SOLITARY METASTASIS OF RENAL
±,LL
CARCINOMA TO URETIIRA
MURRAY G. GOLDBERG . M .D . LEONARD I'LAINE, M .D . From the Department of Urol a Nev Medical Center, New York . New ork
a
report o f a solitary metastasis to the in eth-ea f ted . The patient presented with total grass pat
a
s hemat
I
-acted ra .ar.a! Ball , this is
a case to be reported .
disease to the uretl s a rare entity. 's from renal rcinoma is ding a solitary metastasis of renal to the urethra is an entity not ported . Herein we describe such a
~sented with a oss o unless hematuof long clots . lie denied s maturia, abdominal pain, or s past history revealed that four admission he had a left radical or localized renal cell carcinoma . nargins were free of tumor on miaination . The patient's past medio significant for hypertension, disease, atherosclerotie heart d azoten:da, amination revealed an afebrile well-healed left flank sear, eireumeised without tenderness The perineum, seroturn, and tornial . Rectal examination rerostate . The urine was grossly orv values were remarkable for blood urea nitrozen 25 . 0, and normal liver enzym s . Irribtadder yielded clear wine, and
o
v'OL
it yzxe \twttsra a
the patient continued to pass clots aroun catheter. d . retrograde urethro a n revealed multiple filling defects within the pendulous urethra consistent with clotted blood . 6'biding mrethrography showed a persistent fi}lint,, d cci (Fig . IA) . C.vstoseopy revealed a large exophytie mass in the pendulous urethra adherent to the ventrolateral aspect of the urethra by a broad stalk (Fig . ill) . The mass was excised using a :eseetoseope, and the base v, as fill rated . The pathology was reported as a welt_ differentiated renal tubular aderioearemoma (Fig. 2A) identical to the pathology c f the patient's renal tumor that was removed lour sears ago (Fig . 2B) . .tletastatic evaluation with CAR, computed tomographp of the abdomen and pelvis, bone scan ; gy ; and a magnetic resonance f the penis was negative.
Renal eel is ,Ia percent of adult mali to about 22,000 eases per year that are £ C, to 50 percent have: clinical: (,' ;de of :stasis at the tisane of dia,nosis .= A static spread may be via lymn} liatics or v ,a the blood stream . Blood-borne metastases maybe manifested in any organ . but the sites most
Ficclai- : ) . (A) 'reoperative voiding rysolur0hrography
fIcIll
PrA S t ell t ithill InPendulous urethra . (13) Vndowopic view of Sam attached to arethral looll by its pcdi(vc . p
of !A) I and (
corn l oldy af ected are lung, hone, liver, mdwus tancous tissue, and brain . About 10 percent present with metastases wolong only one organ system, and only 1 .6-:3 .2 percent present with a solitary lesion .'' WaYath : diseme to the urethraa although care, has occurred . There are reports of cancers
3 5"?
from the bladder pros tat" mela ;A lympbonja metastasizing t o the urethr ever, these cases were `Really asic)ciat sad met astawn There are 10 -e cases of renal cell emcnicana njeuv ; tat ic penis " Those lesions were ll to the cO) c2verllosa . Six of those cases ,)r es ented
UROLOGY '
APHIL HUO
I sot
TU; XXVV
however, the source of the bleeding entified . It vas not demonstrated lions had penetrated into the. ose; The MRl was performed to confirm he manor was confined to the . urethra and as extension from a metastasis in the hits in a complete review of the literais is the first report of renal cell car"th a solitary metastasis to the treatment of localized renal nephrectomv tiuhicl'1 ex i -A Gerot r s fascia kidney and adrenal . The e1 ole in the treatment of metastatic reC arcinoma is controversial . Nephrecn I extirpation of solitary synchronous s been .shown to carry a signifiognosis with reported five-year as high as 58 percent .' Excision of achronous metastases has been prognosis .
APRIL. 1 1)
vo ;
15)6 XXX ~C?lBk1i 4
In
4
w of this {ratic is
at,
cal histc
azoteniia, and negative metallatfe workup, are recommending no other therapy other th observation at this tulle . Nev York i . 0()1 DR PL JNI ; t'
Newt
- . Arm I COanear StaCtFnas MY", >ehas.,n Jr ti and Il t, ai r Ser :ices V'sI N'at:,na t . : nna In `.itn a 2 : (1')W, 2 . Fo+ er JH Ir : Aeuharr umv in uretao :ar
^r ~U c2r-
cinoma, e n Cam North Am 14 :',4 (19871 . 3 . Xiicidlrlon B : rS, r t for me a t r c ronaccacinoma . ! hrol 47 :9 ;3 (1'_1G7!,
4 . 'Pull_ t. end whitmn m AV: Sc dr ; . j ,
ct1
a eat-'a0 n , fo r ,en ;ei ,w11
carcinoma ; J Urn! 114 : 838
i, AbahonoBS-adAbcshonsoC 5
51
ta:ctoti to noaaoift,
.tiffs : a Me* i s f he l ter, the sn l a epum Cr , on caste. I o 86 : 99 (196!) . 6 Smith MlVT and Bm acur,i AF Slat :gear caai .s:a du , to
dear cell ca in ma : a + use teraxl and rev sew o tin Man= I Und Go 210 Q=, . . A1 :pe hit P : Tic, na, and
u of surge c i ,ta ;tatie renal ate, :cenot a a tetrnsy cl c° clin :< I s to o{ I06 e:phcantnnczad nests 5 Snag ahac 7 G 13S HIM .
