Sun Maokun, Xu Baoqun, Zhang Heng, Yan Zhipeng, Li Lihua, Sun Yunji
Department of Urology, Shandong Provincial Third Hospital, Shandong University, Jinan, 250012, China; Shandong Stone Disease Prevention and Treatment Center, Jinan, 250012, China.
Department of Pathology, Shandong Provincial Third Hospital, Shandong University, Jinan, 250012, China.
Int J Surg Case Rep. 2025 Sep 3;135:111907. doi: 10.1016/j.ijscr.2025.111907.
The Multiple primary malignant tumors (MPMT) refers to the occurrence of two primary malignant tumors in the same organ or organs in the same patient at the same time. However, MPMT is rare in the urinary system. Congenital urinary tract anomalies (e.g., duplex systems) predispose patients to recurrent infections, stones, and rare malignancies, creating diagnostic and therapeutic challenges.
The patient was an elderly woman presenting with left low back pain and fever. Initial evaluation revealed left duplex kidney with ureteral malformation, complicated by upper kidney abscess, left kidney stone, and ureteropelvic junction stone. A ureteral stent was placed for symptom relief. After admission, enhanced CT/MRI identified left renal rupture with stone leakage, upper renal tumor, and ureteral tumor. Histopathology confirmed high-grade renal cell carcinoma (RCC) and urothelial carcinoma in situ (CIS), classified as a rare "duplication carcinoma." Diagnostic delays occurred due to severe tumor necrosis masking imaging features, inconclusive initial endoscopy, and overlapping symptoms of systemic infection. The patient's complex anatomy (duplex kidney) and multifocal pathology (tumors, stones, infection) required multidisciplinary reevaluation to differentiate malignancy from inflammatory processes.
This case is a high-grade renal cell carcinoma with urothelial carcinoma in situ, which meets the definition of repeat carcinoma. The pathogenesis of this case may be due to the development of malformations of the kidney and ureter combined with tumor compression of the collecting system, which will lead to long-term inadequate drainage and secondary stones, infection, etc. Early diagnosis is the key to improve the survival rate of patients with synchronous carcinomas. Enhanced CT combined with magnetic resonance imaging can be used for initial diagnosis.
Synchronous carcinomas (synchronous RCC and urothelial CIS) in a duplex kidney with stones/pyonephrosis is exceptionally rare, emphasizing the need for vigilance in congenital anomalies. Complex cases demand tailored strategies, integrating urologic, oncologic, and radiologic expertise to address anatomical anomalies, infection, and malignancy simultaneously. Early suspicion of neoplasia in refractory cases is critical to avoid delays.
多发性原发性恶性肿瘤（MPMT）是指同一患者在同一器官或多个器官同时发生两种原发性恶性肿瘤。然而，MPMT在泌尿系统中较为罕见。先天性尿路异常（如重复系统）使患者易发生反复感染、结石及罕见的恶性肿瘤，给诊断和治疗带来挑战。
患者为老年女性，表现为左腰背痛和发热。初步评估发现左重复肾伴输尿管畸形，并发上肾脓肿、左肾结石及肾盂输尿管连接部结石。置入输尿管支架以缓解症状。入院后，增强CT/MRI检查发现左肾破裂伴结石漏出、上肾肿瘤及输尿管肿瘤。组织病理学证实为高级别肾细胞癌（RCC）和原位尿路上皮癌（CIS），归类为罕见的“重复癌”。由于严重的肿瘤坏死掩盖了影像学特征、初次内镜检查结果不明确以及全身感染症状重叠，导致诊断延迟。患者复杂的解剖结构（重复肾）和多灶性病变（肿瘤、结石、感染）需要多学科重新评估，以区分恶性肿瘤与炎症过程。
该病例为高级别肾细胞癌合并原位尿路上皮癌，符合重复癌的定义。该病例的发病机制可能是由于肾和输尿管畸形的发展，加上肿瘤对集合系统的压迫，导致长期引流不畅及继发性结石、感染等。早期诊断是提高同步癌患者生存率的关键。增强CT联合磁共振成像可用于初步诊断。
伴有结石/肾积脓的重复肾中出现同步癌（同步RCC和尿路上皮CIS）极为罕见，强调对先天性异常需保持警惕。复杂病例需要量身定制的策略，整合泌尿外科、肿瘤学和放射学专业知识，以同时处理解剖异常、感染和恶性肿瘤。对难治性病例早期怀疑肿瘤形成对于避免延误至关重要。
