Korean J Urol.  2008 Nov;49(11):1046-1050. 10.4111/kju.2008.49.11.1046.

Bilateral Nephroureterectomy with Radical Cystectomy for Urothelial Tumor Involving the Renal Pelvis, Ureter and Bladder in a Patient Receiving Hemodialysis

• Lee KH
• Choi YH
• Cho SY
• Kim HS
• Cho IR

• KMID: 1328180
• DOI: http://doi.org/10.4111/kju.2008.49.11.1046

Abstract

Transitional cell carcinoma such as renal cell carcinoma is the relatively common urinary tract cancer in patients who are on dialysis. A 66-year-old male patient, who had been on maintenance hemodialysis for 5 years, was suffering from gross hematuria. The subsequent image studies revealed multiple masses at the right renal pelvis, the right distal ureter and the trigonal area at the bladder. We performed cystoscopy to evaluate the multiple bladder papillary masses and their blood clots. The patient then underwent bilateral radical nephroureterectomy and radical cystectomy. Histological examination revealed the papillary urothelial carcinoma. Our case may imply that dialysis patients have an increased susceptibility to urological malignancies. Physicians should always raise the possibility of urological malignancy when encountering a dialysis patient with gross hematuria. Because of the high recurrence rate, a more extensive operation and aggressive follow-up protocols should be done for these patients on dialysis.

Keyword

Kidney; Dialysis; Carcinoma; Transitional cell; Urinary tract

MeSH Terms

Male
Humans

Figure

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  Fig. 1. The abdomino-pelvic computed tomography (CT) scan shows multiple masses at the right renal pelvis, the right distal ureter and the trigonal area at the bladder at the delayed scan phase. Arrow indicates the right distal ureter mass. We can see a high attenuated lesion in the bladder, and the lesion is not enhanced at the delayed phase and it seems to be a blood clot.

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  Fig. 2. On cystoscopic findings multiple bladder papillary masses with blood clots were seen. Both ureteral orifices were not observed due to multiple spreading masses and the bleeding tendency.

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  Fig. 3. Gross findings. Protruding masses were noted in the right renal pelvis, the right distal ureter and the posterior wall of the urinary bladder.

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  Fig. 4. (A) Light microscopic findings. The protruding masses in the urinary bladder revealed low grade papillary urothelial carcinoma (H&E, x10). (B) Low grade papillary urothelial carcinoma is noted in the right distal ureter (H&E, x400). (C) Low grade papillary urothelial carcinoma is noted in the right renal pelvis (upper). The renal parenchyma reveals marked atrophic change, which is consistent with end stage kidney disease (H&E, x100). (D) Immunohistochemical microscopic findings. The urothelial carcinoma cells of the urinary bladder mass are positively stained with CK20 antibody.

Reference

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