution revealed that the ADC value measured for this LELCB was relatively low compared to conventional urothelial carcinomas. This suggests that measuring the ADC value of a lymphoepithelioma-like carcinoma prior to operation may be helpful in predicting LELCB.

Download Full-text

Metastatic Prostate Adenocarcinoma Posing as Urothelial Carcinoma of the Right Ureter: A Case Report and Literature Review

Case Reports in Urology ◽

10.1155/2014/230852 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Tian-bao Huang ◽

Yang Yan ◽

Huan Liu ◽

Jian-ping Che ◽

Guang-chun Wang ◽

...

Keyword(s):

Case Report ◽

Urothelial Carcinoma ◽

Specific Antigen ◽

Skeletal Metastasis ◽

Pathological Examination ◽

Review Of The Literature ◽

Skeletal Scintigraphy ◽

Abnormal Signal ◽

The Right

This is a case report of a 67-year-old patient with distant metastasis of prostate cancer to the right ureter which caused hydronephrosis. At the beginning, both of the cytology of the morning urine and imaging findings were consistent with urothelial carcinoma. Nephroureterectomy was subsequently performed. Interestingly, the pathological examination of the excised ureter revealed that the malignancy was derived from the prostate. No skeletal metastasis was detected. However, after four months of follow-up, several abnormal signal shadows were reported in skeletal scintigraphy and the prostate specific antigen (PSA) was gradually increasing. We present such a case for its unique presentation. A review of the literature is also provided.

Download Full-text

Long-Term Survival after Adrenalectomy for Asynchronous Metastasis of Bladder Cancer to the Bilateral Adrenal Glands

Case Reports in Urology ◽

10.1155/2012/425230 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

S. Washino ◽

M. Hirai ◽

A. Matsuzaki ◽

Y. Kobayashi

Keyword(s):

Bladder Cancer ◽

Urothelial Carcinoma ◽

Adrenal Glands ◽

Adrenal Metastasis ◽

Uneventful Recovery ◽

Term Survival ◽

Long Term Survival ◽

Metastatic Urothelial Carcinoma ◽

The Right

Isolated adrenal metastasis of bladder cancer, particularly the bilateral, is quite rare. Systemic chemotherapy is the treatment of choice for metastatic urothelial carcinoma. However, despite initially promising response rates of approximately 45%–71%, most tumors eventually show progression, and the median survival time following chemotherapy regimen is approximately 14-15 months. Recently, favorable results of surgery for metastatic urothelial carcinoma have been reported. Here, we report a rare case of asynchronous metastasis of bladder cancer to the bilateral adrenal glands with long-term survival after bilateral adrenalectomy. A 69-year-old man underwent radical cystoprostatectomy and ileal conduit urinary diversion for invasive bladder cancer. Ten months later, left adrenalectomy was performed for a left adrenal tumor, revealing metastatic urothelial carcinoma. After adjuvant chemotherapy, a tumor in the right adrenal gland was detected. Right adrenalectomy was done, and the tumor was also found to be metastatic urothelial carcinoma. The patient had an uneventful recovery after starting steroid replacement therapy. Three years later, he was doing well and had no evidence of recurrence. Adrenalectomy for isolated adrenal metastasis of urothelial carcinoma may be a reasonable option, even if such metastases are bilateral.

Download Full-text

A Case of Early Stage Bladder Carcinosarcoma in Late Recurrence of Urothelial Carcinoma after Transurethral Resection

Case Reports in Urology ◽

10.1155/2018/1405108 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Daisaku Hirano ◽

Toshiyuki Yoshida ◽

Daigo Funakoshi ◽

Fuminori Sakurai ◽

Shou Ohno ◽

...

