A case of small cell carcinoma of the ureter with SIADH-like symptoms

Primary small cell carcinoma of the ureter is very rare. We report a case associated with SIADH (syndrome of inappropriate secretion of ADH) -like symptoms. A 53-year-old man presented to our hospital with lower back and left lower quadrant abdominal pain. Computed tomography revealed left hydronephrosis, a peri-ureteral left lower quadrant mass, and retroperitoneal (RP) lymphadenopathy. Transduodendal biopsy of a RP lymph node revealed small cell carcinoma. He was referred to urology for further evaluation. Urography showed an obstructing mass invading the left ureter. Comprehensive metastatic evaluation revealed no other lesions. Thus, we diagnosed primary small cell carcinoma of the ureter with RP lymph node metastases. In addition, he developed SIADH-like symptoms, and we strongly suspected that it was due to ectopic production of ADH from this carcinoma. He was treated with systemic chemotherapy (methotrexate, epirubicin, and cisplatin). Following this, we performed radical nephroureterectomy with RP lymph node resection. However, he died of recurrent disease five months later.     

A case of small cell carcinoma of the ureter

A 69-year-old man was referred to our hospital with a chief complaint of asymptomatic gross hematuria. After radiological evaluations, left nephroureterectomy with bladder cuff was performed under a clinical diagnosis of a left ureteral tumor (2 cm). Histological examination revealed a small cell carcinoma of the ureter (pT3, pN1). After the operation, adjuvant chemotherapy with irinotecan, etoposide and cisplatin was administered in combination with radiation therapy. At 14 months after the operation, there has been no evidence of recurrence. To our knowledge, this is the 22nd report of a small cell carcinoma originating from the ureter.     

Primary clear cell carcinoma of the ureter: a case report

In September 2003, a 58-year-old woman complained of bladder irritation and urinary frequency. She was admitted to a nearby hospital, and an evaluation was performed. Urine cytology revealed a class V, and a tumor was detected in the lower left ureter with mild hydroneprhosis of the left kidney. We performed a left ureteronephrectomy with partial cystectomy in April 2004. The pathological diagnosis was clear cell carcinoma with small foci of conventional urothelial carcinoma of the left ureter (pT3pN0, G3 > G2, INFgamma). And now she lives well without recurrence in August 2005. This is the first case report of clear cell carcinoma of the ureter in Japan.     

Squamous cell carcinoma of the ureter arising seventeen years after total cystectomy for squamous cell carcinoma of the bladder: a case report

We report a case of squamous cell carcinoma of the ureter. A 62-year-old woman had undergone total cystectomy and ileal conduit because of squamous cell carcinoma of the bladder when she was 44 years old. Seventeen years later, she complained of edema and oliguria. Antegrade pyelography and loopography revealed a left ureteral tumor. She underwent left ureterectomy and extirpation of the conduit. Pathological diagnosis was moderately differentiated squamous cell carcinoma of the ureter, pT2. The patient is alive without recurrence or metastasis in the first year after surgery.     

Prostate carcinoma metastatic to ureter

Since carcinoma of the prostate usually metastasizes to pelvic lymph nodes or to bone or by direct extension, a discrete metastatic papillary lesion involving the ureter is unusual. We report such a case in a fifty-three-year-old man. Review of the literature has identified 11 other cases of carcinoma of the prostate metastatic to the ureter. None of the previously reported cases, however, described a discrete papillary intraluminal tumor in which there was no direct extension outside the ureteral wall. In addition, small foci of tumor were within intraluminal lymphatics as well as within the ureterovesical resection margin. These findings together with immunoperoxidase results confirm the unusual behavior and presentation of metastatic prostate carcinoma involving the ureter. Later a bladder tumor developed and histology again revealed metastatic prostate carcinoma.     

