Ureteric secondaries from a hypernephroma

An Unusual and Rare Metachronous Ipsilateral Ureteric Stump Metastasis Post Radical Nephrectomy

We report a case of recurrence of chromophobe renal cell cancer in the ipsilateral ureteric stump eight years later after the primary tumor was excised successfully. Before this detection of the recurrence, the patient had presented with recurrent episodes of hematuria four years after the radical nephrectomy was performed and the investigations were inconclusive. Eventually, the lesion was detected on flexible cystoscopy in the area of the right ureteric orifice protruding in the bladder. Transurethral resection of the tumor surprisingly revealed a chromophobe renal cancer with similar features seen in the primary tumor specimen. The patient underwent robotic-assisted laparoscopic excision of the ureteric stump with a cuff of the bladder and has been recurrence-free for five years on regular surveillance scans.

Solitary contralateral renal pelvis metastasis 9 years after removal of renal adenocarcinoma

Extremely rarely, renal cell carcinoma metastasizes to the contralateral renal pelvis or ureter. The present report concerns a case where a metastatic tumour was successfully removed from the left renal pelvis 9 years after right nephrectomy for the primary tumour.

Urinary tract metastasis from renal carcinoma

Five patients with urinary tract metastases from renal carcinoma are presented. In 4, urinary tract metastasis occurred in the absence of spread elsewhere. The initial presentation in 1 patient was ureteric obstruction; 3 others re-presented with haematuria and the fifth patient was diagnosed post mortem. Metastatic sites included ipsilateral ureter, contralateral ureter, ureteric stump, bladder and prostatic fossa. After previous nephrectomy for renal carcinoma, urinary metastases, although rare, should be considered and investigation of unexplained haematuria should include the ureteric stump. Useful palliation and possibly cure can be achieved by resection of these lesions.

Ureteral and renal pelvic metastases from renal cell carcinoma

Six patients with ureteral or renal pelvic metastases from renal cell carcinoma (RCC) were studied radiologically. Correlation with surgical and histologic findings confirmed renal venous involvement in 5 and lymphatic invasion in 3 patients. The possible role of nephroureterectomy or secondary ureterectomy in patients with RCC is discussed in the background of our cases, as are prior reports of this finding.

Ureteral stump metastases from renal adenocarcinoma

The thirty-second documented case of ureteral stump metastasis from renal adenocarcinoma is presented. It demonstrates well the variable and often unusual presentation of renal adenocarcinoma and the utility of our current diagnostic instrumentation (here ureteroscopy and skinny needle biopsy) in documenting metastatic disease. Also, and in contrast to prior reports, it documents lengthy survival and a lack of extensive metastases in this high risk group of patients. The literature is reviewed and the presentation, metastatic pathways, and management of ureteral stump metastases from renal adenocarcinoma are briefly discussed.

Hypernephroma and associated ureteral involvement

The propensity of a hypernephroma to invade the renal vein and even the inferior vena cava is widely known. However, in contrast to papillary carcinoma of the kidney, hypernephromas rarely involve the ureter. Review of the English literature reveals 42 reported cases of ureteral involvement. Most represented metastases as opposed to direct, contiguous extension which is extremely rare. C case of hypernephroma with contiguous castlike extension into the ureter without mucosal violation is presented. Mechanisms of ureteral involvement and implications regarding treatment of hypernephromas are discussed.