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A 62-year-old woman underwent laparoscopic radial nephrectomy for the left renal cell carcinoma in September 2008. In July2016, the patient developed asymptomatic gross hematuria. Computed tomography (CT) revealed the enlargement of the left ureteral stump and an 11mm nodule in the superior lobe of the right lung. Since [F-18] fluoro-D-glucose-positron emission tomography-CT FDG PET-CT demonstrated a lung tumor, we decided to perform right upper lobectomybyvideo-assisted thoracoscopic surgeryin September. The patient was diagnosed with metastatic renal cell carcinoma. We then removed the left ureteral stump and performed partial cystectomy in November. A pathological examination revealed that the tumor was metastatic clear cell renal cell carcinoma invading the muscle layer. Two months later, the patient developed gross hematuria again. Cystoscopy revealed a 1cm tumor around the scar of partial cystectomy. Transurethral resection was performed, and a pathological examination revealed metastatic renal cell carcinoma. We herein report this case of renal cell carcinoma in which recurrence occurred in the ureteral stump, 8 years after radical nephrectomy.

A 53-year-old man was referred for further examination of left hydronephrosis. He had undergone high anterior resection for sigmoid colon cancer about 2 years previously. Retrograde pyelography demonstrated a filling defect in the middle portion of the left ureter. Brushing cytology of the lesion was class IV. Left nephroureterectomy was performed. Histology indicated metastatic adenocarcinoma from colon cancer.

We report a case of colorectal cancer with metastasis to the upper urinary tract. A 56-year-old man had left flank pain. Ultrasonography and computed tomographic (CT) examination demonstrated left hydronephroureter and a soft-tissue structure within the left ureter. Urinary cytology of the left ureter showed class IIIb. We diagnosed him with ureteral cancer and performed left nephroureterectomy. Microscopic examination demonstrated adenocarcinoma located in ureteral and pelvic wall, especially in blood vessels, with intact mucosa and similar to adenocarcinoma of colon cancer. Therefore metastatic upper urinary tract tumor was suspected. Barium enema and positron emission tomography-CT demonstrated sigmoid colon cancer. Biopsy specimen of colon cancer demonstrated adenocarcinoma, which was consistent with the ureteral tumor. Finally we diagnosed him with metastatic upper urinary tract tumor of sigmoid colon cancer.

A 79-year-old woman presented with gross hematuria. She had undergone a right radical nephrectomy 2 years previously for G2 pT2 renal cell carcinoma, clear cell variant. Intravenous pyelography showed a filling defect in the left ureter. Systemic work-up demonstrated no evidence of other metastases. Partial uretectomy and end-to-end ureteroureterostomy were performed. Histology showed metastatic clear cell carcinoma consistent with the primary renal tumor. Six months after surgery, her serum creatinine was stable at 1.6 mg/dl and she was doing well without evidence of recurrent disease. Solitary metastasis of renal cell carcinoma to the contralateral renal pelvis or ureter is extremely rare, with only 7 cases having been reported. We herein describe the present case and review the relevant literature.

A 66-year-old male was referred to our hospital for evaluation of tumors in his left residual ureter and the lung. He had a history of left nephrectomy due to "malignant renal tumor", performed by a general surgeon at another hospital 16 years ago. Since a definitive diagnosis of the kidney was uncertain, we speculated that the original renal disease was a renal pelvic cancer and had metastasized in the residual ureter and the lung. We performed systemic chemotherapy followed by resection of residual ureter with bladder cuff Pathological examination revealed urothelial carcinoma. However, the lung tumors did not respond to salvage chemotherapy and slowly progressed. Bronchoscopic biopsy was performed 2 years later and histological finding showed clear cell type renal cell carcinoma.

A 58-year-old man, who had undergone sigmoidectomy for sigmoid colon adenocarcinoma 3 years earlier, was referred to our clinic because of left ureteral tumor incidentally found by computed tomography (CT). Under the diagnosis of left ureteral carcinoma, retroperitoneoscopic left nephroureterectomy was performed. Pathological examination revealed adenocarcinoma of the left renal pelvis and ureter. Subtype of the adenocarcinoma was 'enteric type'. Five months later, urine cytology was positive and multiple non-papillary tumors were found on cystoscopy. By the transurethral resection of the tumors, bladder tumors appeared to be adenocarcinoma. Carefully considering the pathological findings and clinical course, we concluded that the tumor was not metastatic but primary adenocarcinoma followed by intravesical recurrence.

We report a 74-year-old male who developed ureteral carcinoma after 11 years of radical cystectomy and rectal bladder reconstruction. The patient had right lumbago and high grade fever and right hydronephrosis. He was suspected to have right ureter tumor under the antegrade pyelography at the time of right nephrostomy, and ureter tumor was diagnosed by the combination of computed tomography and antegrade pyelography. Under this preoperative diagnosis, right nephroureterectomy was performed. The histopathological diagnosis was transitional cell carcinoma. Since the recurrence of urothelial cancer at 10 years after radical cystectomy is rare, we believe our case is useful for the establishment of long-term follow up of bladder cancer.

