Zou Yuhua, Liu Linwei, Xie Xiaojuan, Zhong Cunzhi, Wang Qinlin, Yan Sheng, Liu Quanliang
Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China.
Department of Cardiology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China.
Front Oncol. 2023 Aug 16;13:1197578. doi: 10.3389/fonc.2023.1197578. eCollection 2023.
Upper tract urothelial carcinoma (UTUC) is the most common urothelial malignancy in the renal pelvis or ureter. Renal pelvic carcinoma accounts for 90% of all tumours in the renal pelvis, so the mass in the renal pelvis is usually considered a UTUC. Renal cell carcinoma (RCC) in the renal pelvis, calyces and upper ureter is extremely rare, especially family translocation RCC, which makes this case even more uncommon.
We report the case of a 54-year-old man had intermittent painless gross haematuria with occasional blood clots and urodynia for 2 years. Contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) scan showed an enlarged left kidney, and a soft tissue mass was seen in the renal pelvis, calyces and upper ureter. The patient's urine-based cytology was positive three times. Due to the severity of the upper ureteral lumen stenosis, we did not perform pathological biopsy during ureteroscopy. In the current case, clinical symptoms, imaging examinations, urine-based cytology, and ureteroscopy were combined to obtain a preoperative diagnosis of UTUC. Therefore, robot-assisted laparoscopic left radical nephroureterectomy and retroperitoneal lymphadenectomy were performed. Unexpectedly, the patient was pathologically diagnosed with family translocation RCC after surgery. The surgery was uneventful. There was no intestinal tube injury or other complications perioperatively. The postoperative follow-up was satisfactory.
family translocation RCC in the renal pelvis, calyces and upper ureter is extremely rare, and can be easily confused with UTUC, resulting in the expansion of surgical scope. Preoperative ureteroscopy and biopsy or tumour punch biopsy should be used to obtain accurate pathology as far as possible, and the selection of correct surgical method is conducive to a good prognosis for patients.
上尿路尿路上皮癌（UTUC）是肾盂或输尿管中最常见的尿路上皮恶性肿瘤。肾盂癌占肾盂所有肿瘤的90%，因此肾盂肿物通常被认为是UTUC。肾盂、肾盏和上段输尿管的肾细胞癌（RCC）极为罕见，尤其是家族易位性RCC，这使得该病例更加罕见。
我们报告一例54岁男性，间歇性无痛肉眼血尿伴偶尔血凝块及尿痛2年。增强计算机断层扫描（CT）和磁共振成像（MRI）扫描显示左肾增大，肾盂、肾盏和上段输尿管可见软组织肿物。患者尿细胞学检查三次呈阳性。由于上段输尿管管腔狭窄严重，我们在输尿管镜检查时未进行病理活检。在本病例中，结合临床症状、影像学检查、尿细胞学检查及输尿管镜检查进行术前诊断为UTUC。因此，实施了机器人辅助腹腔镜下左根治性肾输尿管切除术及腹膜后淋巴结清扫术。出乎意料的是，术后患者病理诊断为家族易位性RCC。手术过程顺利。围手术期无肠管损伤或其他并发症。术后随访情况良好。
肾盂、肾盏和上段输尿管的家族易位性RCC极为罕见，易与UTUC混淆，导致手术范围扩大。术前应尽可能采用输尿管镜检查及活检或肿瘤穿刺活检以获得准确病理，选择正确的手术方式有利于患者获得良好预后。
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