[Ureteral metastasis of carcinoma of the kidney]

Involvement of the ureter from metastatic renal cell carcinoma is doubtlessly uncommon. Five cases of ureteric secondaries are studied herein. All were ipsilateral and synchronous with the appearance of the primary tumor except for one that was diagnosed 5 years following nephrectomy. The most consistent clinical feature was that of hematuria which presented in all cases. Urography (IVP) and retrograde ureteropyelography (RUP) proved to be fundamental in the morphologic diagnosis of these lesions. Treatment was always by surgery. The foregoing was combined with immunotherapy (BCG) in one case and palliative external radiotherapy in another case. In all cases, tumor stage and grade were T3-T4 and G2-G3, respectively, and all but one patient presented extrarenal venous spread (3 cases V2 and 1 case V1). The regional lymph nodes were positive in all 5 cases. In 2 cases, the histopathologic examination revealed concomitant metastasis to the ipsilateral adrenal. Because prognosis is poor, the therapeutic alternatives and the possible indication of prophylactic nephroureterectomy in certain cases are discussed.