Introduction
Incidence of transitional cell carcinoma (TCC) or urothelial tumours and renal cell carcinoma (RCC) is high in elderly age group. However, synchronous occurrence of two different urological malignancies in same patient is rare and poses difficult treatment challenge. We present a case of renal cell carcinoma of right kidney and transitional cell carcinoma in the urinary bladder.
Case Report
A 73-year-old patient reported with, painless and paroxysmal haematuria. On examination there was no abdominal lump. Ultrasound showed a large papillary tumour arising from left wall of bladder and a well-circumscribed tumour in mid pole of right kidney. Contrast enhanced computerised tomography (CECT) abdomen revealed a bladder tumour arising from the left lateral wall and a 4cm diameter, enhancing mass lesion in mid pole of right kidney, 4cm in diameter (Fig. 1, Fig. 2). Urine cytology revealed transitional cell carcinoma. The bladder tumour was completely excised in two sessions which showed transitional cell carcinoma Grade II with out muscle invasion. The patient underwent radical nephro-ureterctomy right, in view of mid polar lesion extending through the whole thickness of kidney and to avoid leaving ureteral stump in a setting with TCC bladder (Fig 3). The operation was performed by a lateral kidney incision and the ureter was separated from bladder by cystoscopic electrocautery. The histopathology showed a clear cell renal cell carcinoma, stage T1 N0 M0. Patient is on regular follow up for last 30 months and is recurrence free.
Fig. 1.
CT scan showing bladder tumour
Fig. 2.
CT scan showing right renal tumour
Fig. 3.
Right kidney with tumour
Discussion
The simultaneous occurrence of different types of urological malignancies in the same patient is quite rare. There have been reports in the literature about synchronous renal cell carcinoma and transitional cell carcinoma in the same kidney [1] and also in ureter/urinary bladder [4]. The points are the biological behaviour of the different tumours, the stage of different tumours, co-morbid conditions if any.
Our case had a superficial TCC bladder and a 4cm, clinically stage I, mid pole renal cell carcinoma right kidney. We have offered complete transurethral resection of bladder tumour with surveillance and radical nephro-ureterectomy for the renal tumour. The ureter was removed completely as the patient had already manifested with TCC bladder, to avoid recurrence of TCC in ureteral stump. Metachronous occurrence of TCC has been reported in ureteral stumps of patients who have undergone radical nephrectomy for RCC[5]. The patient has been kept under regular cystoscopic surveillance for any recurrence of TCC and so far remained recurrence free.
Conflicts of Interest
None identified
References
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