尿路上皮惡性腫瘤於移植腎復發：案例報告與文獻回顧

陳鵬¹、黃子豪^1,2、黃志賢^1,2 

¹臺北榮民總醫院 泌尿部； 

²國立陽明交通大學醫學院泌尿學科及書田泌尿科學研究中心 

Urothelial Carcinoma Recurrence in Graft Kidney: Case Report and Literature Review

Peng Chen¹, Tzu-Hao Huang^1,2, William J. Huang^1,2 

¹ Department of Urology, Taipei Veterans General Hospital. 

² Department of Urology, School of Medicine, College of Medicine, Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan

Case Report:

This 40-year-old man had history of end stage renal disease and received hemodialysis since 2014. He underwent deceased donor kidney transplantation in 2018 and was regularly followed at our transplant clinic. Intermittent gross hematuria was noted since 2019/6 and diagnostic ureteroscopy revealed papillary tumors over lower third segment of right ureter. Thus, bilateral laparoscopic radical nephroureterectomy and bladder cuff excision was performed for native kidneys in 2019/7.

However, the patient experienced a series of recurrence on follow-up afterward. Bladder tumor recurrence was found in 2019/10 and transurethral resection of bladder tumor (TURBT) was done, followed by a second look TURBT after one month, which showed residual tumor over right native ureter stump and orifice. The patient then received partial cystectomy in 2019/11 for the tumor over native ureter orifice. Nevertheless. Flat urothelial carcinoma in situ and papillary urothelial carcinoma recurred in bladder on subsequent follow-up courses from 2020/1 to 2020/9. In the meantime, intravesical chemotherapy and BCG instillation had been introduced but turned out to be ineffective. Therefore, we suggested him radical cystoprostatectomy as the most optimal treatment option. The patient accepted the fact and underwent the surgery in 2020/9, and ultimately the pathology disclosed a pT2 muscle invasive bladder cancer. By this time the transplanted graft worked well and maintained a good renal function. A percutaneous nephrostomy to the graft kidney was inserted for long-term graft urinary diversion.

Ten months later in 2021/7, to our astonishment, urine cytology revealed positive for malignant cells, indicating the presence of malignancy in the graft kidney. We did a diagnostic antegrade flexible nephroscopy via the nephrostomy and found a cluster of papillary tumors at the lower calyx of graft kidney. After talking to the patient, we have no choice but to perform the graft kidney nephroureterectomy. Eventually, the pathology yielded pT3 high grade invasive papillary urothelial carcinoma. The patient tolerated the whole course well and he resumed on hemodialysis. No evidence of recurrent disease was found to date.

Conclusions:

Urothelial carcinoma arising from graft kidney was only described through case reports or small series. Incidence reported by literature is rare and varied widely. The reported time between the date of transplantation and the development of urothelial carcinomas in transplanted kidneys was extremely variable as well. The mainstay treatment remains transplant nephroureterectomy.

References:

1. Leon et al, Urology. 2020 Jan; 135:101-105.
2. Bellini et al, Clin Transplant. 2019 Jun;33(6):e13559.