Rapid recurrence of squamous cell carcinoma at a lymphocele after nephroureterectomy: A rare case report

Abstract

Introduction: Lymphoceles are sometimes formed after pelvic lymph node dissection. However, recurrence at lymphoceles has not been reported previously. Here, we report a case of rapid prognosis of the recurrence at a lymphocele after nephroureterectomy.

Case presentation: A 78-year-old man underwent retroperitoneoscopic radical nephroureterectomy with pelvic lymphadenectomy for left ureteral urothelial carcinoma. The histopathological diagnosis was high-grade invasive urothelial carcinoma with squamous differentiation. Follow-up computed tomography at 3 months postoperatively showed a lymphocele with a small solid component, in the left pelvic region. At 7 months postoperatively, he presented with severe fatigue, and computed tomography showed a solid tumor had replaced the lymphocele. Computed tomography-guided biopsy was performed and histopathological diagnosis was squamous cell carcinoma.

Conclusion: This report provides support for possible recurrence at the lymphocele after nephroureterectomy. If lymphocele occurs after surgery for malignant disease, it is recommended to follow up with the possibility of recurrence in the lymphatic cysts in mind.

Keywords: lymphocele; metastasis; squamous differentiation; ureteral cancer; urothelial carcinoma.

Fig. 1

(a) There are invasive urothelial carcinoma, mainly composed of well‐differentiated SCC (hematoxylin‐eosin, bar = 100 μm). (b) There are well‐differentiated SCC and the histopathological findings are similar to those of ureteral cancer (a) (hematoxylin‐eosin, bar = 200 μm).

Fig. 2

The postoperative 3‐month CT scan (a: axial view, b: coronal view) showed a lymphocele with a small solid component in the wall, in the left pelvic region. The coronal view showed the solid component area was distant from the UVJ. The postoperative 7‐month CT scan (c: axial view, d: coronal view) showed a solid mass had replaced the lymphocele in the left pelvic region.

Fig. 3

MRI showed that the mass with arrow pointing was isointense on (a) T1‐ and (b) T2‐weighted imaging and hyperintense on (c) diffusion‐weighted imaging.