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

Abstract

Upper urinary tract urothelial carcinomas (UTUC) account for 5-10% of all transitional cells neoplasms. Kidney-sparing treatment should be considered for low grade (LG) UTUC and for imperative conditions. Percutaneous approach may have a role in LG tumors not manageable endoscopically. Tumor seeding along nephrostomy track is a rare report. We describe the case of a 73-year-old male, with a history of high-grade UC of the left renal pelvis. A CT scan showed the thickening of left renal pelvic wall, and percutaneous biopsy was performed. The patient underwent laparoscopic left nephroureterectomy. 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, compatible with UTUC metastasis. The percutaneous approach should be considered to be the possible cause of tumor seeding. Multimodal therapy seems mandatory, as highlighted in our outcomes, with 5 years of recurrence free survival.

Consultation on UTUC, Stockholm 2018 aspects of diagnosis of upper tract urothelial carcinoma

“…High IRP can result in forniceal rupture and potentially also perirenal tumor seeding [50]. Such seeding has been reported to occur along a percutaneous nephrostomy tract in UTUC patients [51], although no studies in the literature have concerned perirenal or intratubular seeding following URS. Nevertheless, it is crucial to maintain low IRP during URS in UTUC to reduce both general and specific risks related to the disease.…”

Percutaneous Image-guided Core Needle Biopsy for Upper Tract Urothelial Carcinoma

“…17 On closer review of fourteen case reports of "tract seeding" for UTUC from 1986 to 2017, only 2 cases resulted following true PCNB, while 12 occurred following percutaneous resection or placement of a nephrostomy tube. 12,[18][19][20][21][22][23][24][25][26][27][28][29][30] Utilization of coaxial technique in the 2 historical cases of PCNB were 18,19 Our interpretation of these results in light collective work is that PCNB appears to be safe, especially when using contemporary coaxial technique, while percutaneous resection or nephrostomy tube placement may carry a higher rate of tract seeding. The mechanism of tract seeding in cases of percutaneous resection or nephrostomy tube placement is likely secondary to significant reflux of malignant cells along the percutaneous tract, which would theoretically be minimized by PCNB, particularly in the setting of coaxial technique.…”

“…Rare case reports of needle tract seeding have raised concern. 12 Nevertheless, PCNB is occasionally employed when ureteroscopic biopsy is not possible or successful. We report our experience with PCNB for UTUC to primarily understand the safety of this approach as measured by adverse events and tumor seeding of the biopsy tract.…”

Does preoperative percutaneous nephrostomy insertion worsen upper-tract urothelial cancer oncological outcome? A retrospective single center study

“…Tumor seeding after the percutaneous nephrostomy insertion has been reported in case reports but no study has evaluated if PCN procedure alter the risk of tumor seeding or cancer control [ 2 – 4 ]. In our study, the demographic and clinic-pathological data were similar between these two groups except for distribution of tumor location (17(68%) and 236(52%) ureter tumors in the PCN and non-PCN groups respectively, p = 0.002).…”

“…Before definitive upper tract urothelial cancer diagnosis, percutaneous nephrostomy (PCN) may be undertaken for severe infective hydronephrosis or impending renal failure for temporary disease control. Although tumor seeding and invasion through the percutaneous nephrostomy tract has been reported on case reports [ 2 , 3 ], there are no studies comparing locally or systemically driven cancer recurrence rates between preoperative PCN dwelling and non-PCN dwelling patients in preoperative upper-tract urothelial cancer patients. This study is the first study to analyze these two groups’ of patients in the best of our knowledge.…”