Triple Threat: Three Primary Malignancies Simultaneously Involving Three Genitourinary Organs.

Katharina Mitchell, Reima El Naili, Lakshmikumar Pillai, Eric Mark Lopez, John Riordan, Wallis Marsh, Adam Luchey, Ali Hajiran
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Abstract

Statistically, the chance of having concurrent renal cell carcinoma (RCC), urothelial carcinoma of the bladder (UC), and a neuroendocrine tumor (NET) of the renal parenchyma is less than one in a trillion. Herein, we describe an unusual case of a 67-year-old female who presented with bilateral flank pain and severe gross hematuria. Cross-sectional imaging revealed two large heterogeneous, endophytic renal masses with a single enlarged paracaval lymph node. Diagnostic cystoscopy was performed for completion of gross hematuria evaluation and revealed a concurrent papillary bladder tumor. Percutaneous biopsies of bilateral renal masses revealed clear cell RCC involving the left kidney and well-differentiated NET involving the right kidney, and transurethral resection of the bladder tumor revealed high-grade nonmuscle invasive urothelial carcinoma. The patient elected to undergo bilateral nephroureterectomy, radical cystectomy, and retroperitoneal and pelvic lymphadenectomy. Final pathology confirmed the presence of three different malignancies: noninvasive high-grade papillary UC of the bladder (pTaN0), left renal clear cell RCC (pT2bN0), right renal well-differentiated NET, and a single paracaval lymph nodes positive for metastatic NET (pT2aN1).

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三重威胁:三种原发性恶性肿瘤同时累及泌尿生殖器官。
据统计,并发肾细胞癌(RCC)、膀胱尿路上皮癌(UC)和肾实质神经内分泌肿瘤(NET)的几率小于万亿分之一。在此,我们描述一个不寻常的情况下,67岁的女性谁提出了双侧腹部疼痛和严重肉眼血尿。横断影像显示两个大的异质性,内生肾肿块和一个增大的腔旁淋巴结。诊断性膀胱镜检查完成大体血尿评估,发现并发乳头状膀胱肿瘤。双侧肾肿块经皮活检显示左肾为透明细胞RCC,右肾为高分化NET,经尿道膀胱肿瘤切除术显示高级别非肌肉浸润性尿路上皮癌。患者选择行双侧肾输尿管切除术、根治性膀胱切除术、腹膜后及盆腔淋巴结切除术。最终病理证实存在三种不同的恶性肿瘤:无创性膀胱高级别乳头状UC (pTaN0),左侧肾透明细胞癌(pT2bN0),右侧肾高分化NET,以及单个腔旁淋巴结转移性NET阳性(pT2aN1)。
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