Primary Urinary Tract Research Articles

Spontaneous rupture of the renal pelvis due to squamous cell carcinoma of the urinary bladder: a rare case

Bladder cancer is the fourth most common tumor in men and is usually diagnosed around the seventh decade of life. The predominant histological type is transitional cell carcinoma, while squamous cell carcinomas and adenocarcinomas are less common. Spontaneous rupture of the excretory system, an obstructive complication, is a rare occurrence and even more uncommon when caused by neoplasia. The aim of this article is to report the case of a male patient with spontaneous rupture of the pelvis due to squamous cell carcinoma of the bladder. With regard to renal pelvis rupture due to primary urinary tract obstruction, stone formation (lithiasis) is the most common cause, accounting for 50%, while neoplasia ranks fifth. As for the histological subtypes of the neoplasm, it is essential to note that transitional cell carcinoma is observed in 90% of cases.

Demographics, Clinical Characteristics and Survival Outcomes of Primary Urinary Tract Malignant Melanoma Patients: A Population-Based Analysis.

All primary urinary tract malignant melanoma (ureter vs. bladder vs. urethra) patients were identified from within the Surveillance, Epidemiology, and End Results (SEER) database 2000-2020. Kaplan-Maier plots depicted the overall survival (OS) rates. Univariable and multivariable Cox regression (MCR) models were fitted to test the differences in overall mortality (OM). In the overall cohort (n = 74), the median OS was 22 months. No statistically significant or clinically meaningful differences were recorded according to sex (female vs. male; p = 0.9) and treatment of the primary (endoscopic vs. surgical; p = 0.6). Conversely, clinically meaningful but not statistically significant (p ≥ 0.05) differences were recorded according to the patient's age at diagnosis (≤80 vs. ≥80 years old; p = 0.2), marital status (married 26 vs. unmarried 16 months; p = 0.2), and SEER stage (localized 31 vs. regional 14 months; p = 0.4), and the type of systemic therapy (exposed 31 vs. not exposed 20 months; p = 0.06). Finally, in univariable and MCR analyses, after adjustment for the SEER stage and type of systemic therapy, tumor origin within the bladder was associated with a three-fold higher OM (Hazard ratio: 3.00; p = 0.004), compared to tumor origin within the urethra. In conclusion, primary urinary tract malignant melanoma patients have poor survival. Specifically, tumor origin within the bladder independently predicted a higher OM, even after adjustment for the SEER stage and systemic therapy status.

Study on antibacterial activity of medicinal herbs against urinary tract infection (UTI) pathogens

This study is aimed in the direction of the dedication of antimicrobials on native herbals in Tirunelveli district. Tamil Nadu. India. In the direction of fine pathogenic microorganisms isolated from the urinary tract of humans. The urine pattern was gathered from patients who have been processed for the isolation & identity of pathogenic bacteria. The extracts have been subjected for screening of in vitro antibacterial activity against decided primary urinary tract contamination (UTI) causing pathogens viz. (Staphylococcus aureus, Klebsiella pneumonia, Salmonalla typhi, Escherichia coli, and Streptococcus pyogenes) at the concentrations of 25 µl to 200 µl via disc diffusion assay technique. The effects of antibacterial activity discovered that the all extract confirmed suitable inhibitory interest against all the tested pathogens. The leaves of herbs, specifically Azadirachta indica, Ocimum sanctum, and Phyllanthus niruri were taken and an ethanol extract changed into prepared.

MO156: The Choice of Empiric Antimicrobial Agent and its Association with Outcomes in Kidney Transplant Recipients with Urinary Sepsis

