Upper ureteric transitional cell carcinoma, extending to the renal pelvis, presenting as duodenal obstruction

Abstract

A 61-year-old man presented with weight loss, dysphagia and vomiting. A barium swallow revealed a duodenal obstruction at D3. CT of the abdomen and pelvis showed a left upper ureteric tumour extending to the renal pelvis compressing the duodenum and causing left-sided hydronephrosis. Cystoscopy and left-sided ureteroscopy proved difficult and were unable to visualise or biopsy the mass, but a left ureteric stent was placed. Laparoscopic biopsy of the mass was completed and histology revealed transitional cell carcinoma. The patient went on to receive palliative chemotherapy, which relieved the small bowel obstruction, and the patient was able to eat solid food 8 weeks later. This case highlights a previously unreported cause of duodenal obstruction.

Figure 1

Dilated duodenum up to D3 visualised on barium swallow.

Figure 2

Axial view of CT showing duodenal compression secondary to upper ureteric mass.

Figure 3

Coronal view of CT showing duodenal compression secondary to upper ureteric mass.

Figure 4

Perirenal mass biopsy (H&E staining ×4). Fibroadipose connective tissue. There is mild chronic inflammation and there are small clusters of suspicious cells (red arrow).

Figure 5

Perirenal mass biopsy (Pancytokeratin immunostaining ×40). Clusters of malignant cells highlighted by pancytokeratin immunohistochemistry. These cells were positive with CK7 and CK20.