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Only for medical professionals to read and learn together.
Ureteral obstruction is a common disease.
Its etiology includes intraluminal factors such as urinary calculi, tumors or benign strictures, and extraluminal factors such as benign prostatic hyperplasia, retroperitoneal or pelvic tumors.
Timely diagnosis and treatment are essential to quickly restore kidney function.
However, acute kidney injury caused by ureteral obstruction is not uncommon.
Sometimes the diagnosis process of the patient is obstructed and long, which increases the physical and psychological torture of the patient.
Let's take a look at the process of finding the cause of the ureteral obstruction patient experienced.
Case data The protagonist of today’s story comes from a case report published by Koichi K and others in Case Reports in Medicine.
This is a 76-year-old man with pain in the right rib area for 3 months.
He has no history of smoking and no respiratory symptoms.
The patient's physical examination was generally normal.
Laboratory examination showed that serum creatinine increased to 123.
8 μmol/L, and tumor markers such as PSA, AFP, β-HCG, CEA and CA19-9 were all within the normal range.
The results of urinalysis were unremarkable.
The doctor is considering acute kidney injury, but the cause is unclear and needs to arrange further examinations for the patient.
Abdominal CT showed an uneven retroperitoneal mass with hydronephrosis on the right side.
T1W MRI showed a retroperitoneal mass of 3×3×5 cm with compression of the inferior vena cava.
T1W enhancement showed a circular high signal edge.
Figure a: MRI T1W shows retroperitoneal mass (thick arrow) with compression of the inferior vena cava (thin arrow).
Figure b: MRI T1W enhancement shows a circular high signal edge.
The right retrograde ureterography shows a 7 cm external pressure obstruction in the middle of the right ureter. At this time, the doctor suspected a malignant tumor of the ureter, but there was no abnormality in the cytology result of the urine sample taken from the right ureter.
Retrograde ureterography showed an external pressure obstruction (arrow) in the 1/3 of the right ureter.
The doctor was in perplexed contemplation.
While the chest CT made the doctor shocked, he also saw the dawn of a clear diagnosis.
Chest CT showed a dense soft tissue nodule with rich blood vessels in the right lower lobe, with a size of 3×2 cm and a burr-like edge.
The morphological features of chest CT of the soft tissue density nodules in the right lower lobe are highly suggestive of primary bronchial lung cancer.
The patient was further performed head CT and bone scan, etc.
, and there was no obvious metastasis.
Fiberoptic bronchoscopy showed a mass in the bronchial lumen and blocked the lumen, while brushing under the microscope indicated that the tumor was poorly differentiated adenocarcinoma.
The above examination basically excluded other metastases.
The doctor further performed CT-guided fine-needle aspiration biopsy of retroperitoneal tumors.
Pathological examination showed poorly differentiated adenocarcinoma with fibrosis.
This pathological feature is consistent with metastatic lung adenocarcinoma.
At this point, the diagnosis of lung adenocarcinoma with focal (ureteral) retroperitoneal metastasis [stage IV (T2N0M1)] can be concluded.
The patient started to receive chemotherapy, but 6 months later the patient died due to compression of the inferior vena cava by retroperitoneal metastases.
Secondary retroperitoneal fibrosis This is a case of unilateral ureteral obstruction combined with postrenal acute kidney injury.
The results of pathological examination confirmed that the retroperitoneal mass was the metastasis of the malignant tumor spreading to the retroperitoneal tissue and secondary fibrosis.
Retroperitoneal fibrosis (Retroperitoneal fibrosis) is a rare disease that causes unilateral or bilateral ureteral obstruction.
The average age at diagnosis is 59.
1±14.
9 years, of which 69.
4% are male.
The typical feature of retroperitoneal fibrosis is chronic inflammatory cell infiltration, surrounding the abdominal aorta, iliac artery, ureter or duodenum and other retroperitoneal tissues and organs.
The etiology of retroperitoneal fibrosis includes idiopathic and secondary.
The cause of secondary retroperitoneal fibrosis Secondary retroperitoneal fibrosis is often associated with malignant tumors.
