Primary small cell carcinoma of the ureter with associated hyponatremia and rapid progression to bladder involvement: a case report

Yu-Hsiang Chuang, Ghulam Mustafa Nandwani (Lead / Corresponding author), Magdelena Szewczyk-Bieda, Neil Kernohan, Muhammad Zeeshan Aslam

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Abstract

Background: Primary small cell carcinoma (SmCCa) of the ureter is rare. The majority of patients present with visible haematuria. Diagnosis is confirmed by histopathology. Associated hyponatraemia in GU lesion can be due SmCCa can be useful for early diagnosis aggressive ureteric tumors. The current management includes radical surgery or radiotherapy with concomitant chemotherapy to improve survival and quality of life. Case presentation: We present a case of a 77 years female who was found to have unilateral hydronephrosis with a 5 cm filling defect in the distal ureter on CT urogram. Further staging showed organ-confined disease. Serum sodium levels were low at presentation. At the time of planned nephroureterectomy (NU), cystoscopy revealed a bladder tumor obstructing the right ureteric orifice. TURBT was performed instead. After TURBT, there was marked hyponatremia and histology was small cell carcinoma (SmCCa). Paraneoplastic SIADH was the likely cause. Neoadjuvant chemotherapy (NACT) followed by radiotherapy (RT) was chosen for definitive treatment. This resulted in an excellent response supported by radiological evidence of almost complete resolution of the tumor. Conclusion: The presence of genitourinary lesion and hyponatremia should raise suspicion of paraneoplastic SIADH. The case suggests the emphasis of histological diagnosis of the genitourinary lesion with existing hyponatraemia to provide better outcome with NACT followed by definitive treatment. We share our experience of NACT and RT in the management of ureteric SmCCa extension to the bladder.

Original languageEnglish
Article number24
Number of pages6
JournalAfrican Journal of Urology
Volume28
Issue number1
Early online date11 Jun 2022
DOIs
Publication statusPublished - Dec 2022

Keywords

  • Bladder
  • Hyponatremia
  • SIADH
  • Small cell carcinoma
  • Ureter

ASJC Scopus subject areas

  • Urology

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