Abstract BACKGROUND AND AIMS Efficient antibiotic therapy remains the cornerstone of successful sepsis treatment. Urinary sepsis, which remains the most common sepsis type in kidney transplant recipients (KTRs), is characterized by high prevalence of multidrug-resistant (MDR) bacterial strains, often limiting the choice of antimicrobial agents. The primary aim of this study was to elucidate the efficiency of primary empiric antimicrobial therapy in KTRs hospitalized for urosepsis, depending on the antibiotic choice. METHOD All primary urosepsis cases in KTRs hospitalized in 2014–2019 in the Transplantation Department of the Wroclaw Medical University Hospital were included retrospectively as the study group (n = 101). A total of 100 random KTRs hospitalized for primary urinary tract infection (UTI) were set as control group. The primary endpoint was the need for antibiotic change after 3 days of completed empiric treatment (due to lacking clinical response or proven antibiotic resistance). All patients were treated according to SSC guidelines with delay in antibiotic administration of no more than 1 h after the diagnosis of sepsis. RESULTS In the urosepsis and UTI groups, the need for antibiotic change after 3 days of treatment equaled 45.6% and 11%, respectively. Patients with urosepsis and inappropriate antibiotic therapy were at increased risk of death (OR = 10.1 with P = .021), need for acute renal replacement therapy (OR = 4.73 with P = .012) and non-recovery from AKI (OR = 3.18 with P = .031). Similar but not statistically significant trend was observed in the UTI group for lacking recovery from AKI (OR = 1.64 with P = .636). In both groups, the length of hospital stay was significantly longer in patients who did not receive appropriate empiric antimicrobial drug. Following antimicrobial agents were associated with appropriate successful treatment rates in the urosepsis and UTI groups: ciprofloxacine (0% versus 63%), amoxiciline with clavulonic acid (16.7% versus 89%), piperaciline with tazobactam (57% versus 60%), cefuroxime (67% versus 100%), third generation cephalosporines (76% versus 92%) and carbapenemes (100% versus 100%). CONCLUSION A delay in successful antibiotic therapy, caused by inappropriate choice of antimicrobial agents, for the treatment of urosepsis in KTRs is associated with detrimental kidney graft outcomes. Ciprofloxacine and amoxiciline with clavulonic acid should not be used for empiric therapy of urosepsis in this patient cohort. The development of urosepsis in KTRs as compared to non-septic UTI is associated with greater risk of antibiotic resistance among causative microorganisms and increased risk of antimicrobial failure.

Does Xylinas' nomogram accurately predict intravesical recurrence risk after radical nephroureterectomy for primary upper urinary tract urothelial carcinoma when applied to Asian populations?

To validate a prognostic nomogram (Xylinas' nomogram) for intravesical recurrence after radical nephroureterectomy for primary upper urinary tract urothelial carcinoma patients of Asian descent. Clinicopathological and survival data from 243 primary urinary tract urothelial carcinoma patients who underwent radical nephroureterectomy with bladder cuff excision between January 2004 and May 2017 were collated. Univariate and multivariable Cox regression analyses were performed to identify independent risk factors associated with intravesical recurrence-free survival. External validation was determined using regression coefficients abstracted from previously published data. Performance was then quantified through calibration and discrimination, according to concordance indexes (c-index) in receiver operating characteristic curves. 163 patients met our eligibility criteria and were finally included in this study. At a median follow-up of 60months, intravesical recurrence occurred in 29.4% (n=48). Multivariable analysis revealed that being male, ureteral tumor location, tumor multifocality and previous bladder cancer were independent prognostic factors of intravesical recurrence-free survival. When Xylinas' nomogram was applied to our cohort, the discriminatory power was found to be roughly equivalent with a c-index of 68.3% for the reduced model and 68.4% for the full model. Calibration plots also revealed intravesical recurrence predictions at 3, 6, 12, 18, 24 and 36months had relative concordance. Contrasting the respective performances of the reduced and full model suggests there is no significant difference between the two (all P>0.05). This nomogram appears accurate at predicting intravesical recurrence after radical nephroureterectomy for primary urinary tract urothelial carcinoma in Asian populations. However, it remains necessary to data mine for unknown prognostic factors for optimization. Further external validation is required across larger, ethically diverse populations before applying this nomogram in clinical practice.

Urinary Tract Aspergillosis in a Patient With Diabetes Who Underwent Total Abdominal Hysterectomy

Urinary tract aspergillosis is uncommon even in the era of increased frequency of invasivemycoses. Experience is largely from isolated case reports and few case series or reviews.The majority of cases involve transplant recipients predominantly following renaltransplantation but is also reported in other immunocompromised states such as AIDS anduncontrolled diabetes mellitus. Most cases represent haematogenous spread to renalparenchyma, often in the absence of recognized focus of infection, presenting as small orlarge abscesses, infarcts, renal insufficiency or urinary drainage system fungal balls withobstructive uropathy. Diagnosis is usually made on the basis of renal tissue aspiration, urinecultures or by histopathology of the suspicious mass passed through urinary tract. Theeffective management of invasive aspergillosis includes strategies to optimize preventionand early antifungal treatment, immunomodulation, and, in some cases, surgery. Neweranti-Aspergillus drugs notably voriconazole offer less toxic therapeutic options and are quitesuccessful in combination with drainage measures to relieve urinary stasis. This reportdescribes a case of primary urinary tract aspergillosis with fungal bezoars formation in a 37years old female, diabetic, hypertensive, who presented with intermittent urinary tractobstruction and was successfully managed by oral voriconazole for six weeks as itraconazolewas found refractory.
 Bangladesh J Obstet Gynaecol, 2018; Vol. 33(1) : 74-77