Malignant tumors that cause secondary retroperitoneal fibrosis mainly include urinary malignancies, lymphoma, sarcoma, multiple myeloma, carcinoid, colorectal cancer, prostate cancer, gastric cancer, pancreatic cancer, breast cancer, cervix or uterus Endometrial cancer and lung cancer.
Although the original text did not specifically mention the diagnosis of retroperitoneal fibrosis, considering the pathological results, the cause of the patient’s ureteral obstruction is likely to be the retroperitoneal fibrosis secondary to lung cancer, which also suggests that clinicians may be concerned about retroperitoneal fibrosis.
Insufficient understanding of chemistry.
Lung cancer metastasis and ureteral obstruction In cancers that cause ureteral obstruction, the most common primary tumors are located in the cervix, prostate, bladder, and colorectal.
The main sites of non-small cell lung cancer metastasis include brain, bone, liver, adrenal glands, thoracic cavity and distant lymph nodes.
The remaining proportion of metastases less than 5% are mainly located in soft tissues, kidneys, pancreas, spleen, peritoneum, intestines, etc.
, ureters, tonsils, etc.
, Nasal cavity, heart, breast, thyroid and other parts of the metastasis are extremely rare.
So far, only a few cases have been reported about ureteral metastasis and obstruction secondary to lung cancer.
In the autopsy data of 1281 patients with lung cancer, 2 cases (0.
2%) found ureteral metastasis.
Rare metastasis of lung cancer In another case of non-small cell lung cancer with secondary ureteral metastasis reported by Ren F et al.
, the patient was a 61-year-old man who was diagnosed as invasive lung adenocarcinoma after right upper lobe resection and systemic lymph node dissection.
.
Twelve months after the operation, during the routine follow-up examination, CT of the lower abdomen showed a soft tissue mass with continuous uneven enhancement in the lower part of the ureter.
The pathology after the operation confirmed that it was a ureteral metastasis of primary lung cancer.
Hiraki A et al.
reported a case of lung adenocarcinoma with hydronephrosis.
The cause was metastasis and compression of the right iliac fossa lymph nodes.
In most cases of non-small cell lung cancer with secondary ureteral metastasis, because the early symptoms of ureteral metastasis may be masked by the primary tumor or other metastases, or because the patient’s general condition is not good, the clinician has not been able to precede the death of the patient.
Diagnosis or suspected ureteral metastasis. In the above cases, ureteral metastasis has even become the first clinical manifestation of potential small cell lung cancer.
Patients with advanced non-small cell lung cancer usually require systemic chemotherapy and targeted therapy.
However, when such patients are complicated by hydroureter and dilatation, surgical treatment is generally required.
Pathological examination can determine the consistency of the primary and metastatic lesions.
Therefore, at this time, surgery is a means of integrating treatment and diagnosis.
In summary, because ureteral metastases of non-small cell lung cancer are extremely rare, and routine preoperative examinations usually do not include enhanced CT examination of the lower abdomen, it is easy to misdiagnose or miss ureteral metastases in clinical work.
Nevertheless, clinicians should be aware that patients with lung cancer (especially non-small cell lung cancer) can metastasize to the ureter and develop hydronephrosis in addition to the most common metastatic sites such as the brain and liver.
Therefore, when patients with non-small cell lung cancer have urinary system symptoms, the possibility of ureteral metastasis should be highly regarded.
References: [1] Kodama K, Imao T, Komatsu K.
Metastatic ureteral involvement of non-small cell lung cancer.
Case Rep Med.
2011;2011:394326.
doi: 10.
1155/2011/394326.
Epub 2011 Mar 30.
PMID : 21541230; PMCID: PMC3085393.
[2] Lee SJ, Eun JS, Lee EY, et al.
THU0572 Association between retroperitoneal fibrosis and malignancy: a possible paraneoplastic syndrome[J].
2017: 422.
[3] Tanaka T, Masumori N .
Current approach to diagnosis and management of retroperitoneal fibrosis.
Int J Urol.
2020 May;27(5):387-394.
doi: 10.
