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Case Reports
. 2019 Nov-Dec;45(6):1266-1269.
doi: 10.1590/S1677-5538.IBJU.2019.0053.

Ureteropelvic junction obstruction caused by metastatic cholangiocarcinoma

Nicholas A Pickersgill  1 , Alec J Wright  2 , Robert S Figenshau  1
Affiliations
Case Reports

Ureteropelvic junction obstruction caused by metastatic cholangiocarcinoma

Nicholas A Pickersgill et al. Int Braz J Urol. 2019 Nov-Dec.

Abstract

We describe the rare case of a 61-year-old female with right ureteropelvic junction (UPJ) obstruction caused by metastatic cholangiocarcinoma. Her past medical history was notable for cholangiocarcinoma treated with neoadjuvant chemoradiation and two orthotopic liver transplants six years earlier. Urology was consulted when she presented with flank pain and urinary tract infection. Diagnostic workup demonstrated right UPJ obstruction. She was managed acutely with percutaneous nephrostomy. She subsequently underwent robotic pyeloplasty and intrinsic obstruction of the UPJ was discovered. Histological examination revealed adenocarcinoma, consistent with systemic recurrence of the patient's known cholangiocarcinoma.

Keywords: Ureteropelvic junction obstruction; neoplasm; pyeloplasty.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1. Coronal (a) and axial (b) contrast-enhanced computed tomography revealed moderate-to-severe right hydronephrosis with decreased nephrogram of the right kidney, concerning for high-grade right UPJ obstruction.
Figure 2
Figure 2. Right retrograde pyelogram performed prior to stent placement revealed moderate hydronephrosis and features concerning for ureteropelvic junction obstruction.
Figure 3
Figure 3. Invasive moderate-to poorly-differentiated adenocarcinoma infiltrating bile duct fibrotic stroma seen in 100x (a) and 400x (b) magnifications. Right ureteropelvic junction biopsy is shown in 100x (c) and 400x (d) magnifications. Similarly, relatively bland low magnification morphology is seen in the primary (a) and metastatic (c) cholangiocarcinoma. Hyperchromasia and high nuclear-to-cytoplasmic ratios are better appreciated at higher magnification. Desmoplastic stromal response is seen around infiltrating malignant glands (d).
See this image and copyright information in PMC

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