Bretterbauer Katharina, Drerup Martin, Heidler Stefan, Lösch Georg, Albrecht Walter
Department of Urology, Landesklinikum Mistelbach.
Department of Urology, Paracelsus Medical University of Salzburg.
Urol J. 2017 Nov 4;14(6):5073-5074. doi: 10.22037/uj.v14i6.3795.
Ureteral metastasis of renal cell carcinoma (RCC) is rare and usually confined to the ipsilateral ureter. In literature, about 50 cases have been reported so far. Of these, only 14 metastasized metachronously to the contralateral ureter.A seventy-one-year-old man was hospitalized with recurrent painless severe haematuria. Seven years previously, he had undergone radical nephrectomy of the right kidney due to a clearcell renal cell carcinoma (cRCC), Fuhrman grad 2. Intravenous urography and a retrograde ureterogram revealed a filling defect (25 mm) in the left distal ureter, which we expected to be an urothelial carcinoma. Biopsy was not possible, due to ureteral stricture. Diagnostic workup revealed no other sites of metastasis. To preserve kidney function and quality of life we refrainedfrom performing nephroureterectomy and opted for an autotransplantation of the solitary left kidney with ureteral reimplantation in the bladder. We resected the ureter and histopathologicial examination showed a metastasis of cRCC, Fuhrman grade 2.Postoperatively, the patient developed an acute postrenal failure, hence a nephrostomy and a bladder catherization were performed. After this, the patient improved significantly and the drains could be removed. Currently the patient is free of complaints. The residual and contralateral ureter is a potential metastatic site after RCC. Autotransplantation is an option forsurgical treatment.
肾细胞癌（RCC）的输尿管转移罕见，通常局限于同侧输尿管。据文献报道，迄今为止约有50例。其中，仅14例异时转移至对侧输尿管。一名71岁男性因反复无痛性严重血尿入院。7年前，他因透明细胞肾细胞癌（cRCC）、Fuhrman 2级接受了右肾根治性切除术。静脉肾盂造影和逆行输尿管造影显示左输尿管远端有一个充盈缺损（25mm），我们预计这是一例尿路上皮癌。由于输尿管狭窄，无法进行活检。诊断性检查未发现其他转移部位。为了保留肾功能和生活质量，我们未进行肾输尿管切除术，而是选择了将孤立的左肾自体移植并将输尿管重新植入膀胱。我们切除了输尿管，组织病理学检查显示为cRCC转移，Fuhrman 2级。术后，患者出现急性肾后性肾衰竭，因此进行了肾造瘘术和膀胱插管。此后，患者明显好转，引流管可以拔除。目前患者无不适主诉。RCC术后，残余输尿管和对侧输尿管是潜在的转移部位。自体移植是一种手术治疗选择。