1111/iju.
14218.
Epub 2020 Mar 12.
PMID: 32166828.
[4] Hiraki A, Ueoka H, Gemba K, Kuyama S, Kishino D, Tabata M, Kiura K, Tanimoto M, Harada M.
Hydronephrosis as a complication of adenocarcinoma of the lung.
Anticancer Res.
2003 May-Jun;23(3C):2915-6 PMID: 12926134.
[5] Niu, F.
, Zhou, Q.
, Yang, J.
et al.
Distribution and prognosis of uncommon metastases from non-small cell lung cancer.
BMC Cancer 16, 149 (2016).
[6] Ren F, Liu M, Xu X, Zhang H, Li X, Liu J, Chen J.
Ureteral metastasis of non-small-cell lung cancer: a case report.
Onco Targets Ther.
2019 Jan 15;12:619-623.
doi: 10.
2147/OTT.
S189334.
PMID: 30697059; PMCID: PMC6339466.
[7] RJ Babaian, DE Johnson , AG Ayala, and ET Sie.
Secondary tumors of ureter.
Urology, vol.
14, no.
4, pp.
341–343, 1979.
Source of this article: Medical Emergency and Critical Care Channel Author of this article: Editor-in-Chief of CHENG KT: Copyright CiCi Affirm that this article is original, welcome to forward it to the circle of friends-End-Johnson, AG Ayala, and ET Sie.
Secondary tumors of ureter.
Urology, vol.
14, no.
4, pp.
341–343, 1979.
Source of this article: Medical Emergency and Critical Care Channel Author of this article: Chief Editor of CHENG KT: CiCi Copyright statement The original text of this article is welcome to forward to the circle of friends-End-Johnson, AG Ayala, and ET Sie.
Secondary tumors of ureter.
Urology, vol.
14, no.
4, pp.
341–343, 1979.
Source of this article: Medical Emergency and Critical Care Channel Author of this article: Chief Editor of CHENG KT: CiCi Copyright statement The original text of this article is welcome to forward to the circle of friends-End-
Ureteral obstruction is a common disease.
Its etiology includes intraluminal factors such as urinary calculi, tumors or benign strictures, and extraluminal factors such as benign prostatic hyperplasia, retroperitoneal or pelvic tumors.
Timely diagnosis and treatment are essential to quickly restore kidney function.
However, acute kidney injury caused by ureteral obstruction is not uncommon.
Sometimes the diagnosis process of the patient is obstructed and long, which increases the physical and psychological torture of the patient.
Let's take a look at the process of finding the cause of the ureteral obstruction patient experienced.
Case data The protagonist of today’s story comes from a case report published by Koichi K and others in Case Reports in Medicine.
This is a 76-year-old man with pain in the right rib area for 3 months.
He has no history of smoking and no respiratory symptoms.
The patient's physical examination was generally normal.
Laboratory examination showed that serum creatinine increased to 123.
8 μmol/L, and tumor markers such as PSA, AFP, β-HCG, CEA and CA19-9 were all within the normal range.
The results of urinalysis were unremarkable.
The doctor is considering acute kidney injury, but the cause is unclear and needs to arrange further examinations for the patient.
Abdominal CT showed an uneven retroperitoneal mass with hydronephrosis on the right side.
T1W MRI showed a retroperitoneal mass of 3×3×5 cm with compression of the inferior vena cava.
T1W enhancement showed a circular high signal edge.
Figure a: MRI T1W shows retroperitoneal mass (thick arrow) with compression of the inferior vena cava (thin arrow).
Figure b: MRI T1W enhancement shows a circular high signal edge.
The right retrograde ureterography shows a 7 cm external pressure obstruction in the middle of the right ureter. At this time, the doctor suspected a malignant tumor of the ureter, but there was no abnormality in the cytology result of the urine sample taken from the right ureter.
Retrograde ureterography showed an external pressure obstruction (arrow) in the 1/3 of the right ureter.
The doctor was in perplexed contemplation.
While the chest CT made the doctor shocked, he also saw the dawn of a clear diagnosis.
