H Krishnamoorthy, V Pushpangathan, G Joseph, S Abraham
clear cell, metastasis, renal cell carcinoma, urinary bladder
H Krishnamoorthy, V Pushpangathan, G Joseph, S Abraham. Renal Cell Carcinoma Metastasis In Urinary Bladder. The Internet Journal of Urology. 2002 Volume 1 Number 2.
Renal cell carcinoma occurring in the urinary bladder is an unusual presentation. We present the report of a case of clear cell variety of renal cell carcinoma presenting as metastasis in the urinary bladder mucosa, six months after radical nephrectomy
A 53-year-old lady presented with total painless hematuria and a mass in the region of right kidney. Urine cytology was negative for malignant cells. Ultrasound scan of abdomen showed a mixed echoic mass in the mid-portion of right kidney with involvement of renal pelvis. CT scan of abdomen showed contrast enhancing solid lesion of right kidney (Fig. No.1) with extension to the renal pelvis and upper ureter. There was no evidence of distant metastases. Due to the ureteral extension of the tumour, radical nephroureterectomy with excision of cuff of bladder was done. The histopathology report was clear cell variety of renal cell carcinoma, stage pT3, N0, M0. At 3 months of follow up, Ultrasound and CT scan of abdomen did not show any evidence of local recurrence or distant metastasis. However, there was total painless hematuria at 6 months after surgery. Urine cytology was negative for malignant cells. CT scan abdomen revealed no local recurrence. But there was a solid mass of about 3 cm in the right lateral wall of bladder (Fig. No.2). Cystoscopy showed solid tumour arising from the lateral wall of urinary bladder away from the previous scar. Transurethral resection of tumour was done. The histopathology report was clear cell variety of renal cell carcinoma involving the urinary bladder mucosa. There was no deep muscle infiltration. Post operatively she, was given alpha interferon + 5-Fluorouracil as adjuvant therapy for three months. She has no recurrence after 6 months of further follow up.
Though lymphatic spread of renal cell carcinoma is common, blood borne metastases can occur in lungs, liver, subcutaneous tissue and central nervous system. Papillary variety of renal cell carcinoma tends to have more loco-regional invasion with lymph node spread, while clear cell variety has more propensity for vascular invasion. Certain unusual sites of metastasis of renal cell carcinoma have been reported earlier. These include oral mucosa (1), lacrymal gland (2) and parotid gland (3). However this is the first reported instance of metastasis of renal cell carcinoma in urinary bladder. The route of spread to the urinary bladder mucosa could have been tumour cell seeding, hematogenous or lymphatic.
DR.H.KRISHNAMOORTHY CONSULTANT UROLOGIST LOURDES HOSPITAL KOCHI, S.INDIA 682 012 e-mail: email@example.com