Mitchell Katharina, El Naili Reima, Pillai Lakshmikumar, Lopez Eric Mark, Riordan John, Marsh Wallis, Luchey Adam, Hajiran Ali
West Virginia University Department of Urology, Morgantown, WV, USA.
West Virginia University Department of Pathology, Morgantown, WV, USA.
Case Rep Urol. 2023 Apr 17;2023:3242986. doi: 10.1155/2023/3242986. eCollection 2023.
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).
从统计学角度来看，同时患有肾细胞癌（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，我们描述了一例不同寻常的病例，一名67岁女性，出现双侧胁腹疼痛和严重肉眼血尿。横断面成像显示两个大的异质性内生性肾肿块，伴有一个肿大的腔静脉旁淋巴结。为完成对肉眼血尿的评估进行了诊断性膀胱镜检查，发现同时存在乳头状膀胱肿瘤。双侧肾肿块的经皮活检显示左肾为透明细胞肾细胞癌，右肾为高分化神经内分泌肿瘤，膀胱肿瘤经尿道切除显示为高级别非肌层浸润性尿路上皮癌。患者选择接受双侧肾输尿管切除术、根治性膀胱切除术以及腹膜后和盆腔淋巴结清扫术。最终病理证实存在三种不同的恶性肿瘤：膀胱非侵袭性高级别乳头状尿路上皮癌（pTaN0）、左肾透明细胞肾细胞癌（pT2bN0）、右肾高分化神经内分泌肿瘤以及一个腔静脉旁淋巴结有转移性神经内分泌肿瘤阳性（pT2aN1）。