Primary melanoma of the urinary tract; Clinicopathologic and molecular review of a case series

Primary melanoma of the urinary tract is a very rare and aggressive cancer. It accounts for less than 1% of all the melanoma cases, making it difficult to histopathologically diagnose and manage. We present a retrospective case series of eight primary urinary tract melanoma with clinical, pathological, and molecular findings to add more insight to this challenging disease. These cases were evaluated for histopathological, immunohistochemical, and molecular features of melanoma that were most commonly found in the urethra, followed by those in the bladder and ureter. Identification of nested growth patterns and in situ melanocytic components at cell edges are helpful in the histopathological diagnosis of amelanotic or hypomelanotic tumors. Our results indicate that urinary tract melanoma has several molecular traits, such as gene expression patterns. Genetic mutations may be related to metastasis, as well as provide targets for the management programs.

A case report of primary upper urinary tract signet-ring cell carcinoma and literature review

BackgroundUpper tract urothelial carcinoma with pure non-urothelial histology is an exception but variants are present in ~ 25% of cases. Primary upper urinary tract signet -ring cell carcinoma is extremely rare.Case presentationWe report the case of a 65-year-old male diagnosed primary upper urinary tract signet-ring cell carcinoma while underwent percutaneous nephrolithotomy. Radical nephroureterectomy and adjuvant chemotherapy were performed sequentially. The patient is now recovering well with a regular follow-up for more than 1 year.ConclusionsThe upper urinary tract malignancy often appears as a high grade, high stage tumor and has a uniformly poor prognosis, but a timely multimodal management can bring a good outcome.

A Large Renal Mass: Dilemmas With Unusual Features on Imaging

A 50-year-old man presented with palpable abdominal mass which on CT revealed a large tumor replacing the entire right kidney, filling the right hemi-abdomen and travelling down the ureter into the bladder with retroperitoneal lymphadenopathy. Urine cytology and metastatic workup were negative. Ultrasound guided renal biopsy revealed diffuse large B cell lymphoma (DLBCL) and the patient was started on combination chemotherapy. Primary urinary tract lymphomas comprise <1% of all renal tumors and primary urinary tract DLBCL lymphomas carry a worse prognosis than nodal DLBCL. Biopsy of very large renal masses without distant metastasis or hematuria may significantly change management.

Acute and recurrent urinary tract infections in women presenting in primary practice

Acute and recurrent urinary tract infections in women presenting in primary practice Abstract. Acute and recurrent urinary tract infections in women of all age groups are becoming an increasing problem in primary care and medical practice. Symptoms can be relieved by a guideline-oriented acute therapy and a multimodal infection prophylaxis. The restoration of the body's natural defence mechanisms plays a central role. This article informs about the causes, the basic diagnostic examinations and the practical use of therapeutic and prophylactic measures.

Impact of host-pathogen-treatment tripartite components on early mortality of patients with Escherichia coli bloodstream infection: Prospective observational study.

BackgroundRisk factors affecting early morality of patients with Escherichia coli bloodstream infection (BSI) were investigated including the host-pathogen-treatment tripartite components.MethodsSix general hospitals in South Korea participated in this multicentre prospective observational study from May 2016 to April 2017 and a total of 1492 laboratory-confirmed E. coli BSI cases were studied. Cox regression was used to estimate risks of the primary endpoint, i.e., all-cause mortality within 30 days from the initial blood culture. Six multivariate analysis models were constructed in accordance to the clinical importance and intra- and inter-component multicollinearity.FindingsAmong the 1492 E. coli BSI cases, 9.5% (n = 141) patients expired within 30 days. Six models of multivariate analysis indicated risk factors of critical illness, primary infection of peritoneum, and chronic liver disease including cirrhosis for host variables; of phylogenetic group B2, ST131-sublineage H30Rx, multidrug resistance, group 1 CTX-M extended-spectrum beta-lactamase production, and having either of fyuA, afa, and sfa/foc virulence genes for causative E. coli pathogen variables; and of delayed definitive therapy for antimicrobial treatment variables. In addition, as a protective factor, primary urinary tract infection was identified.InterpretationDespite decades' effort searching for the risk factors for E. coli BSI, systemic understanding covering the entire tripartite component is still lacking. This study detailed the organic impact of host-pathogen-treatment tripartite components for early mortality in patients with E. coli BSI.

