A 52-year-old man came to our hospital with fever, right flank pain, pollakiuria and gastric dyspepsia.
Two years ago the patient occasionally presents these symptoms since a simple nephrectomy for symptomatic chronic pyelonephritis was performed.
She had no other history of interest.
The patient had a right hydronephrosis secondary to pyeloureteral junction lithiasis.
Before nephrectomy an intravenous urography (IVU) was performed, we can see that she had a discharge nephrostomy.
There is a lithiasis that does not completely divide the 1.5 cm route, in addition the two upper thirds of the right ureter are relaxed.
There is distal ureteral stenosis and a second stone.
Physical examination revealed right flank pain without palpable masses.
The rectal examination is normal.
Urgent blood and urine analyses showed no abnormalities.
The simple plate of the urinary tract showed a radiopaque image in the lower pelvis compatible with lithiasis.
Ultrasound also confirmed the existence of an intravesical lithiasis.
Dilatation of the ureteral remnant was also observed.
Computed tomography (CT) allowed a better definition of the morphology of the structures.
The ureter showed a 4 cm delay from the bladder to the contralateral renal hilium.
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We conclude that the symptoms were secondary to ureteral dilation and the presence of lithiasis, bladder and ureteral, and it was decided to perform a cystolithotomy due to a pararectal incision.
During the intervention we found a very hard ureter in its distal end.
Complete removal was achieved although the right seminal vesicle was also resected due to adherence to adjacent tissues.
No lymphadenopathy was observed.
The ureter measured 24 cm long by 4 wide, had an important ulceration, 10 cm distal were very hard in consistency.
The ureteral lumen was 1.5 cm in diameter.
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Microscopically, there is total replacement of the urothelial epithelium by a malignant neoplasm of my type moderately differentiated intestinal adenocarcinoma that presents tubular and glandular growth patterns, with nuclear pleomorphism and marked atypia in addition to numerous figures.
The neoplasia affects the entire ureter producing extensive emphasis on the stenotic area, profusing the mucosa, the muscularis propria to the periureteral adipose tissue, and with a more superficial growth in the area covered.
No conserved urothelium was observed.
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The entire ureter was affected but the seminal vesicle was tumor free.
The immunohistochemical study was strongly positive for cytokeratin 7 but did not express cytokeratin 20 or p53.
Primary adenocarcinomas of the ureter are very rare, so we requested a TAC non-pelvic, pancreatic adenocarcinoma, gastroscopy especially digestive tract collography to rule out a primary tumor.
Tumor markers were also requested: PSA, CEA and CA 19.9.
All the tests were negative except for bladder cancer in which a small polyp was resected.
Anatomopathological examination concluded that it was a tubular adenoma with low grade dysplasia.
The patient was admitted to the emergency room where he was treated with a local anesthetic.
After chemotherapy, a year and a half after surgery, a single lung metastasis was resected.
Currently the patient is very good general condition.