Chest CT showed a dense soft tissue nodule with rich blood vessels in the right lower lobe, with a size of 3×2 cm and a burr-like edge.
The morphological features of chest CT of the soft tissue density nodules in the right lower lobe are highly suggestive of primary bronchial lung cancer.
The patient was further performed head CT and bone scan, etc.
, and there was no obvious metastasis.
Fiberoptic bronchoscopy showed a mass in the bronchial lumen and blocked the lumen, while brushing under the microscope indicated that the tumor was poorly differentiated adenocarcinoma.
The above examination basically excluded other metastases.
The doctor further performed CT-guided fine-needle aspiration biopsy of retroperitoneal tumors.
Pathological examination showed poorly differentiated adenocarcinoma with fibrosis.
This pathological feature is consistent with metastatic lung adenocarcinoma.
At this point, the diagnosis of lung adenocarcinoma with focal (ureteral) retroperitoneal metastasis [stage IV (T2N0M1)] can be concluded.
The patient started to receive chemotherapy, but 6 months later the patient died due to compression of the inferior vena cava by retroperitoneal metastases.
Secondary retroperitoneal fibrosis This is a case of unilateral ureteral obstruction combined with postrenal acute kidney injury.
The results of pathological examination confirmed that the retroperitoneal mass was the metastasis of the malignant tumor spreading to the retroperitoneal tissue and secondary fibrosis.
Retroperitoneal fibrosis (Retroperitoneal fibrosis) is a rare disease that causes unilateral or bilateral ureteral obstruction.
The average age at diagnosis is 59.
1±14.
9 years, of which 69.
4% are male.
The typical feature of retroperitoneal fibrosis is chronic inflammatory cell infiltration, surrounding the abdominal aorta, iliac artery, ureter or duodenum and other retroperitoneal tissues and organs.
The etiology of retroperitoneal fibrosis includes idiopathic and secondary.
The cause of secondary retroperitoneal fibrosis Secondary retroperitoneal fibrosis is often associated with malignant tumors.
Malignant tumors that cause secondary retroperitoneal fibrosis mainly include urinary malignancies, lymphoma, sarcoma, multiple myeloma, carcinoid, colorectal cancer, prostate cancer, gastric cancer, pancreatic cancer, breast cancer, cervix or uterus Endometrial cancer and lung cancer.
Although the original text did not specifically mention the diagnosis of retroperitoneal fibrosis, considering the pathological results, the cause of the patient’s ureteral obstruction is likely to be the retroperitoneal fibrosis secondary to lung cancer, which also suggests that clinicians may be concerned about retroperitoneal fibrosis.
Insufficient understanding of chemistry.
Lung cancer metastasis and ureteral obstruction In cancers that cause ureteral obstruction, the most common primary tumors are located in the cervix, prostate, bladder, and colorectal.
The main sites of non-small cell lung cancer metastasis include brain, bone, liver, adrenal glands, thoracic cavity and distant lymph nodes.
The remaining proportion of metastases less than 5% are mainly located in soft tissues, kidneys, pancreas, spleen, peritoneum, intestines, etc.
, ureters, tonsils, etc.
, Nasal cavity, heart, breast, thyroid and other parts of the metastasis are extremely rare.
So far, only a few cases have been reported about ureteral metastasis and obstruction secondary to lung cancer.
In the autopsy data of 1281 patients with lung cancer, 2 cases (0.
2%) found ureteral metastasis.
Rare metastasis of lung cancer In another case of non-small cell lung cancer with secondary ureteral metastasis reported by Ren F et al.
, the patient was a 61-year-old man who was diagnosed as invasive lung adenocarcinoma after right upper lobe resection and systemic lymph node dissection.
.
Twelve months after the operation, during the routine follow-up examination, CT of the lower abdomen showed a soft tissue mass with continuous uneven enhancement in the lower part of the ureter.
The pathology after the operation confirmed that it was a ureteral metastasis of primary lung cancer.
Hiraki A et al.
reported a case of lung adenocarcinoma with hydronephrosis.
