Ureteropelvic Junction Obstruction Secondary to Metastatic Relapse of Breast Cancer

Abstract

We describe the case of a 53-year-old woman with a history of localized breast cancer who presented with flank pain and was found to have new-onset obstruction of the left ureteropelvic junction. Although initially believed to be unrelated to her history of prior malignancy, intraoperative assessment of tissue from the ureteropelvic junction during planned laparoscopic pyeloplasty revealed urothelial infiltration by carcinoma of breast origin.

Keywords: Breast cancer metastasis; Hydronephrosis; Ureteropelvic junction obstruction.

Figure 1

CT urogram. (A) Noncontrast phase image illustrating left hydronephrosis with tapering at the left UPJ (arrow) on coronal section. (B) Contrast-enhanced image revealing left UPJ obstruction (arrow) with no enhancement of periureteral tissue or retroperitoneal pathology and the absence of crossing vessels. (C) Excretory phase image demonstrating delayed left nephrogram and absent opacification of the left renal pelvis and proximal ureter with concomitant tapering at the left UPJ (arrow).

Figure 2

Intraoperative appearance of L UPJ during planned laparoscopic pyeloplasty. The UPJ and adjacent proximal ureter appear encased by a desmoplastic rind compared with more distal ureteral and renal pelvis tissues which have a healthy, pinkish appearance.

Figure 3

Left UPJ Tissue. (A) Invasive carcinoma infiltrating fibroconnective tissue; H&E stain, original magnification ×40. (B) Invasive carcinoma is highlighted by positive staining for Estrogen Receptor (ER); ER immunostain, original magnification ×40.