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case_images: Noncontrast CT scan at initial presentation, demonstrating (A) severe hydroureteronephrosis and (B) a 2.5 mm distal ureteral stone.
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case_images: An abdominal and pelvis CT scan revealed severe right-sided hydroureteronephrosis, marked renal cortical thinning, and a 2.5 mm distal ureteral calculus (Fig. 1A, B).
case_images: Intraoperative ureteroscopy revealing a mass in the distal ureter (A) and retrograde pyelogram showing a filling defect and extent of ureteral tumor involvement (B).
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case_images: (A) Low magnification of the ureteral biopsy showing small blue cells with substantial crush artifact infiltrating fibrous tissue, (B) at higher magnification, cytoplasm is scant and nuclear molding is present, (C) immunohistochemical staining revealed diffuse positivity for synaptophysin, and (D) only minimal dot-like positivity for EMA, consistent with small cell carcinoma. EMA, epithelial membrane antigen.
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case_images: The immunohistochemical staining revealed positivity for synaptophysin that supported the neuroendocrine phenotype; staining for urothelial carcinoma (GATA 3 and p63), gynecologic cancer (PAX8), lymphoma (PAX5 and LCA), or sarcoma (Myogenin, CD31 and Desmin) was negative (Fig. 3).
case_images: Metastatic work-up after the diagnosis of small cell carcinoma with contrast-enhanced CT of the abdomen-pelvis showing extensive retroperitoneal adenopathy (A), response to chemotherapy demonstrating ~50% reduction in the lymph nodal burden (B).
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case_images: At 3 months of follow-up, she was doing well with lymphadenopathy reduction of 50% (Fig. 4B) and no evidence of disease progression.