Invasive Urothelial Carcinoma of the Ureter with Associated Obstructive Uropathy and Chronic Pyelonephritis: A Case Report and Literature Review

Abstract

Introduction: urothelial carcinomas can develop from any urothelium lined surface in the body and they are the seventh most common cancers seen globally. Urothelial carcinoma of the upper urinary tract (involving the renal pelvis and ureter) is not common. Case Presentation: A 66-year-old male presented with recurrent left flank pain, recurrent urinary tract infection and occasional haematuria of six month's duration. Abdominal Computerized Tomography (CT) done showed moderate left hydro-ureter and hydro-nephrosis and a mass was seen in the lower one-third of the left ureter. Features seen at CT was suggestive of urothelial carcinoma of the distal left ureter.  No mass lesion or tumour was seen in the urinary bladder. Radical nephroureterectomy with excision of the bladder cuff was performed and the diagnosis was confirmed after histopathologic evaluation. Discussion: This case report highlights the rare presentation of invasive urothelial carcinoma of the ureter with associated obstructive uropathy and the role of radiologic imaging in diagnosis and thorough histopathologic evaluation in the determination of tumour grade and tumour stage and ultimate prognosis of patients. Conclusion: A high index of suspicion is needed for diagnosis based on presenting symptoms, and examination findings. Tumour grade and stage in upper urinary tract urothelial carcinoma are good predictors of clinical outcomes and prognosis.