Keyword(s):

Urothelial Carcinoma ◽

Transurethral Resection ◽

Early Stage ◽

Bladder Wall ◽

Late Recurrence ◽

Gross Hematuria ◽

Pelvic Mri ◽

History Of ◽

The Right ◽

Immunohistochemical Studies

Carcinosarcomas of the urinary bladder are rare biphasic neoplasms, consisting of both malignant epithelial and malignant mesenchymal components, and the prognosis of this tumor is unfavorable in most patients with even possibility of resection of disease. A 77-year-old male with a history of transurethral resection (TUR) of urothelial carcinoma (UC) of the bladder and adjuvant intravesical chemotherapy with pirarubicin 10 years ago revisited our department with a gross hematuria. Cystoscopy demonstrated an approximately 2.5 cm nonpapillary tumor on the right wall of the bladder. Pelvic MRI showed the tumor without extending the base of the bladder wall. The tumor could be completely removed with TUR. The malignant epithelial elements consisted of high-grade UC and the majority of mesenchymal components were fibrosarcomatous differentiation based on immunohistochemical studies. The tumor could be pathologically also suspected to be an early stage on TUR specimens. Although he has received no additional intervention due to the occurrence of myocardial infarction at three weeks after the TUR, he has been alive with no evidence of recurrence of the disease 27 months after the TUR. Some early stages of bladder carcinosarcoma might have a favorable prognosis without aggressive treatments.

Download Full-text

Two Different Upper Tract Urological Malignancies on Either Side

Case Reports in Urology ◽

10.1155/2021/9981381 ◽

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.

Download Full-text

Case Report: Good responsiveness of metastatic sarcomatoid urothelial carcinoma with chondrosarcomatous differentiation to immune checkpoint inhibitor after radical surgery and adjuvant chemotherapy

F1000Research ◽

10.12688/f1000research.27244.1 ◽

2020 ◽

Vol 9 ◽

pp. 1458

Author(s):

Hyung Ho Lee ◽

Hye Ju Kang ◽

Weon Seo Park ◽

Wonyoung Choi ◽

Ho Kyung Seo ◽

...

Keyword(s):

Adjuvant Chemotherapy ◽

Urothelial Carcinoma ◽

Immune Checkpoint ◽

Immune Checkpoint Inhibitor ◽

Radical Surgery ◽

Checkpoint Inhibitor ◽

Final Diagnosis ◽

Histological Variant ◽

Grade 3 ◽

The Right

Background: Sarcomatoid urothelial carcinoma with chondrosarcomatous differentiation (SUCCD) in the ureter has a poor prognosis and is a rare histological variant of ureteral cancer. The majority of ureteral cancers are urothelial carcinomas. Clinical case: We present a case of well-controlled metastatic SUCCD treated with an immune checkpoint inhibitor after radical surgery and failed adjuvant chemotherapy. The patient was a 68-year-old male with previous cure history of cT1 staged esophageal squamous cell carcinoma referred to the urology department for a right hydronephroureterosis complicating an intraureteral enhancing mass. After ureteroscopic biopsy and intraureteral urine cytology, atypical pleomorphic cell nests and chondroid tissue consistent with sarcomatoid urothelial carcinoma were observed. The patient underwent a successful radical right nephroureterectomy with bladder cuffing. The final diagnosis was a pT3N0 sarcomatoid urothelial carcinoma (heterologous component: chondrosarcoma > 95%) located at the right distal ureter and right renal calyx with infiltration of the periureteric fat and renal parenchyma of the renal capsule. On the postoperative one-month follow-up computed tomography scan, multiple enlarged lymph nodes and metastatic lung nodules were detected. The initiated adjuvant three cycles of gemcitabine-carboplatin therapy was marked by disease progression; thus, second-line therapy with atezolizumab was used for treatment. After five cycles of atezolizumab, the tumors showed a partial response without any grade 3 complications. Conclusion: The recurrent metastatic SUCCD showed good response to the immune checkpoint inhibitor after unsuccessful therapy with radical surgery and first line chemotherapy despite the unfavorable outcome of the pathology.

Download Full-text

FGFR alterations in urothelial carcinoma: Picking the right target

Bulletin du Cancer ◽

10.1016/j.bulcan.2021.02.014 ◽

2021 ◽

Author(s):

Paul Hubert ◽

Zohair Selmani ◽

Yohann Loriot ◽

Antoine Thiery-Vuillemin

Keyword(s):

Urothelial Carcinoma ◽

The Right

Download Full-text

Robotic nephroureterectomy in a horseshoe kidney for upper tract urothelial carcinoma

BMJ Case Reports ◽

10.1136/bcr-2020-234901 ◽

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.

Download Full-text