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Ureteral Metastasis from Renal Adenocarcinoma Presenting a Bizarre Urogram
THE .JOUK'{AL Ol•' lJROLOG-Y
Vol. 83, Ko. 2, February 1960 Printed
[I.S.A.
TJRETERAL ::\IETASTASIS FROJVI RENAL ADENOCARCIXOJ\IA PRESEST1 A BIZARRE UROG RAlVI JAJ\IES W. SARGENT Freteral metastases from n:nal tumors arc uncommon but have bern reported, \Vrcbskr and Spivak1 reported 11 metastasis to tlw ureter from an aclenocarcinoma of the contralatcrnl kidney. ~\1itclwll2 reported a urc:tcrnl mc:ta,tasis from a renal adenocarcinoma and believed tbat tlw metastasis occurred by retrograde migration into the nreternl veins from a tumor thrombus of the renal vein. Hr: believes such urctcral nwtastascs to be ram and strengthens his opinion by citing an extensive: review of both renal and uretc:rnl tumors by Riches in 19i51 in which 110 mention was made of ureteral metastases from renal tumors. :\1acalpine'3 in 1948 reported a single-: ('ase: of metastasis to 11 urnteral stump years aftr;r ncpbrectomy for renal aclrnocarcinoma, Stahl'1 re('ently reported a pnmary rcrml cell carcinoma in the ureter of a young child. Because of the rarity of the condition, ancl also because of the intc:rC'sting urogram, the following ('asc is briefly sumnrnrizecl. ~\lr. A.. F., aged 61, was hospitalized for mid-cpigastric rlistreps attributed to a km11Yn rluo
A clwst x-rny re\'E'aled multiple bihten.d nodular pulmonary metastases. A plain mogrnm (KVB) imlicakd n m,1~,c; in the region of the left kiclnc,y. Within tlw ums:-· wern ;c.everal an:as of fiocculent calcification An cx<·retory urngrnm proved tlw right urinary tmd to he' normal, Them was no function Oil the left.
:Fm. 1
The, left rctrngrade pyclogram stmtr:d dmrnckristic:s of 11 tous tumor of the left kidtlf'~'. Of profollnd interest, howrver, was t!1c' u1wxpectecl finding of a large pcil,qxiid rna~.~ the upper ureter, apparently from the medial wall ol' the metc,r as inclicatrd Uw ,1bcence of contra~t mnterial su1Tounding the lesion in this nrrn. 'With the prcopPrnti\'C' carcinoma of the: left kidrwy epithelionm of the left ureter, prepared for nephro-urcteredomy. At SL1r1sr:ry u.
Accepted for pnblicc1,tion J unc ll, JD59. Wcechsler, H. and Spivak, L. · Metastasis in urnter from adenocarcinoma of the contralat.en,l kidnev. N, Y. State J. 57: 1942-HJ44, 1957. 2 l\Iitchell, J. E. secondaries from a hypernephroma. Brit. J, 45: 392--394, 1958, 3 JVIacaipine: Quoted by hyperneph'Stahl, D. :M.. : Unusual roma, (renal cell nreter in a child. J. Urol., 80: 176-179, 1
97
98
JAMES W, SARGENT
large renal mass was found covered by many dilated and engorged veins. Prior to mobilizing the kidney the ureter was explored and found to be normal for a few centimeters distal to the renal pelvis. At that point the ureter entered an oval mass approximately 3 by 5 cm. in size which was made up of innumerable dilated and engorged blood vessels. Believing these extensive varicosities to account for the "papillary" appearance of the mass in the ureter, the ureter was transected distally and nephrectomy
performed. In the course of preparing the renal pedicle it was necessary to milk a tumor thrombus the size of one's index finger from the proximal portion of the vena cava back through the renal vein prior to clamping and ligating the renal vein separately. Upon opening the ureter at the site in question the varicosities had collapsed. Protruding into the lumen was a small solid tumor histologically identical to the renal adenocarcinoma. Figure 2, A illustrates ureteral metastases
A
Fm. 2
Ul:tETEHAL _ME1\\B1'AS1S FHOM RK',AL C_-\Hcr:--:01L-\
from a renal aclcnocarcinoma. The lumen of the ureter i~ filled 1Yith a metrrstm,is s00n grmnng from the ureteral walL In addition, another metastasis (see arrmY) is oeclucling a ureteral Yt'Jll.
In figure 2, B the 1rnlb of tlw Lll'etn and aclYentitia can be seen to be filled with large Yaricositi0s and venous cinnsoicfa which luwe now collapsed. The occluded ureteral w:ins resulted in these Yariccsities. Them n1ricmities Ydl('n filled with blood filled the ureteral lumen
irregularly, giving the urngraphic appearn nee. of a polypoicl tumor Of tlw mckrnl renal cdl carcinoma reported ,~tali!' filler! thn un,tc;r as a solid mnss and pres(']lted no associated varicosities. SU}m!AHY
A Luogram is pn:srnted which drmcw~t.rntcs :i. bizarre Lll'eternl defect cmi~c,cl h:v a ran' 11rdcrn l mctastm,is from a renal adenocal'l'inoma.
