Triple Threat: Three Primary Malignancies Simultaneously Involving Three Genitourinary Organs

Katharina Mitchell; Reima El Naili; Lakshmikumar Pillai; Eric Mark Lopez; John Riordan; Wallis Marsh; Adam Luchey; Ali Hajiran

doi:10.1155/2023/3242986

Triple Threat: Three Primary Malignancies Simultaneously Involving Three Genitourinary Organs

Case Rep Urol. 2023 Apr 17:2023:3242986. doi: 10.1155/2023/3242986. eCollection 2023.

Authors

Katharina Mitchell¹, Reima El Naili², Lakshmikumar Pillai³, Eric Mark Lopez⁴, John Riordan¹, Wallis Marsh⁵, Adam Luchey¹, Ali Hajiran¹

Affiliations

¹ West Virginia University Department of Urology, Morgantown, WV, USA.
² West Virginia University Department of Pathology, Morgantown, WV, USA.
³ West Virginia University Department of Vascular Surgery, Morgantown, WV, USA.
⁴ Berkeley Medical Center Nephrology, Martinsburg, WV, USA.
⁵ West Virginia University Department of Surgical Oncology, Morgantown, WV, USA.

Abstract

Statistically, the chance of having concurrent renal cell carcinoma (RCC), urothelial carcinoma of the bladder (UC), and a neuroendocrine tumor (NET) of the renal parenchyma is less than one in a trillion. Herein, we describe an unusual case of a 67-year-old female who presented with bilateral flank pain and severe gross hematuria. Cross-sectional imaging revealed two large heterogeneous, endophytic renal masses with a single enlarged paracaval lymph node. Diagnostic cystoscopy was performed for completion of gross hematuria evaluation and revealed a concurrent papillary bladder tumor. Percutaneous biopsies of bilateral renal masses revealed clear cell RCC involving the left kidney and well-differentiated NET involving the right kidney, and transurethral resection of the bladder tumor revealed high-grade nonmuscle invasive urothelial carcinoma. The patient elected to undergo bilateral nephroureterectomy, radical cystectomy, and retroperitoneal and pelvic lymphadenectomy. Final pathology confirmed the presence of three different malignancies: noninvasive high-grade papillary UC of the bladder (pTaN0), left renal clear cell RCC (pT2bN0), right renal well-differentiated NET, and a single paracaval lymph nodes positive for metastatic NET (pT2aN1).

Publication types

Case Reports