Abstract
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.
Highlights
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 ureteral orifice
The occurrence of contralateral UTUC after nephroureterectomy is even rarer with the prevalence of 0.5% developing metachronous UTUC.[4]
This study showed that HER2 expression is significantly associated with a higher stage of tumor and worse recurrence-free in UTUC patients.[7]
Summary
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 ureteral orifice. Case presentation The patient is an Indonesian male born in 1978 who works as a cook He was admitted to Ciptomangunkusumo National Hospital (RSCM) in November 2017 with gross haematuria as the chief complaint. A biopsy was conducted, and pathology examination concluded that the tumor was an infiltrative papillar urothelial carcinoma pT1 high grade (Figure 2b). Left nephrostomy and biopsy were conducted and pathology workup showed papillary arranged tumor mass. The patient was diagnosed with left UTUC cT4N0M1 in renal pyelum (Figure 3b). Nephroscope post-laser ablation examination shows some tumor residue (Figure 4b). The patient was given intracavitary chemotherapy using gemcitabine through nephrostomy. The examination conducted in September 2020 showed a normal right kidney with no hydronephrosis, but there was a sign of intraluminal neobladder clotting. Abdominal MRI in May 2021 showed benign calyx dilatation suspicious due to stricture and heterogeneous renal parenchyma (Figure 5)
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