401 - Urothelial carcinoma of the kidney in a patient with ovarian and breast cancer

Case Summary

68/F, Filipino, diagnosed with ovarian CA stIV (lung) 1992, s/p TAHBSO, s/p platinum-based chemotherapy, on surveillance.

In 2012, had painless hematuria. Referred to a nephrologist. Urinalysis done showed large hematuria, few WBCs, treated as UTI, with resolution of hematuria while on antibiotic therapy, but with recurrence after. All other workups/imaging (UTZ, CT scan) normal.

August 2012, screening mammogram done showed breast mass, R (IDCA stIIB, ER+ PR- HER2-), s/p MRM, s/p 6 cycles Paclitaxel Carboplatin, with resolution of hematuria while on treatment.

January 2013, chemo completed, started on Letrozole. Recurrence of hematuria. All workups/imaging normal.

May 2013, still with hematuria. CT scan showed L hydronephrosis and L hydroureter, may be secondary to a previous passage of stone or distal ureteral stricture. No discrete mass or intraluminal filling defects noted. Advised observation.

June 2013, still with hematuria. Treated as UTI, with resolution of hematuria while on antibiotic therapy, but with recurrence after. All other workups/imaging/cystoscopy with biopsy normal.

November 2013, still with hematuria. CT scan showed an ill-defined soft tissue density at upper pole of L kidney with involvement of both calyx and parenchyma, measuring 2.3 x 2.9 x 2.2 cm, with mild dilatation of distal L ureter, with ill-defined nodule measuring 0.9 x 0.9 cm adjacent to the distal segment which could be a prominent-sized lymph node.

December 2013, s/p Radical nephrectomy L. Histopath showed Invasive papillary urothelial carcinoma, high grade, pelvis, tumor size 3.7 cm in single widest diameter, with invasion to the lamina propria of the pelvis and into the renal parenchyma, with lymphovascular invasion, ureteral margins, perinephric fat and major renal vessels, negative for tumor. Final diagnosis is Invasive papillary urothelial carcinoma, L renal pelvis, StIII (pT3N0M0), s/p 6 cycles Gemcitabine Carboplatin.

Past medical history unremarkable, nonsmoker, no alcohol intake, no exposure to chemicals, G0 with surgical menopause 48 yo, with family history of rhabdomyosarcoma (father) and breast cancer (sister).

BRCA mutation testing done, negative.

Currently, patient is 73 years old, asymptomatic, on surveillance.

Editorial acknowledgement

Clinical trial identification