Abstract
BackgroundClear cell renal carcinoma is known for its propensity for metastatic spread. Common sites of metastasis are the lungs, bones, lymph nodes, liver, adrenals and brain, but all organs can be affected. Contralateral ureteral metastasis is a rare phenomenon, and only a few cases have been reported in the literature.Case presentationWe present the case of a 58-year-old Caucasian patient with a single contralateral ureteral metastasis of a clear cell renal carcinoma.ConclusionUreteral metastasis of clear cell renal carcinoma is very rare, and there is no well-established treatment. For patients with low metastatic spread/volume, the aim should be to preserve kidney function, and thus metastasectomy should be considered.
Highlights
Clear cell renal carcinoma is known for its propensity for metastatic spread
Radical or partial nephrectomy is the standard of treatment, while for advanced or metastatic Renal cell carcinoma (RCC), a cytoreductive nephrectomy followed by systemic therapy has been the standard of care
We present a rare case of contralateral ureteral metastasis that was successfully treated with open segmental ureterectomy and end-to-end anastomosis, with good functional and oncological outcomes
Summary
Renal cell carcinoma (RCC) accounts for 2–3% of all cancers worldwide, and 80% of these are clear cell RCC [1]. The histopathological examination revealed a clear cell renal carcinoma, maximum diameter of 10.2 cm, with foci of sarcomatoid differentiation, infiltration of the perirenal fat and vascular invasion, and negative margin. At the 4-month follow-up, the patient presented with persisting painless macrohematuria, and follow-up CT of the chest/abdomen/pelvis showed a solid, contrastenhanced lesion of the right mid-ureter with significant growth (18 mm) in the excretory phases (Fig. 2). The final histology showed a single metastasis of a clear cell renal carcinoma with a maximum diameter of 22 mm, in line with the initially diagnosed tumor of the left kidney (Fig. 4). The patient remained disease-free for 3 years but subsequently developed a secondary clear cell RCC within the inferior pole of the right kidney, with maximum diameter of 14 mm, which was successfully treated with a robotic-assisted partial nephrectomy. The follow-up with magnetic resonance imaging (MRI) at 6 months showed no tumor recurrence
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