Synchronously occurring transitional cell carcinoma of the ureter with adrenocortical carcinoma

A sixty eight-year-old man was admitted to our hospital complaining of macroscopic hematuria. Ultrasonography, X-ray and laboratory examination revealed a right ureter tumor and left non-functioning adrenal tumor. Pathological diagnosis was transitional cell carcinoma of the ureter and left adrenocortical carcinoma. A review of persistent Japanese literature revealed this case to be the 97th case of non-functioning adrenocortical carcinoma and the first case synchronously occurring with transitional cell carcinoma of the ureter. Forty eight cases of synchronously occurring transitional cell carcinoma of the ureter with cancers in other organs, especially renal cell carcinoma and gastric cancer, have been reported. Recently, an increasing number of cases of non-functioning adrenal carcinoma are detected by CT scan, ultrasonography, adrenal radioisotopic scintigraphy and urinary 17-OHCS, 17-KS.     

Laparoscopic management of a single system ectopic ureterocele with transitional cell carcinoma in the distal ureter

Single system ectopic ureterocele associated with transitional cell carcinoma in the ureter has not been described previously. Only two cases of transitional cell carcinoma in a single ectopic ureter have been reported in the published literature. With the development of minimally invasive surgery, we report the first case of single system ectopic ureterocele with transitional cell carcinoma in the distal ureter that was successfully managed by laparoscopic surgery.     

Laparoscopic management of a transitional cell carcinoma arising in a right ectopic ureter

Ectopic ureter is a rare abnormality, so presenting a transitional cell carcinoma (TCC) arising from an ectopic ureter is extremely rare. We report here a case of a man with an invasive transitional cell carcinoma arising from a right ectopic ureter and managed by laparoscopy. To our knowledge, this is the fourth case described in the literature, and the second case of a TCC arising in a right ectopic ureter.     

Malignant lymphoma of the ureter: a case report

We report a case of malignant lymphoma (ML) of the ureter. A 71-year-old man was admitted to our hospital with the chief complaint of macroscopic hematuria. IVP showed the dilation of left ureter and renal pelvis. Retrograde pyelography showed a 2cm filling defect in the right middle ureter. From the data given, a right ureteral tumor was suspected, and we performed tumor biopsy under an ureteral scope. Since it was diagnosed not as transitional cell carcinoma (TCC) of ureter but as ML with strong inflammation, partial ureterectomy and uretero-uretero anastomosis were done. Histological diagnosis was B cell follicular center lymphoma. Because Ga-scintigraphy revealed no evidence of other involement, it was diagnosed as ML originating from ureter. ML secondarily invading the urinary tract organs is commonly found, but ML originating from the urinary tract is rare. Especially, in regards to ML originating from ureter, only 16 cases have been reported in Japan.     

Bilateral amyloidosis of the ureter associated with carcinoma

We report a case of coexisting amyloid and neoplasm in a localized ureteral lesion. This case also represents the third reported instance of sequential bilateral ureteral amyloidosis. Right nephroureterectomy revealed amyloid and an in situ focus of low grade transitional cell carcinoma. Three years later amyloid in the distal left ureter was resected and the gap was bridged by a bladder hitch and Boari flap. Subsequent followup has been uneventful.     

Primary small cell carcinoma of the ureter

We report a case of primary small cell carcinoma of the ureter. These tumors are very rare, locally aggressive and with poor prognosis. A 77-year-old man presented with left flank pain and microhematuria. Following diagnosis of ureteral carcinoma, nephroureterectomy was carried out, and adjuvant chemotherapy and radiotherapy were given. The patient had no evidence of recurrence or metastasis, 13 months postoperatively. We provide a bibliographic review and comment on its clinical and pathologic characteristics, diagnostic methods and latest modifications in therapy.     

Alpha-fetoprotein-producing adenocarcinoma of the ureter.

We report a case of primary ureteral tumor producing alpha-fetoprotein (AFP). Computerized tomography, ultrasonography and endoscopy of the bile duct revealed no obvious tumor in the liver, gallbladder, bile duct, pancreas or ovary. Total nephroureterectomy was performed, and histopathological examination revealed adenocarcinoma of the ureter lined with transitional cell carcinoma in its base. The tumor was stained with immunohistological AFP stain, and the high serum AFP level normalized after resection of the tumor.     

