A 57 years old male patient has been presented with
painless gross hematuria together with clots. The
multiple and fixed lymphadenopathies at the
supraclavicular region extending to lower and middle
jugular region (5x5 cm diameter) was clarified during
the medical examination. The hydronephrosis in the
right kidney, and a hyperdense soft tissue mass in the
distal section of the right ureter was appeared with
using the method of abdominopelvic tomography.
Mass was seen as protruding in the polypoid form from the base of the bladder, through to the lumen (Figure
1). Multiple lymph nodes in the right inferior jugular
chains, bilateral submandibular and submental, left
jugular and posterior cervical region determined by
cervical tomography. The biggest lymph node (a
diameter of 33x16 mm) was in the left submandibular
region (Figure
2).
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Figure 1: Abdominopelvic tomography; a hyperdense soft
tissue mass protruding in the polipoid form from the base of
the bladder towards to the lumen. |
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Figure 2: Cervical tomography; left jugular and posterior
cervical region. The biggest lymph node in a diameter of
33x16 mm in the left submandibular region |
A polypoid tumoral formation (diameter of 2x3
cm) extending from right ureter orifice towards to the
bladder lumen was established. Right
nephrouretectomy with bladder cuff resection, and
excisional biopsy from supraclavicular
lymphadenopathy were performed during operation.
These pathologic specimens exhibited as TCC with
Grade II involving all layers of the ureter which
invades the vascular spaces. The excisional biopsy
obtained from supraclavicular lymphnode region was
reported as TCC metastasis (Figure 3).
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Figure 3: Lymph node specimen; transitional cell carcinoma
metastasis that was detected by excisional biopsy from
supraclavicular lenf node region. |
The adjuvant methotrexate, vinblastine,
epirubicin, cisplatin (MVEC) chemotherapy was
administered to the patient in the post-operative period.
In the tomographic assessment multiple lymph nodes in
with different sizes were shown in supraclavicular,
hilar, paratracheal, axillar, paracaval, paraaortic and
parailiac regions. The maximum size of lymph nodes
was in 32 x 29 mm. The patient received salvage
chemotherapy, including gemcitabine plus cisplatin
cures as three times and died due to widespread
metastases 15 months later.
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