Tumor Seeding of Percutaneous Nephrostomy Tract from Urothelial Carcinoma of the Kidney

Abstract

Urothelial carcinoma (UC) of the renal pelvis has been rarely shown to metastasize to the skin. Tumor seeding from iatrogenic procedures is a source of spreading of UC to the skin. We herein present a case of primary UC of the renal pelvis with spreading to the skin from a percutaneous nephrostomy tract.

Upper Urinary Tract Urothelial Carcinoma Tumor Seeding along Percutaneous Nephrostomy Track: Case Report and Review of the Literature

“…This site metastasis has a very low incidence and a small number of cases has been reported in literature ( table 1 ) [4][5][6][7][8][9] . One of the first reports by Sharma et al [5] described a percutaneous nephroscopic resection of TCC involving the renal pelvis.…”

“…Recently, Sorokin et al [4] described a case of urothelial tumor seeding along a percutaneous access route in a patient who carried a nephrostomy tube for 5 months. He was treated by chemotherapy and radiotherapy, and few months later, he expired from metastatic disease [6] .…”

“…All case reports showed aggressive high-grade tumors [4][5][6][7][8][9] . The spreading along the percutaneous access route could be avoided by a retrograde endoscopic approach [5] .…”

“…Since the first description of the tumor seeding, different authors suggested some pre-operative assessments for reducing incidence, such as obtaining percutaneous access and performing tumor biopsy or resection at the same time [4] . Some authors suggested postoperative radiotherapy either by placing radioactive iridium wires into nephrostomy site or by placing an external beam in the entire percutaneous access route [10] .…”

“…Seven months later, he was admitted for left flank pain due to a mass along the percutaneous track site. Mass en-bloc resection was performed, and histopathology finding demonstrated undifferentiated carcinoma, The UC tumor recurrence has been frequently investigated in high-grade and high-stage disease, while the spilling of tumor cells along nephrostomy tract is an issue rarely reported in the literature [4][5][6][7][8][9] . …”