The cause was metastasis and compression of the right iliac fossa lymph nodes.
In most cases of non-small cell lung cancer with secondary ureteral metastasis, because the early symptoms of ureteral metastasis may be masked by the primary tumor or other metastases, or because the patient’s general condition is not good, the clinician has not been able to precede the death of the patient.
Diagnosis or suspected ureteral metastasis. In the above cases, ureteral metastasis has even become the first clinical manifestation of potential small cell lung cancer.
Patients with advanced non-small cell lung cancer usually require systemic chemotherapy and targeted therapy.
However, when such patients are complicated by hydroureter and dilatation, surgical treatment is generally required.
Pathological examination can determine the consistency of the primary and metastatic lesions.
Therefore, at this time, surgery is a means of integrating treatment and diagnosis.
In summary, because ureteral metastases of non-small cell lung cancer are extremely rare, and routine preoperative examinations usually do not include enhanced CT examination of the lower abdomen, it is easy to misdiagnose or miss ureteral metastases in clinical work.
Nevertheless, clinicians should be aware that patients with lung cancer (especially non-small cell lung cancer) can metastasize to the ureter and develop hydronephrosis in addition to the most common metastatic sites such as the brain and liver.
Therefore, when patients with non-small cell lung cancer have urinary system symptoms, the possibility of ureteral metastasis should be highly regarded.
References: [1] Kodama K, Imao T, Komatsu K.
Metastatic ureteral involvement of non-small cell lung cancer.
Case Rep Med.
2011;2011:394326.
doi: 10.
1155/2011/394326.
Epub 2011 Mar 30.
PMID : 21541230; PMCID: PMC3085393.
[2] Lee SJ, Eun JS, Lee EY, et al.
THU0572 Association between retroperitoneal fibrosis and malignancy: a possible paraneoplastic syndrome[J].
2017: 422.
[3] Tanaka T, Masumori N .
Current approach to diagnosis and management of retroperitoneal fibrosis.
Int J Urol.
2020 May;27(5):387-394.
doi: 10.
1111/iju.
14218.
Epub 2020 Mar 12.
PMID: 32166828.
[4] Hiraki A, Ueoka H, Gemba K, Kuyama S, Kishino D, Tabata M, Kiura K, Tanimoto M, Harada M.
Hydronephrosis as a complication of adenocarcinoma of the lung.
Anticancer Res.
2003 May-Jun;23(3C):2915-6 PMID: 12926134.
[5] Niu, F.
, Zhou, Q.
, Yang, J.
et al.
Distribution and prognosis of uncommon metastases from non-small cell lung cancer.
BMC Cancer 16, 149 (2016).
[6] Ren F, Liu M, Xu X, Zhang H, Li X, Liu J, Chen J.
Ureteral metastasis of non-small-cell lung cancer: a case report.
Onco Targets Ther.
2019 Jan 15;12:619-623.
doi: 10.
2147/OTT.
S189334.
PMID: 30697059; PMCID: PMC6339466.
[7] RJ Babaian, DE Johnson , AG Ayala, and ET Sie.
Secondary tumors of ureter.
Urology, vol.
14, no.
4, pp.
341–343, 1979.
Source of this article: Medical Emergency and Critical Care Channel Author of this article: Editor-in-Chief of CHENG KT: Copyright CiCi Affirm that this article is original, welcome to forward it to the circle of friends-End-Johnson, AG Ayala, and ET Sie.
Secondary tumors of ureter.
Urology, vol.
14, no.
4, pp.
341–343, 1979.
Source of this article: Medical Emergency and Critical Care Channel Author of this article: Chief Editor of CHENG KT: CiCi Copyright statement The original text of this article is welcome to forward to the circle of friends-End-Johnson, AG Ayala, and ET Sie.
Secondary tumors of ureter.
Urology, vol.
14, no.
4, pp.
341–343, 1979.
Source of this article: Medical Emergency and Critical Care Channel Author of this article: Chief Editor of CHENG KT: CiCi Copyright statement The original text of this article is welcome to forward to the circle of friends-End-
