Urothelial Carcinoma Seeding at Site of Nephrostomy

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 that progressively grew in size over 4 months (Figure 1b). Biopsy of the mass revealed UC.