两侧两种不同的上尿路泌尿系统恶性肿瘤。

Case Reports in Urology Pub Date : 2021-09-21 eCollection Date: 2021-01-01 DOI:10.1155/2021/9981381
W S L De Silva, S R De Almeida, G D B J Karunarathne, A A S Samarathunga, K M C S Gannoruwa, J A S B Jayasundara
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引用次数: 0

摘要

导言:泌尿生殖系统是公认的多发性原发性恶性肿瘤的发病部位,即使没有综合征性异常。然而,据我们所知,到目前为止,外科文献中尚未报道一例上尿路上皮癌(UTUC)合并对侧肾细胞癌(RCC)。案例演示。一名52岁斯里兰卡男性患者在检查无痛可见血尿时发现右下输尿管肿瘤和左肾肿块。右侧输尿管肿瘤尺寸为32 × 22 mm,导致中度肾积水和右肾皮质变薄,左侧肾肿块尺寸为43 × 38 mm,累及下极。右侧输尿管病变活检显示为高级别移行细胞癌伴局灶嵌套型,左侧肾肿块活检显示为透明细胞癌。右侧肾输尿管切除术和左侧部分肾切除术均在6周内完成。两个切除标本的组织学证实了活检结果。讨论。高风险上尿路上皮癌,如本例患者的右输尿管肿瘤,需要行肾输尿管切除术,这使得对侧肾细胞癌的治疗更加复杂。在对该患者的两种恶性肿瘤进行肿瘤合理的手术治疗后,确保了足够的功能性肾残余。结论:当UTUC合并对侧RCC时,患者管理面临挑战。在处理涉及两侧上尿路的复杂泌尿生殖系统恶性肿瘤病例时,除了肿瘤合理的手术切除外,保存肾脏排泄功能必须被视为一个重要的决定因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Two Different Upper Tract Urological Malignancies on Either Side.

Two Different Upper Tract Urological Malignancies on Either Side.

Two Different Upper Tract Urological Malignancies on Either Side.

Two Different Upper Tract Urological Malignancies on Either Side.

Introduction: The genitourinary system is a recognized site for multiple primary malignant neoplasms even without syndromic anomalies. However, to the best of our knowledge, a case of upper tract urothelial carcinoma (UTUC) with contralateral renal cell carcinoma (RCC) is not reported in surgical literature so far. Case Presentation. A 52-year-old Sri Lankan male patient was found to have a right lower ureteric tumour and a left renal mass together upon investigating for painless visible hematuria. The right ureteric tumour measured 32 × 22 mm resulting in moderate hydronephrosis and cortical thinning of the right kidney, and the left renal mass measured 43 × 38 mm involving the lower pole. The biopsy of the right ureteric lesion revealed a high-grade transitional cell carcinoma with focal nested pattern and that of the left renal mass revealed a clear cell carcinoma. Right nephroureterectomy followed by a left partial nephrectomy was performed in six weeks' interval. The histology of both the resected specimens confirmed the biopsy findings. Discussion. A high-risk upper tract urothelial carcinoma such as the right ureteric tumour of this patient required a nephroureterectomy which makes the management of the contralateral renal cell carcinoma more complex. An adequate functional renal remnant was ensured after offering oncologically sound surgical treatment for both the malignancies of this patient.

Conclusion: A UTUC when associated with a contralateral RCC poses challenges in patient management. The preservation of renal excretory function has to be considered as an important determinant in addition to oncologically sound surgical resection when managing complex cases of genitourinary malignancies involving both sides of the upper urinary tract.

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