A rare and advanced case of upper tract high-grade myxoid urothelial carcinoma
Komjáti Klaudia dr.1, Giba Nándor dr.2, Kovács László dr1, Eizler Kornélia, dr.2, Fekete Zoltán dr.1
1Fejér Megyei Szt. György Egyetemi
Oktató Kórház, Urológia Osztály,
Székesfehérvár (osztályvezető: Fekete Zoltán dr.)
2Fejér Megyei Szt. György Egyetemi Oktató Kórház, Patológia Osztály, Székesfehérvár Osztályvezető: Micsik Tamás dr.)
Objective: We present a rare histological variant of the urothelial carcinomas. We describe the diagnostic procedures, the clinical features, the aspects of the histological investigation, and the specificity of our case.
Case report: An elderly, otherwise healthy man presented at our urology outpatient clinic with haematuria and dysuria. The first ultrasound examination showed an unifocal specimen originated from the left ureter ostium and bilateral dilation of the upper urinary tract, with urine retention in the bladder. Due to the impaired renal function, we omitted the contrast-enhanced abdominal-pelvic CT scan. Continuous wearing of urethral catheter did not improve the renal function. The patient underwent transurethral resection of the bladder tumour and the incision of the bladder neck, the result of the histology examination was low-grade urothelial carcinoma. General condition of the patient deteriorated and he was admitted to the hospital with haematuria and upper and left quadrant abdominal pain on multiple occasions. The repeated ultrasound examination showed multiplex tumour mass in the renal pelvis, inhomogeneous perinephric remodelling and hilar metastases. On physical examination, the left renal mass was palpable. Since the patient was in great pain we performed an open uretero-nephrectomy with relative urgency. The histopathological examination of the uretero-nephrectomy specimen confirmed a myxoid high-grade urothelial carcinoma. After the operation the general condition of patient further deteriorated, and died shortly after. From the first examination until the death only four months passed.
Conclusion: Myxoid high-grade urothelial carcinoma is a poorly reported malignancy. The first line therapy for myxoid high-grade urothelial carcinoma in the upper and lower urinary tract – based on limited experience – is primarily surgical. We review the clinicopathological features, the immune phenotypisation, the diagnostic steps, and the difficulties of differential diagnostic. Our aim is to make the diagnosis of the disease easier for urologists and pathologists. Only a few cases have been reported most of which are about urothelial carcinoma in the bladder. No clear conclusion can be made based on these limited data. Early diagnosis and surgical treatment can be life saving for these patients. We can conclude that in the suspicion of upper urinary tract carcinoma, fast diagnostics and treatment should be forced.