RCC with tumor thrombosis of proximal ureter: an unusual cas
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Renal cell carcinoma (RCC) is the most common type of malignant mass found in the kidney. It demonstrates well-described and relatively predictable patterns of growth and extra-renal spread – all of which are used for clinical staging of the disease.

Published in the journal Urology Case Reports, the authors present a case of a 79-year-old male who has originally reported for management of chronic interstitial cystitis (IC). On annual visit, he was noted to have intermittent gross hematuria and underwent a hematuria work-up. Abdominal CT scan identified an incidental renal mass with features suspicious for malignancy.

A confirmatory MRI further characterized the left renal mass with dilation of the proximal collecting system due to obstruction of the ureter. Given these obstructive findings, he underwent ureteroscopy. This revealed clot-like material within the proximal ureter that appeared grossly consistent with possible tumor thrombus.

He then underwent robot assisted laparoscopic radical nephrectomy one week later and suffered no complications. Palpation of the gross specimen following the procedure indicated a cord-like mass within the ureter. He was discharged home on postoperative day 4.

Histopathological analysis of the surgical specimen revealed a 9.5 × 6.0 × 6.0 cm clear cell renal cell carcinoma (ISUP Grade 4 of 4) with necrosis and pathological stage T3aN0 due to “invasion of the pelvicalyceal system”. Tumor extension was observed within the lumen of the proximal ureter – a highly unusual pattern of RCC spread.

Intraoperatively, the ureter was dissected and removed at the level of the iliac vessels. Additional gross tumor extension was identified within the perinephric tissue, the renal sinus soft tissue, and the pelvicalyceal system which was nearly replaced by tumor. The renal vein was free of tumor.

- Renal cell carcinoma with tumor thrombus in the renal pelvis and ureter is rarely described. Due to rarity of this tumor characteristic, it is unclear what luminal spread of RCC within the ureter portends with respect to malignant or prognostic potential and how it should affect the TNM staging of renal cell carcinoma.

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