PARIETAL METASTASIS IN NEPHRECTOMY TRACK REVEALS PYELIC TRANSITIONAL CELL CARCINOMA

Abstract

A 53-year-old woman presented with acute renal insufficiency. Evaluation revealed right ureteral stenosis with a right atrophic kidney and hydronephrosis on the left side. No etiology was found but bilateral ureteritis caused by pelvic irradiation for cervical carcinoma 19 years earlier was suspected. Right nephrectomy for pain relief and left ureteral reimplantation on a tubular graft bladder were performed. Hydronephrosis recurred when the ureteral catheter was removed. A temporary nephrostomy tube was placed in the renal cavities, and a Double-J* catheter was inserted. The catheter was removed 9 months later and hydronephrosis recurred. A new nephrostomy and Double-J catheter were placed. A 4 cm. subcutaneous mass developed 6 months later in the nephrostomy tracks with left renal cavity dilatation. Computerized tomography (CT) showed a subcutaneous mass without any retroperitoneal extension. The left pyelic cavity appeared heterogeneous, probably due to clot formation following recent removal and insertion of the catheter. The tumor was excised, and histological results demonstrated metastasis from poorly differentiated transitional cell carcinoma. The primitive tumor was evaluated. Renal CT, cystoscopy, retrograde ureteropyelography and biopsy of the vesicoureteral junction were normal. A high grade of urothelial proliferation was demonstrated on urinary cytology. CT guided pyelic microscopic biopsy revealed poorly differentiated transitional cell carcinoma, which seemed to invade the renal parenchyma. Renal magnetic resonance imaging showed a 4 cm. pyelic posterior heterogeneous lesion. Left nephroureterectomy was performed. Pathological examination revealed high grade transitional cell carcinoma infiltrating the renal parenchyma without node infiltration. At 7-month followup the patient was on hemodialysis.