SYNCHRONOUS RENAL CELL CARCINOMA AND TRANSITIONAL CELL CARCINOMA OF URINARY BLADDER: A RARE CASE REPORT AND LITERATURE REVIEW

Mayank Bhasin, Rajeev Sarpal* and Shikhar Agrawal

ABSTRACT

Introduction: Simultaneous occurrence of different primary genitourinary malignancies is a rare entity. First case of simultaneous dual urological malignancy was reported by Graves and Templeton in 1921. Since then many cases of dual or triple genitourinary malignancy have been reported but due to limited literature treatment has not been standardized and poses a challenge in its management. Case summary: 73/M presented with complaints of hematuria with clot retention from 6 hours and painless hematuria from 15 days. Hematological profile showed neutrophilic predominant leucocytosis. CECT abdomen showed heterogeneously enhancing mass lesion at middle and lower pole of left kidney 72 x 67 x 65 mm with normal right kidney and a small nodular hypotense lesion in right lateral wall of urinary bladder. Patient was planned for Cystoscopy and left open Radical Nephrectomy. Cystoscopy showed mass on right lateral wall of bladder for which TURBT was done. Postoperative period was uneventful. Histopathological examination showed left Renal cell carcinoma clear cell type (Fuhrman grade III) (pT 3NxMX). TURBT chips showed high grade TCC (pT1NoMo). Patient is currently on regular follow up from 15 months with no evidence of recurrence. Discussion: Synchronous occurrence of multiple urological malignancies is a rare finding. Review of literature shows that RCC is associated with prostate, bladder, rectal cancer, non-Hodgkin’s lymphoma and lung cancer on long-term follow-up. Association with these in a synchronous way is very rare. So there is a great need for careful diagnostic work-up to detect others in the presence of one. Similar case was reported by Srinath et al in year 2005 for which radical nephro-uretectomy was done. Similarly in a study done by Nienie et al on 17 cases of concurrent RCC with TCC bladder none of cases emerged with ureter recurrence during follow up. So we believe that management plans should be individualized.

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