±,LL
CARCINOMA TO URETIIRA
MURRAY G. GOLDBERG . M .D . LEONARD I'LAINE, M .D . From the Department of Urol a Nev Medical Center, New York . New ork
a
report o f a solitary metastasis to the in eth-ea f ted . The patient presented with total grass pat
a
s hemat
I
-acted ra .ar.a! Ball , this is
a case to be reported .
disease to the uretl s a rare entity. 's from renal rcinoma is ding a solitary metastasis of renal to the urethra is an entity not ported . Herein we describe such a
~sented with a oss o unless hematuof long clots . lie denied s maturia, abdominal pain, or s past history revealed that four admission he had a left radical or localized renal cell carcinoma . nargins were free of tumor on miaination . The patient's past medio significant for hypertension, disease, atherosclerotie heart d azoten:da, amination revealed an afebrile well-healed left flank sear, eireumeised without tenderness The perineum, seroturn, and tornial . Rectal examination rerostate . The urine was grossly orv values were remarkable for blood urea nitrozen 25 . 0, and normal liver enzym s . Irribtadder yielded clear wine, and
o
v'OL
it yzxe \twttsra a
the patient continued to pass clots aroun catheter. d . retrograde urethro a n revealed multiple filling defects within the pendulous urethra consistent with clotted blood . 6'biding mrethrography showed a persistent fi}lint,, d cci (Fig . IA) . C.vstoseopy revealed a large exophytie mass in the pendulous urethra adherent to the ventrolateral aspect of the urethra by a broad stalk (Fig . ill) . The mass was excised using a :eseetoseope, and the base v, as fill rated . The pathology was reported as a welt_ differentiated renal tubular aderioearemoma (Fig. 2A) identical to the pathology c f the patient's renal tumor that was removed lour sears ago (Fig . 2B) . .tletastatic evaluation with CAR, computed tomographp of the abdomen and pelvis, bone scan ; gy ; and a magnetic resonance f the penis was negative.
Renal eel is ,Ia percent of adult mali to about 22,000 eases per year that are £ C, to 50 percent have: clinical: (,' ;de of :stasis at the tisane of dia,nosis .= A static spread may be via lymn} liatics or v ,a the blood stream . Blood-borne metastases maybe manifested in any organ . but the sites most
Ficclai- : ) . (A) 'reoperative voiding rysolur0hrography
fIcIll
PrA S t ell t ithill InPendulous urethra . (13) Vndowopic view of Sam attached to arethral looll by its pcdi(vc . p
of !A) I and (
corn l oldy af ected are lung, hone, liver, mdwus tancous tissue, and brain . About 10 percent present with metastases wolong only one organ system, and only 1 .6-:3 .2 percent present with a solitary lesion .'' WaYath : diseme to the urethraa although care, has occurred . There are reports of cancers
3 5"?
from the bladder pros tat" mela ;A lympbonja metastasizing t o the urethr ever, these cases were `Really asic)ciat sad met astawn There are 10 -e cases of renal cell emcnicana njeuv ; tat ic penis " Those lesions were ll to the cO) c2verllosa . Six of those cases ,)r es ented
UROLOGY '
APHIL HUO
I sot
TU; XXVV
however, the source of the bleeding entified . It vas not demonstrated lions had penetrated into the. ose; The MRl was performed to confirm he manor was confined to the . urethra and as extension from a metastasis in the hits in a complete review of the literais is the first report of renal cell car"th a solitary metastasis to the treatment of localized renal nephrectomv tiuhicl'1 ex i -A Gerot r s fascia kidney and adrenal . The e1 ole in the treatment of metastatic reC arcinoma is controversial . Nephrecn I extirpation of solitary synchronous s been .shown to carry a signifiognosis with reported five-year as high as 58 percent .' Excision of achronous metastases has been prognosis .
APRIL. 1 1)
vo ;
15)6 XXX ~C?lBk1i 4
In
4
w of this {ratic is
at,
cal histc
azoteniia, and negative metallatfe workup, are recommending no other therapy other th observation at this tulle . Nev York i . 0()1 DR PL JNI ; t'
Newt
- . Arm I COanear StaCtFnas MY", >ehas.,n Jr ti and Il t, ai r Ser :ices V'sI N'at:,na t . : nna In `.itn a 2 : (1')W, 2 . Fo+ er JH Ir : Aeuharr umv in uretao :ar
^r ~U c2r-
cinoma, e n Cam North Am 14 :',4 (19871 . 3 . Xiicidlrlon B : rS, r t for me a t r c ronaccacinoma . ! hrol 47 :9 ;3 (1'_1G7!,
4 . 'Pull_ t. end whitmn m AV: Sc dr ; . j ,
ct1
a eat-'a0 n , fo r ,en ;ei ,w11
carcinoma ; J Urn! 114 : 838
i, AbahonoBS-adAbcshonsoC 5
51
ta:ctoti to noaaoift,
.tiffs : a Me* i s f he l ter, the sn l a epum Cr , on caste. I o 86 : 99 (196!) . 6 Smith MlVT and Bm acur,i AF Slat :gear caai .s:a du , to
dear cell ca in ma : a + use teraxl and rev sew o tin Man= I Und Go 210 Q=, . . A1 :pe hit P : Tic, na, and
u of surge c i ,ta ;tatie renal ate, :cenot a a tetrnsy cl c° clin :< I s to o{ I06 e:phcantnnczad nests 5 Snag ahac 7 G 13S HIM .
