Metastatic Involvement of the Ureter from Recurrent Pancreatic Cancer in a Patient with Multiple prior Malignancies:
Hiroshi Shintani1, Sohei Iwagami2, Katsuji Tokuhara1
1Department of Surgery, Kishiwada Tokushukai Hospital, Osaka, Japan.
Introduction:
Ureteral metastasis is an exceptionally rare manifestation of malignant disease, with pancreatic cancer as the primary source being particularly uncommon. Because ureteral involvement typically reflects advanced systemic disease and is associated with poor prognosis, early and accurate diagnosis is essential for appropriate clinical management.
Case Presentation:
A 74-year-old man with a history of surgically treated gastric, colorectal, and pancreatic cancers was under routine follow-up after curative resection of pancreatic cancer. Surveillance computed tomography revealed a periureteral mass accompanied by left-sided hydronephrosis. Subsequently, serum tumor marker levels increased, and 18F-fluorodeoxyglucose positron emission tomography/computed tomography demonstrated increased metabolic uptake confined to the periureteral lesion. As imaging findings alone were insufficient to determine the primary origin, surgical resection was performed. Histopathological and immunohistochemical analyses revealed features consistent with pancreaticobiliary adenocarcinoma, confirming periureteral metastasis from recurrent pancreatic cancer. Postoperatively, systemic chemotherapy with gemcitabine plus nab-paclitaxel was initiated.
Conclusion:
This case highlights that pancreatic cancer can cause isolated ureteral metastasis even several years after curative surgery. In patients with a history of multiple malignancies, newly identified periureteral lesions should raise suspicion for metastatic disease, and histopathological confirmation is essential to establish the primary origin and guide optimal systemic therapy.