324 B. Wisconsfr1. ,Ive., J.fil1c1mkee ?!, lri.s,
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Vol. 83, Ko. 2, February 1960 Printed
[I.S.A.
TJRETERAL ::\IETASTASIS FROJVI RENAL ADENOCARCIXOJ\IA PRESEST1 A BIZARRE UROG RAlVI JAJ\IES W. SARGENT Freteral metastases from n:nal tumors arc uncommon but have bern reported, \Vrcbskr and Spivak1 reported 11 metastasis to tlw ureter from an aclenocarcinoma of the contralatcrnl kidney. ~\1itclwll2 reported a urc:tcrnl mc:ta,tasis from a renal adenocarcinoma and believed tbat tlw metastasis occurred by retrograde migration into the nreternl veins from a tumor thrombus of the renal vein. Hr: believes such urctcral nwtastascs to be ram and strengthens his opinion by citing an extensive: review of both renal and uretc:rnl tumors by Riches in 19i51 in which 110 mention was made of ureteral metastases from renal tumors. :\1acalpine'3 in 1948 reported a single-: ('ase: of metastasis to 11 urnteral stump years aftr;r ncpbrectomy for renal aclrnocarcinoma, Stahl'1 re('ently reported a pnmary rcrml cell carcinoma in the ureter of a young child. Because of the rarity of the condition, ancl also because of the intc:rC'sting urogram, the following ('asc is briefly sumnrnrizecl. ~\lr. A.. F., aged 61, was hospitalized for mid-cpigastric rlistreps attributed to a km11Yn rluo
A clwst x-rny re\'E'aled multiple bihten.d nodular pulmonary metastases. A plain mogrnm (KVB) imlicakd n m,1~,c; in the region of the left kiclnc,y. Within tlw ums:-· wern ;c.everal an:as of fiocculent calcification An cx<·retory urngrnm proved tlw right urinary tmd to he' normal, Them was no function Oil the left.
:Fm. 1
The, left rctrngrade pyclogram stmtr:d dmrnckristic:s of 11 tous tumor of the left kidtlf'~'. Of profollnd interest, howrver, was t!1c' u1wxpectecl finding of a large pcil,qxiid rna~.~ the upper ureter, apparently from the medial wall ol' the metc,r as inclicatrd Uw ,1bcence of contra~t mnterial su1Tounding the lesion in this nrrn. 'With the prcopPrnti\'C' carcinoma of the: left kidrwy epithelionm of the left ureter, prepared for nephro-urcteredomy. At SL1r1sr:ry u.
Accepted for pnblicc1,tion J unc ll, JD59. Wcechsler, H. and Spivak, L. · Metastasis in urnter from adenocarcinoma of the contralat.en,l kidnev. N, Y. State J. 57: 1942-HJ44, 1957. 2 l\Iitchell, J. E. secondaries from a hypernephroma. Brit. J, 45: 392--394, 1958, 3 JVIacaipine: Quoted by hyperneph'Stahl, D. :M.. : Unusual roma, (renal cell nreter in a child. J. Urol., 80: 176-179, 1
97
98
JAMES W, SARGENT
large renal mass was found covered by many dilated and engorged veins. Prior to mobilizing the kidney the ureter was explored and found to be normal for a few centimeters distal to the renal pelvis. At that point the ureter entered an oval mass approximately 3 by 5 cm. in size which was made up of innumerable dilated and engorged blood vessels. Believing these extensive varicosities to account for the "papillary" appearance of the mass in the ureter, the ureter was transected distally and nephrectomy
performed. In the course of preparing the renal pedicle it was necessary to milk a tumor thrombus the size of one's index finger from the proximal portion of the vena cava back through the renal vein prior to clamping and ligating the renal vein separately. Upon opening the ureter at the site in question the varicosities had collapsed. Protruding into the lumen was a small solid tumor histologically identical to the renal adenocarcinoma. Figure 2, A illustrates ureteral metastases
A
Fm. 2
Ul:tETEHAL _ME1\\B1'AS1S FHOM RK',AL C_-\Hcr:--:01L-\
from a renal aclcnocarcinoma. The lumen of the ureter i~ filled 1Yith a metrrstm,is s00n grmnng from the ureteral walL In addition, another metastasis (see arrmY) is oeclucling a ureteral Yt'Jll.
In figure 2, B the 1rnlb of tlw Lll'etn and aclYentitia can be seen to be filled with large Yaricositi0s and venous cinnsoicfa which luwe now collapsed. The occluded ureteral w:ins resulted in these Yariccsities. Them n1ricmities Ydl('n filled with blood filled the ureteral lumen
irregularly, giving the urngraphic appearn nee. of a polypoicl tumor Of tlw mckrnl renal cdl carcinoma reported ,~tali!' filler! thn un,tc;r as a solid mnss and pres(']lted no associated varicosities. SU}m!AHY
A Luogram is pn:srnted which drmcw~t.rntcs :i. bizarre Lll'eternl defect cmi~c,cl h:v a ran' 11rdcrn l mctastm,is from a renal adenocal'l'inoma.
324 B. Wisconsfr1. ,Ive., J.fil1c1mkee ?!, lri.s,
,,
<
·_--i·
'I
I