Is fluoroquinolone monotherapy a useful alternative treatment for Pseudomonas aeruginosa bacteraemia?

Pseudomonas aeruginosa bacteraemia is associated with high mortality, and most monotherapies are beta-lactam-based. We aimed to investigate clinical outcomes of definitive fluoroquinolone monotherapy versus beta-lactam monotherapy for P. aeruginosa bacteraemia. This retrospective study enrolled adult patients receiving definitive monotherapy with beta-lactam or fluoroquinolone between November 2013 and November 2014 at Taipei Veterans General Hospital. The independent risk factors for 28-day mortality were analyzed by logistic regression and propensity score-adjusted analysis. Among the 105 patients enrolled, 78 patients received beta-lactams and 27 received fluoroquinolones (20 with ciprofloxacin and 7 with levofloxacin). Primary bacteraemia (39.0%) and urinary tract infections (37.1%) were the most common sources of bacteraemia. The 28-day mortality rate was 11.1% for those receiving fluoroquinolones and 32.1% for those receiving beta-lactams (P = 0.062). The 28-day mortality rate between the two groups stratified by APACHE II and Pitt bacteraemia scores showed no significant differences in each category. Propensity score-adjusted multivariate analysis revealed that definitive therapy with a fluoroquinolone was not associated with 28-day mortality (OR 0.42; 95% CI 0.08-2.23; P = 0.305). Fluoroquinolone might be an alternative to beta-lactam as a definitive monotherapy for P. aeruginosa bacteraemia provided they are active in vitro. Our results could be a basis for further studies and provide a possible target for antibiotic stewardship interventions in P. aeruginosa bacteraemia.

Secondary Tumors of the Urinary System: An Imaging Conundrum

Imaging features of metastases to the urinary system may closely mimic primary urinary tract tumors, and differential diagnosis by imaging alone may be problematic or even impossible in some cases. The main purpose of this article was to familiarize radiologists with imaging findings of metastasis to the urinary system on cross-sectional imaging, with an emphasis on abdominal and pelvic computed tomography and magnetic resonance imaging. In addition, we review the clinical importance and implications of metastases to the urinary tract and provide information on diagnostic work-ups.

Primary Urinary Tract Lymphoma: Rare but Aggressive.

Primary urinary tract lymphoma (PUTL) is an uncommon disease with only a few case reports in the literature. Information about 1,264 patients diagnosed between 1983 and 2013 with PUTL was extracted from the Surveillance, Epidemiology and End Results database. Kaplan-Meier curves and multivariable regression analysis were used to analyze the survival and identify prognostic factors. A comparison of nodal diffuse large B-cell lymphoma (DLBCL) with PUTL DLBCL was performed. In addition, we compared the characteristics of kidney and bladder lymphoma. PUTL incidence was 1 case/1,000,000 people per year. DLBCL was found to be the predominant histology. Five-year overall survival and cancer-specific survival were 49% and 58%, respectively. DLBCL histology, male gender, stage III-IV disease, and advanced age were found to be poor prognostic factors. Surgery may be beneficial. Urinary tract DLBCL has a worse prognosis than nodal DLBCL. To our knowledge, this is the largest population-based study of PUTL in the literature. The survival of patients has not improved in the era of modern therapies therefore new treatments are needed.

Evaluation and management of Staphylococcus aureus bacteriuria: an updated review.

There is little guidance regarding the evaluation and management of patients with Staphylococcus aureus bacteriuria (SABU). Here, we aimed to provide an up-to-date review of the literature. We searched PubMed, Scopus, and clinical trial registries for articles evaluating the epidemiology of SABU, risk factors of SABU, the association of SABU with urinary tract infection, bacteremia and invasive S. aureus infections, and the management of patients with SABU. S. aureus is an uncommon isolate in urine cultures. It is more common among certain patients, e.g., patients with indwelling urinary tract devices or prior urinary tract instrumentation. SABU may represent asymptomatic bacteriuria, primary urinary tract infection, or hematogenous seeding of the urinary tract associated with other foci of infection. SABU may also serve as the focus for subsequent bacteremia and invasive infections. We did not find any clinical trials regarding the management of patients with SABU. Based on our review, we suggest an algorithmic approach for the evaluation and management of patients with SABU. However, evidence from clinical trials is lacking and there are several gaps in the current literature. These are discussed in this review.