A 66-year-old man was admitted to our hospital with left flank pain. Drip infusion pyelography (DIP) and abdominal computed tomography (CT) showed urinary extravasation. Magnetic resonance imaging (MRI) and retrograde pyelography (RP) demonstrated stenosis of the ureter. Left nephroureterectomy was performed. Histopathological examination showed poorly differentiated adenocarcinoma, located in the ureteral wall with intact mucosa and adventitia. After the operation, sigmiod colon carcinoma was pointed out by colon fiberscope, and sigmoidectomy was performed.

We report a case of squamous cell carcinoma of the ureter. A 62-year-old woman had undergone total cystectomy and ileal conduit because of squamous cell carcinoma of the bladder when she was 44 years old. Seventeen years later, she complained of edema and oliguria. Antegrade pyelography and loopography revealed a left ureteral tumor. She underwent left ureterectomy and extirpation of the conduit. Pathological diagnosis was moderately differentiated squamous cell carcinoma of the ureter, pT2. The patient is alive without recurrence or metastasis in the first year after surgery.

An 86-year-old man was admitted to our hospital with a complaint of gross hematuria. Urological examination revealed right hydronephrosis and poorly differentiated adenocarcinoma of the prostate with bone metastases. Abdominal computed tomographic scan and retrograde pyelography showed thickening of the ureteral wall with irregular stenosis in the right upper ureter. Right nephroureterectomy demonstrated diffuse lymphatic infiltration of PSA-positive cancer cells in the submucosa and muscle layer of the ureter as well as renal pelvis. This is the 6th reported case of metastatic ureteral tumor from prostate cancer in the Japanese literature.

A 67-year-old man was referred for further examination of left hydronephrosis. He had undergone anterior resection for rectal cancer 2 years previously and also right lobectomy for a solitary hepatic metastasis one year postoperatively. Antegrade pyelography demonstrated a filling defect in middle portion of the left ureter. Cytology of the aspirated urine was class V. Left nephrourete-rectomy was performed. Histologically metastatic adenocarcinoma with intact ureteral mucosa was demonstrated.

Spontaneous rupture of the right upper ureter caused by metastatic ureteric tumor in an 80-year-old man is reported. He was admitted to our hospital with right lower abdominal pain. Ultrasonography showed mild right hydronephrosis and a low echogenicity mass under the right kidney. Drip infusion pyelography and abdominal computerized tomography showed extravasation of contrast medium around the right upper ureter. Retrograde pyelography was unsuccessful because of edema of the bladder wall. Right ureterocutaneostomy was performed under the diagnosis of spontaneous rupture of the right ureter. The right ureter was completely obstructed 3 cm below the point where it crossed the common iliac artery. At this site, the ureteric wall was hard, thickened, and adherent to the surrounding tissue. The lesion was a metastatic adenocarcinoma. The origin of the tumor could not be found, but pancreatic cancer was suspected on the basis of elevated CEA and PSTI levels. He died of peritonitis carcinomatosis at 8 months after surgery. Thirty three cases of spontaneous rupture of the ureter and 60 cases of metastatic ureteric tumor have been reported in Japan. However, our patient is the first reported case of spontaneous rupture of the ureter caused by a metastatic ureteric tumor in the Japanese literature.

This is a case report of the 21st documented case of ureteral metastasis from renal cell carcinoma. A 75-year-old woman was admitted because of asymptomatic gross hematuria. Right radical nephrectomy for renal cell carcinoma had been performed 2 years and 9 months prior to admission. Cystoscopy revealed efflux of blood from right ureteral orifice. Right retrograde ureterogram revealed a filling defect at the upper end of the stump, where a soft tissue mass was observed by computerized tomographic scan. She underwent right ureteral stump excision with a bladder-cuff. Pathological study was consistent with metastatic renal cell carcinoma. The literature on ureteral metastasis from renal cell carcinoma is briefly reviewed and a mechanism for the metastasis is proposed.

A case of solitary metastasis to residual ureter from renal cell carcinoma is reported. In November, 1987, a 56-year-old male had undergone left radical nephrectomy with renal cell carcinoma (clear cell subtype, G2, Inf alpha). He was doing well until June in 1989 when macroscopic hematuria occurred. A tumor from residual ureter with a large blood clot was detected on cystoscopy. A malignant tumor from the residual ureter was suspected and it was extirpated. Histological diagnosis revealed the same findings as the primary renal tumor. No other metastasis was detected. Only 8 cases of ureteral metastasis from renal cell carcinoma after radical nephrectomy have been previously reported in the Japanese literature.

A case of ureteral metastasis from renal cell carcinoma is reported. A 71-year-old man who had received radical nephrectomy for left renal cell carcinoma, G1 and about two years earlier presented with asymptomatic macrohematuria. He had received interferon therapy and surgical treatments for bone metastasis two times after the operation. Cystoscopic examination revealed bleeding from the left residual ureter but CT scan showed no abnormal findings. Left ureterectomy and partial cystectomy was performed and a small finger tip-sized tumor was found at 13.5 cm above the ureteral orifice. Pathological examination showed metastatic renal cell carcinoma, G1 > G2. Histologically and clinically, this tumor seemed to have metastasized by a hematological pathway. Seventeen cases of ureteral metastasis of renal cell carcinoma have been reported previously in the Japanese literature.

