Metastatic Ureteral Tumor from Adenocarcinoma of Colon

Abstract

Metastatic tumors of the ureter are rare. In most published cases the diagnosis was not made until postmortem examination or when gross metastases were present. A 69-year-old female was found to have colonic adenocarcinoma with liver metastases 17 months before she was admitted to our ward. After she underwent right hemicolectomy her liver metastases were wellcontrolled by adjuvant chemotherapy. Ureteral stricture over the upper third of the right ureter with hydroureteronephrosis was noted incidentally on abdominal computed tomography 9 months after the completion of postoperative chemotherapy. Metastatic evaluation including subsequent biopsies under ureteroscopy revealed urothelial hyperplasia with reactive atypia. Subsequently, segmental resection of the upper third of the right ureter was performed and histologic examination confirmed metastatic adenocarcinoma of the ureter from the colon. The patient is alive with disease and has been undergoing subsequent chemotherapy up to the present. The differential diagnosis of ureteral lesions causing stricture cannot be achieved by radiographic study only. Pathologic confirmation remains necessary for the diagnosis of malignancy, especially of metastatic nature. If a patient with ureteral stricture has a history of a primary neoplasm, a secondary ureteral tumor, although rare, must be maintained in the differential diagnosis.