Prognosis and treatment of primary urinary tract small cell carcinoma

Objective To investigate the clinicopathological features, treatment modalities, and prognostic factors for survival in patients with urinary tract small cell carcinoma( UT-SCC). Methods A total of 25 patients treated from June 2000 to December 2014 were included in the retrospective study. The data included age, gender, primary tumors origins, stage, treatment modalities, progression-free survival(PFS), overall survival(OS), pathology and immunohistochemistry. Of these cases, 22 were male, and the other was female, whose age was 45-79 years (mean age 67). 20 cases small cell carcinoma of bladder patients and 2 small cell carcinoma of prostate cancer patients were included. The number of small cell carcinoma in pelvis, ureter and retroperitoneal was 1 respectively. The patients with small cell carcinoma of the urinary tract were classified as disease and extensive disease. 17 bladder small cell carcinomas were limited disease and 3 cases were extensive disease; Prostate small cell carcinomas were both extensive disease; The small cell carcinomas in pelvis, ureter were limited disease; The small cell carcinoma in retroperitoneal was extensive disease. 10 bladder small cell carcinomas which were limited disease received radical cystectomy. 6 of 10 patients received etoposide and cisplatnum (EC). 4 of 10 patients received gemcitabine and cisplatnum (GC). 7 bladder small cell carcinomas patients who with limited disease refused to receive radical cystectomy in which 2 patients received TURBT and 5 patients received TURBT followed chemotherapy. Both prostate small cell carcinomas received chemoradiotherapy. 2 small cell carcinomas in upper urinary tract (pelvis and ureter) received radical nephroureterectomy with bladder cuff resection. The patient of retroperitoneal small cell carcinoma received percutaneous nephrostomy after biopsy. The progression-free survival (PFS) and overall survival (OS) of these patients are analyzed; the influence of TURBT with adjuvant chemotherapy and clinicopathologic characteristics were analyzed in median PFS and OS. PFS and OS were compared between groups as a function of time, using a Kaplan-Meier survival curve analysis and the log-rank significance test. All statistical tests were two-sided, and P values < 0.05 were considered statistically significant. Results 25 patients with a pathologic confirmation of UT-SCC, either by biopsy or surgery, were finally included. These patients were classified as pure UT-SCC (14) and Mixed UT-SCC (11). Mixed UT-SCC was defined as tumors containing both SCC and non-SCC components, regardless of the proportion of the latter. 13 cases were strongly positive and 3 cases were weakly positive in neuron specific enolase (NSE) level. 8 cases were strongly positive and 2 cases were weakly positive in CgA level. Patients with limited disease experienced a significant longer PFS and OS compared with extensive disease subjects (PFS 13.2 vs. 7.8 χ2=13.53 P<0.01; OS 27.2 vs. 12.7 χ2=19.88 P<0.01). Patients with bladder SCC showed a significantly higher median PFS and OS compared with patients with SCC of other parts of urinary tract (PFS 12.8 vs. 8.2 χ2=12.00, P=0.001; OS 26.3 vs. 13.2 χ2=14.45, P<0.01). The two different chemotherapy regimens (GC and EC) have no influence on survival (PFS: 16.3 vs.12.5, χ2=3.34, P=0.07; OS 29.5 vs.22.8, χ2=1.66, P=0.198). TURBT followed by adjuvant therapy have no influence on survival (PFS 14.5 vs.12.0 t=1.30 P=0.251; OS 24.5 vs. 28.4 t=0.50, P=0.636). Conclusions The primary tumors origins and stage may have influence on survival in patients with UT-SCC. Patients with bladder small cell carcinoma and limited disease experienced a longer survival. Key words: Urological neoplasms; Small cell carcinoma; Treatment; Prognosis

Risk factors analysis and prognosis of bladder carcinoma occurrence in patients with transitional-cell carcinoma of primary upper urinary tract after radical operation