Solitary ureteral metastases of renal cell carcinoma

Metachronous presentation of metastatic renal cell carcinoma (RCC) to the ureter is extremely rare. We report a solitary metachronous metastatic RCC in the contralateral ureter 14 months after right radical nephrectomy for Fuhrman grade 2 pT3a clear cell disease after the patient re-presented with gross hematuria. The proximal left ureteral lesion was excised followed by ileal-ureteral interposition. Pathologic examination confirmed metastatic RCC. To date, only 51 cases of metastatic RCC to the ureter have been reported, with only 6 occurring metachronously in the contralateral ureter. Also, we report the presence of focal extramedullary hematopoiesis occurring within this metastatic lesion.     

A case of synchronous contralateral renal cell carcinoma and ureteral transitional cell carcinoma

A case of synchronous contralateral renal cell carcinoma and ureteral transitional cell carcinoma is reported. A 56-year-old man, who had been incidentally found to have an abnormal mass in the upper pole of the right kidney on ultrasound sonography, was admitted on January 8, 1985. CT scanning and renal arteriography revealed right renal malignancy. Right radical nephrectomy was performed and histological examination showed adenocarcinoma, granular cell type of the right kidney. He was discharged on February 3, 1985. Two months postoperatively, he was rehospitalized for macroscopic hematuria. Left retrograde pyelogram showed obstruction at middle ureter and cytology of urine from left ureter was positive. So a left ureteral tumor was suspected, and partial resection of left ureter and ureteroureterostomy were performed. Histological examination revealed ureteral transitional cell carcinoma. He is now doing well at 6 months following the lat surgery, without any evidence of recurrence.     

Metastatic renal cell carcinoma to contralateral ureter presenting as acute obstructive renal failure after radical nephrectomy

Metastatic renal cell carcinoma commonly involves the lungs, bone, liver, adrenal glands, and brain. Less commonly affected organs include the gallbladder, thyroid, and pancreas. Even metastatic spread to the contralateral kidney and the bladder has been reported. Computed tomography is the standard imaging technique to evaluate for contralateral involvement. One of the disadvantages of computed tomography as a screening modality is its difficulty in identifying small ureteral lesions. We report a rare case of metastatic renal cell carcinoma in the contralateral ureter presenting as acute obstructive renal failure after radical nephrectomy.     

Signet-ring cell carcinoma of the urinary bladder associated with transitional cell carcinoma of the right ureter

We report on a case of a 72-year-old male with vesical signet-ring cell carcinoma containing a transitional cell carcinoma (TCC) component. It was associated with pure TCC of the right ureter. No other microscopic changes were found in the bladder. The pathogenesis of this signet-ring cell carcinoma is described.     

Cystic renal cell and squamous cell carcinoma of single kidney with concurrent transitional cell carcinoma of ipsilateral ureter and urinary bladder.

We report on a case of the simultaneous occurrence of cystic renal cell and squamous cell carcinoma in a single kidney in a patient with concurrent transitional cell carcinoma of the ipsilateral ureter and urinary bladder. A review of the literature reveals this to be the first such occurrence.     

Transitional carcinoma of the ureter and ipsilateral synchronous renal cell carcinoma in hydronephrotic atrophic kidney: infrequent association

We report a new case of simultaneous occurrence of renal cell carcinoma and transitional cell carcinoma into ipsilateral ureter. A review of the literature to date indicates this is the 45 world-wide case and the 8 in the Spanish publications.     

Multiple synchrone urologische Tumore bei einem dialysepflichtigen Patienten

We report the case of a 67-year-old patient on hemodialysis with asymptomatic gross hematuria and increased PSA levels who was diagnosed with invasive bladder cancer. The postoperative histological studies revealed a bilateral renal cell carcinoma, right ureter and renal pelvis carcinoma in situ and prostate cancer. We believe this to be the first case of such a combination of synchronous urinary tract tumors. When treating urological cancer patients on hemodialysis, one should be aware of a possible combination of multiple synchronous urinary tract tumors.     

Primary carcinosarcoma: a rare cause of unilateral ureteral obstruction

We report a case of unilateral ureteral obstruction owing to carcinosarcoma of the distal ureter. Tumor recurred 6 months after ureteronephrectomy and the patient died 2 1/2 years later. A review of the literature revealed only 3 other cases of ureteral carcinosarcoma, all of which had a similar aggressive course. Recognition and separation of this entity from the more usual transitional cell carcinoma are important because of its apparent poorer prognosis.