Presentation
Operated colorectal carcinoma with recurrence, for follow-up imaging.
Patient Data
Large enhancing mass, surrounded by urine in the left renal collecting system immmediately adjacent to the nephrostomy tube. An additional similar lesion is present in the distal left ureter.
RIF stoma.
Large volume recurrent colorectal tumor in the left side of the pelvis, invading the distal ureter, bladder and extending to the pelvic side wall. This is adjacent to the origin anastomosis site - the staples can be seen.
Several hepatic metastases.
Note also the enhancing ureteric wall - either tumor extension or due to secondary infection of the renal tract.
2010 Histopathology Report
Pelvic Mass Biopsy
Biopsy contains a ureter with surrounding fibrovascular tissue containing a tumor composed of columnar cells arranged in tubules. The cells have hyperchromatic nuclei.
Appearances in keeping with colorectal adenocarcinoma.
2013 Cytology Report (Urine Sample from nephrostomy tube)
The specimen contains occasional clusters of malignant cells with nuclear polymorphism, hyperchromasia, coarse chromatin, raised nuclear/cytoplasmic ratio and vacuolated cytoplasm.
Appearances in keeping with metastatic adenocarcinoma
Case Discussion
This is a rare example of a urinary tract metastasis - in this instance from a colorectal primary, following invasion of the distal ureter adjacent to the original anastomosis site.
The tumor seeded via retrograde flow of urine into the left renal pelvis. This was proven on urine samples from the nephrostomy tube, which identified adenocarcioma of colorectal origin.
Urinary tract metastases are uncommon, with documented cases from breast, lung, stomach and prostate cancers. Rare reports exist from a primary colorectal tumor.
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