Objective To analysis the risk factors and prognosis of bladder carcinoma currence in patients with transitional-cell carcinoma of primary upper urinary tract after radical operation. Methods The clinical data were retrospectively collected in 115 patients with carcinoma of primary upper tract. The protein expressions of tumor markers Ki-67 and P53 were detected by immunohistochemistry. Combined with traditional cliniopathological factors and molecular markers, the risk factors of bladder carcinoma occurrence were analyzed. Results The incidence of bladder cancer was 11.3%(13/115) and the mean follow-up time was 48.5 months. Age more than 65 years (P=0.040), ureteral tumors (P=0.008) and the lower expression of Ki-67 (P=0.041) were independent predictors for bladder cancer. The survival time of non-progression were (92.1±13.3) and (112.8±4.3) months in bladder tumor group and non-bladder tumor group, but there was no significant difference between the two groups (P>0.05). The survival time of no disease were (113.5±4.3) and (116.0±5.0) months, respectively (P>0.05). Conclusions Advance age, lower ureteral tumors and down-expression of Ki-67 were independent predictors for bladder tumor recurrence in primary upper tract urothelial carcinomas after nephroureterectomy. There was no relationship between bladder tumor recurrence and oncological outcomes. However, close follow-up and rigorous treatment are essential for patients with high risk factors. Key words: Carcinoma, transitional cell; Urinary Bladder neoplasms; Prognosis

The relationship between patient characteristics and the development of a multi-resistant healthcare-associated infection in a private South Australian hospital

The prevention of healthcare-associated infections (HAI) and the rise of multi-resistant organisms are significant public health issues. Infections caused by multi-resistant organisms (MRO) can have similar clinical manifestations to infections caused by non-multi-resistant organisms (non-MROHAI) but antibiotic treatment options are more limited, which can result in treatment failure. This study aimed to reduce the incidence of MRO HAI in a specific South Australian hospital setting by identifying factors that are associated with MRO transmission. Using a case-control design, we analysed data from 1017 adult patients who developed an HAI in the 9-year period from 2003 to 2011 in a private South Australian hospital. We compared risk factors in patients who developed MRO HAI (cases) with risk factors in patients who developed non-MRO HAI (controls). Data were collected from the hospital's patient management database and individual medical records, and analysed using univariate and multivariate techniques. Independent predictors for the development of MRO HAI were the presence of an indwelling urinary catheter and renal disease. The development of a secondary infection was significantly more likely in MRO relative to non-MRO HAI, as was secondary bloodstream infection following a primary urinary tract infection. All effective interventions for reducing MRO, specifically in UTI, should be implemented where feasible. Increased healthcare worker education on aseptic non-touch technique, and safe insertion and management of an IDC, particularly important in patients with underlying renal disease, could assist in decreasing the risk of MRO HAI in this setting.

Tumour multiplicity as a risk factor for the development of bladder tumours after primary upper urinary tract cancer

Objective: To determine the independent risk factors for intravesical tumour recurrence in patients with primary urothelial cancer of the upper urinary tract. Patients and methods: Of the 60 patients who underwent nephroureterectomy for urothelial cancer of the upper urinary tract, the data from 49 patients were retrospectively reviewed. Patients with a previous history or concomitance of bladder cancer were excluded from the study. Multivariate analysis by Cox’s proportional hazards model was used to determine independent risk factors for intravesical tumour recurrence. Results: Of the 49 patients reviewed, 22 (44.9%) experienced subsequent intravesical tumour recurrence during a mean follow-up period of 26 months (range 3–103). On multivariate analysis, tumour multiplicity had a statistically significant impact on the risk of intravesical tumour recurrence ( P &lt; 0.01). Conclusion: Neither the pathology of the upper urinary tract cancers nor the method of treatment was associated with recurrent bladder cancers. Only tumour multiplicity had a significant impact on the incidence of intravesical tumour recurrence.

Metastasis to the ovaries from transitional cell carcinoma of the bladder and renal pelvis: a report of two cases

Ovarian metastases from a primary urinary tract carcinoma are extremely rare. This can be difficult to distinguish from transitional cell carcinomas (TCC) of ovarian origin because of histologic similarity. A 65-year-old woman who was diagnosed with renal pelvis TCC 4 months prior was referred for evaluation of a left ovarian mass. A 47-year-old woman who underwent radical cystectomy due to bladder TCC 1 year ago was referred because of a right ovarian mass. Both patients underwent a bilateral salpingo-oophorectomy. The tumor cells had morphology identical to those of the primary urinary tract tumors. Gynecologic oncologists should consider metastatic TCC of the ovary from urinary tract origin, as well as breast, and gastrointestinal tract origins.