Tibial Bone Metastasis of Ureteral Transitional Cell Carcinoma with Low Back Pain-A Case Report

Abstract

Of the upper urinary tract (UUT) transitional cell carcinomas (TCCs), only about 25% are ureteral TCC. Typical ureteral carcinoma symptoms are painless hematuria and flank pain. Bone metastasis of ureteral cancer is always directly invasive to nearby bone structures such as the spine, pelvis, and hip bone. Distal bone metastasis such as that in the tibial bone, however, is rare. This report describes a female patient who initially presented with left early stage ureteral transitional cell carcinoma (pT1N0M0) after nephroureterectomy and bladder cuff excision in MK 92. She complained of low back pain and suspected combined radicular pain in MK94. Due to poor response to initial conservative treatment, the patient was eventually diagnosed with right tibial bone metastasis. Three years after surgical intervention chemotherapy to treat the metastasis, follow-up examination revealed stable condition. In clinical practice, accurate differential diagnosis is essential in patients with low back pain and low leg pain, HIVD with radicular pain, and metastatic bone lesions. Detailed patient history and physical and neurological examinations are essential. Further survey for other etiologies is indicated in patients who respond poorly to conservative treatment, particularly those with history of urinary tract cancer.