This is an open access article under the terms of a license that permits non-commercial use, provided the original work is properly cited.  
© 2021 The Authors. Société Internationale d'Urologie Journal, published by the Société Internationale d'Urologie, Canada.

Key Words Competing Interests Article Information

Transitional cell carcinoma, nephrostomy, 
tumor seeding

None declared.

Patient Consent: Obtained.

Received on September 6, 2021 
Accepted on September 17, 2021

Soc Int Urol J.2021;2(6):382

DOI: 10.48083/ZVXI1252

FIGURE 1A.  

Cross-sectional CT scan showing the tumor extending from 
the kidney along the previous nephrostomy tract to the skin 
externally

FIGURE 1B.  

Mass seen at the patient's flank next to the nephrostomy

382 SIUJ  •  Volume 2, Number 6  •  November 2021 SIUJ.ORG

CLINICAL PICTURE

Urothelial Carcinoma Seeding at  
Site of Nephrostomy
Ala'a Farkouh, Mohammed Shahait

King Hussein Cancer Center, Department of Surgery, Amman, Jordan

A 57-year-old man, with a history of nephrolithiasis and 
heavy smoking (80 pack years at presentation), presented 
to a tertiary cancer center 2 years ago with urothelial 
carcinoma (UC) in the right distal ureter associated 
with lung metastasis. On initial presentation, the patient 
complained of right flank pain, gross hematuria, and 
weight loss. Imaging revealed a 3.7 cm right distal ureter 
mass with severe right hydronephrosis (Figure 1a) and 
a 3.2 cm lung lesion, which was proven by biopsy to 
be metastatic UC. A right nephrostomy was inserted 
for palliation of symptoms and to manage recurrent 

obstructive pyelonephritis. The patient’s disease 
progressed despite multiple lines of chemotherapy 
and immunotherapy. He developed infection at the 
nephrostomy site with associated emphysematous 
pyelonephritis. This was managed with antibiotics and 
placement of a new nephrostomy at a different site, and 
palliative nephrectomy was considered. After resolution 
of the infection, the patient was noted to have a small 
malodorous mass at the site of the previous nephrostomy 
t hat progressively grew in size over 4 mont hs  
(Figure 1b). Biopsy of the mass revealed UC.