腎細胞癌合併對側輸尿管轉移案例報告及論文回顧
謝昆霖1 、賴韋宏1 、黃冠華2  
奇美醫學中心 外科部 泌尿科1; 泌尿腫瘤外科2
Renal cell carcinoma with synchronous contralateral ureteric metastasis
– a case report and literature review
Kun-Lin Hsieh1, Wei-Hong Lai1 , Steven Kuan-Hua Huan2
Division of Urology1, Department of Surgery, Chi Mei Medical Center
Division of Uro-Oncology2, Department of Surgery, Chi Mei Medical Center
 
Purpose:
When treating the renal cell carcinoma (RCC), preservation of renal function is important as cancer control. Besides, metastasis of renal cell carcinoma (RCC) to ureter is extremely rare. In our review, total 54 cases had been reported about RCC with ureteric metastasis and just only 11 patients of them developed contralateral ureteric metastasis. We here presented RCC with synchronous contralateral ureteric metastasis and our management to this patient. We also reviewed the associated literature in this report.         
Case report:
A 61-year-old healthy man suffered from intermittent painless hematuria for two months. He visited other hospital firstly, where intravenous pyelography revealed obstructive lesion over right ureter. He then went to our outpatient department for second opinion. Impaired renal function with serum creatinine (Cr) showed 1.63 mg/dL and glomerular filtration rate (GFR) calculated 34 ml/min. Abdominal computed tomography (CT) revealed right upper-third ureter tumor with moderate hydronephrosis. Besides, a tumor about 3cm at left kidney was also detected, which favor RCC. Thus, the diagnosis ureterorenoscopy (URS) was performed, and pathology from endoscopic biopsy to right ureter tumor presented with metastasis RCC.
Considering about preservation of renal function as well as principle of RCC management, we performed the cytoreductive nephrectomy with metastasectomy for him. Laparoscopic partial nephrectomy to left RCC and segmental resection of right ureter with ureteroureterostomy was done. The target therapy, Sunitinib, is also prescribed for the metastatic status of RCC. He recovered well and no tumor progression found during six months follow up till now. Image showed no dilatation of right pyelocalyceal system, and postoperative renal function is preserved as Cr: 1.67 mg/dL at 3-month-later follow up.               
 Discussion:
It is reported that approximately one third of patients with RCC present with metastases. Several atypical presentations and rare metastatic sites had been reviewed in the literature.1 RCC with ureteric metastasis is very rare and just about 54 cases had been reported.2 Due to only 4 cases had been reported of RCC presented as synchronous contralateral ureteric metastasis, there is no consensus as to the most appropriate management.
Cytoreductive nephrectomy and surgical metastasectomy has been shown to improve survival benefit.3 It had been recommend as principle of management metastasis RCC.4 Our patient has favorable outcome including not only tumor prognosis but also renal function.
Besides, we also learned from this case that detailed evaluation to patient with suspect ureter lesion is very important. Awareness of these metastatic tumors could lead to early detection and improvement in management.5  
Conclusion:
In our review, this is the 5th case presented as RCC with synchronous contralateral ureteric metastasis. Partial nephrectomy with segmental resection of contralateral ureter seems effective as surgical treatment. It had satisfied outcome in not only prognosis of cancer but also renal function.    
Reference:
  1. Sountoulides, et al. Journal of Medical Case Reports (2011) 5:429
  2. Salim Said Al-Busaidy, et al. British Journal of Medical and Surgical Urology (2011) 4, 86-88
  3. Francesco Greco. EUROPEAN UROLOGY (2013) 63, 653–656
  4. Kidney Cancer of NCCN guideline. Version 3. 2015
  5. KEVIN C. et al. UROLOGY (2006) 68: 428e5-7
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    台灣泌尿科醫學會
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    2015-05-27 12:22:00
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