Metastasis to the proximal ureter from prostatic adenocarcinoma: A rare metastatic pattern

Abstract

Prostate cancer is one of the most common male malignancies, but it rarely metastasizes to the proximal ureter. We report a case of a 76-year-old man who presented with flank pain and lower urinary tract symptoms. Abdominal computed tomography scan revealed multiple filling defects at the middle of the left ureter, enlarged retroperitoneal lymph nodes, and probable psoas invasion. The patient underwent nephroureterectomy with excision of a cuff of bladder, and was found to have an adhesion between the middle part of left ureter and psoas intraoperatively. The pathological examination displayed positive immunohistochemical staining with prostate-specific antigen and prostate acid phostate, supporting the diagnosis of metastatic ureteral tumour from prostate cancer. In this case, periureteral soft tissue and ureteral muscular layer were infiltrated by metastatic tumour, whereas the mucosa was spared. The periureteral lymphatic pathway played an important role in the metastatic procedure of prostate cancer to the proximal ureter.

Fig. 1a.

A computed tomography scan showing multiple filling defects at the middle of left ureter, and probable left psoas invasion.

Fig. 1b.

A computed tomography scan showing enlarged retroperitoneal lymph nodes (arrow).

Fig. 2a.

Hematoxylin-eosin appearance of metastatic ureteral tumour, the adventitia and muscular layer of ureter invading by malignant cells, but ureteral mucosa was spared (×100).

Fig. 2b.

Immunohistochemical staining of ureteral tumour positive for prostate-specific antigen (×100).

Fig. 2c.

Immunohistochemical staining of ureteral tumour positive for prostate acid phostate (×200).