A Rare Case of Primary Ureteric Carcinoma managed with Surgery and Adjuvant Therapy.

Dr. M Venkataramana (M.D.)¹, Dr. Y Sree Sowmya (M.D.)^1*

1. MD Radiation oncology, Head of department, GEMS Ragolu, Andhra Pradesh, 532484.

Corresponding Author: Dr. Y Sree Sowmya (M.D.), (M.D. Radiation oncology), Senior Resident, Department of Radiation Oncology, GEMS Hospital, Ragolu, Andhra Pradesh.

Copy Right: © 2022 Dr. Y Sree Sowmya (M.D.), This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received Date: September 27, 2022

Published Date: October 05, 2022

Abstract

Introduction

Ureteric neoplasms are rare malignancies. Urothelial carcinoma of the upper urinary tract accounts for 7% of all kidney tumors and 5% of all urothelial malignancies(1). Concomitant bladder and ureter tumours when seen may occur synchronously or metachronously. Ureteral tumors are usually seen in the distal third of the ureter. The median age at diagnosis is 71 years, and higher-grade tumors are most likely to occur in elderly patients(2).

Cigarette smoking is one of the most important factors contributing to the overall incidence of urothelial cancer(3). Patients with renal pelvis or ureter tumours usually present with gross or microscopic hematuria (75 to 90 percent)(4).The other less common symptoms include pain (8% to 40%), bladder irritation (5% to 10%), or other constitutional symptoms (5%). About 10% to 20% of patients may present with a flank mass secondary to tumor or hydronephrosis.

Staging consists of a complete history and physical examination, complete blood count, and liver and kidney function tests. Cystoscopy is important to look for the high incidence of multiple tumors(5).

Here we discuss a case of primary Ureteric carcinoma that was managed by radical excision followed by adjuvant chemotherapy.

Case History

A 57-year-old male presented to our hospital with gross painless hematuria and left flank pain radiating to the groin for two months. There were no medical comorbidities. He had a history of Tobacco smoking for 10 years. Per abdominal examination did not reveal any significant findings other than left flank tenderness. Routine laboratory examination findings were within normal limits. MRI pelvis revealed dilated left ureter with heterogeneous T2 and STIR isointense mass lesion causing severe luminal narrowing in the distal third of the left ureter for a length of 60 mm with homogeneous enhancement post- contrast with no evidence of extraluminal spread. Left VUJ was unremarkable. Periureteic fat planes were normal (Figure 1). The right kidney was normal. Chest imaging did not show any primary or metastatic disease.

Cystoscopy revealed normal bladder mucosa. He underwent radical nephroureterectomy with bladder cuff excision in April 2022. Gross examination showed an exophytic growth measuring 5.2 x 2.8 x 1 cm originating from ureteral mucosa. (Figures 2 and 3)

Microscopic examination high grade invasive papillary urothelial carcinoma invading muscularis (Figures 4, 5 and 6). All margins were negative for invasive carcinoma.