First case of a primary osteosarcoma of the ureter: diagnostic findings, course of disease and treatment

Extract

Case report

In October 2005, a 61-year-old patient was admitted with symptomatic right sided hydronephrosis. She was treated for breast cancer in 2003 with radical mastectomy and chemotherapy and for cervical carcinoma in 1983, which was cured by a Wertheim-Meigs operation and radiotherapy.

An intravenous pyelogram was performed, which demonstrated occlusion of the right distal ureter (Figure 1). A subsequent ureteroscopy revealed a hard, round mass in the distal ureter that was not removable and occluded the lumen. Biopsies were taken and histopathology revealed a highly pleomorphic neoplasm composed of myxoid spindle cell sarcomatous elements and more closely packed spindle cells with malignant osteoid production. Distal ureteric resection with bladder-cuff and ureterocystoneostomy were performed (R0-resection). The patient made a good recovery from surgery and was discharged. Adjuvant chemotherapy was recommended but rejected by the patient.

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In January 2006, the patient returned to the outpatient clinic, suffering from macrohaematuria and right sided flank pain. Cystoscopy suggested tumour recurrence in the region of the neo-ostium. Biopsies were taken and histopathology revealed an early relapse of the previous osteosarcoma. To define the tumour stage, a CT-scan was performed and revealed a dilated right renal pelvis (Figure 2) and a grossly dilated right ureter without further evidence of extraluminal tumour relapse or evidence of metastatic disease. An ureteronephrectomy with partial bladder resection was conducted. Histology confirmed local and extraureteral tumour relapse (R2-resection). Furthermore, a metastasis in the renal pelvis, infiltrating the renal parenchyma, was detected. Palliative chemotherapy, according to the COSS (Co-operative osteosarcoma study group) trial,¹ was initiated.