A case of contralateral ureteral metastasis from renal cell carcinoma is reported. A 52-year-old man underwent left nephrectomy for renal cell carcinoma of November 20, 1986. He was clinically asymptomatic for 4 years 8 months after the operation. He was admitted on August 14, 1991, because of right loin pain. Right retrograde pyelography and percutaneous pyelography showed a filling defect in the right ureter at the level of L3. After the right ureter was explored, the tumor lesion of ureter was resected and end to end anastomosis of the ureter was performed. Histopathologic examination showed a metastatic clear cell carcinoma consistent with a renal primary. The contralateral ureteral metastasis from renal cell carcinoma is very rare and only 15 cases have been reported previously.

We report a case of metastatic ureteral tumor resulting from gastric cancer in a 56-year-old female. She had undergone distal gastrectomy for gastric cancer in our hospital 3 years earlier, on the histological diagnosis of poorly differentiated adenocarcinoma with absolute curative resection. In March, 1987, she visited our hospital complaining of microscopic hematuria and lumbago. Intravenous pyelography and left retrograde pyelography revealed the stenotic change of the left ureter and hydronephrosis. Endoscopic ureteral biopsy was performed, and the histological diagnosis was an inflammatory change of the ureter. But the hydronephrosis increased, so partial ureterectomy was performed. The histological examination confirmed adenocarcinoma in the left ureter resulting from gastric cancer. From the 340th postoperative day, she complained of general fatigue and vomiting, and gastroscopy revealed recurrent gastric cancer.

A case of solitary ureteral metastasis from cervical cancer in a 36-year-old female is reported. On April 4, 1988, the patient visited the gynecological department of our hospital with abnormal genital bleeding. Colposcopy and cervical biopsy revealed invasive cervical cancer, and computerized tomography (CT) indicated right hydronephrosis. She was referred to the urological department for further examinations. Right retrograde pyelography (RP) however could not be performed. On April 13, 1988, the patient underwent laparotomy due to acute abdomen, which was proved to be caused by subileus. On exploration, a tumor was found in the lower one third section of the right ureter, whereupon a right nephroureterectomy was performed because primary ureteral tumor was suspected. The histology of the ureteral tumor revealed it to be a metastatic squamous cell carcinoma identical to that obtained from punch biopsy of the cervix. At that time, a hysterectomy could not be done because of invasive cervical cancer. Following the operation, radiation therapy was conducted for primary cervical cancer. At present, 7 months after the operation, the patient is alive with good performance status.

A 63-year-old woman admitted because of a right non-visualizing kidney. Right ureteral tumor was clinically diagnosed by routine examinations. Pathological finding after right nephroureterectomy and partial cystectomy revealed adenocarcinoma of the ureter. She also had a history of gastrectomy for gastric cancer 4 years before. Metastatic adenocarcinoma of the right ureter from the stomach was the final diagnosis made after the pathological comparison of the two specimens. Thirty nine cases of metastatic ureteral tumor from the digestive organs were reported in Japan. The autopsy suggests that metastatic ureteral tumors occur more often than we may expect and as metastatic and invasive ureteral tumors from digestive organ, are often confused, the criteria to distinguish between them must be established.

Among the secondary ureteral tumors, there have been a few true metastases to the ureters. We report a case of metastatic ureteral tumor from the pancreas, and review and discuss 60 cases collected from the Japanese literature.

Ureteral tumors were found in 4 out of 88 patients with bladder tumors who had been followed up at our clinic between July 4, 1984 and June 30, 1986. Radical nephroureterectomy and partial cystectomy were performed in 3 of them, and transurethral resection in the remaining one. The pathogenesis of the secondary ureteral tumors was discussed from the standpoints of implantation by vesicoureteral reflux, multicentricity, lymphatic or vascular spread and direct extension along the mucosa in these 4 cases. The ureteral tumor might have occurred in cases with multiple, recurrent or high grade bladder tumors and in cases with bladder tumors suffering from vesico-ureteral reflux. This study suggests that urine cytology, cystoscopy, retrograde cystography and excretory urography might be necessary in the cases of bladder tumors that had been treated with surgery with bladder preserved.

One hundred and eighty-six patients with primary transitional cell carcinoma underwent radical cystectomy between 1965 to December, 1986. Four of them (2.2%) had developed upper urinary tract transitional cell carcinoma. Three of the 4 patients had received various transurethral treatments for the primary bladder lesions before radical cystectomy, but one patient had undergone total cystectomy and ileal conduit as primary treatment. All of the upper urinary tract tumors were invasive. Three patients died and one is alive. We consider the following to be high risk patients for the development of upper tract recurrence. 1) patients with carcinoma-in-situ and multicentric tumors in the bladder, 2) patients with recurrent bladder cancer treated with bladder preserving treatment for a long periods, 3) patients with vesicoureteral reflux, and 4) occupational bladder cancer patients.