Eight cases in hundred years

Dear friends! Today we are telling you about an extremely rare, medically speaking, casuistic case of pancreatic cancer, diagnosed at the N. Lopatkin Scientific Research Institute of Urology and Interventional Radiology – branch of the Federal State Budgetary Institution “National Medical Research Radiological Centre” of the Ministry of Health of the Russian Federation. Candidate of Medical Sciences talks about this in details. Dmitry Perepechin, the senior researcher at the Department of Oncourology of N. Lopatkin Scientific Research Institute of Urology and Interventional Radiology.

– Recently, a 67-years-old patient came to us with complaints of periodic pain in the suprapubic area. The woman came after the recommendation of her attending physician in her hometown. The case seemed controversial to him, and he decided to refer the patient to specialists from the federal center,” says Dr. Perepechin.

– So, what had happened?

In 2017, the patient was diagnosed with pancreatic cancer, we made a resection and gave her several courses of chemotherapy. But, surprisingly, 6 years later, during a routine examination, the attending physician identified an enlargement of the ureter and found a rather rare benign tumor formation there, it was a fibroepithelial polyp. He did not stop there, magnetic resonance imaging confirmed thickening of the ureteral wall, which astonished him even more, because this usually indicates the presence of urothelial cancer, but the patient had no obvious symptoms. To clarify the situation, the doctor decided to send the patient to the N. Lopatkin Scientific Research Institute of Urology and Interventional Radiology, as to the one of the leading institutions that provide organ-preserving treatment for cancer of the upper urinary tract.

-Fibroepithelial polyp is a rare benign tumor that affects the proximal part of the ureters in men and less often in women.

At first, we didn’t even believe what we saw,” says Dmitry Vladimirovich. “After additional research, we identified not only a polyp in the ureter, but also an isolated metastasis of pancreatic cancer. Recall that pancreatic cancer is one of the most aggressive tumors with an asymptomatic onset and a poor prognosis.

And it is extremely, extremely rare that it metastasizes to the ureter.

In our case, the fibroepithelial polyp was a “mask” for metastasis. it was visible in the lumen of the ureter, and metastatic tissue grew into it from the outside. The malignant tumor “hide” inside the benign one, forming a kind of “mushroom” with a visible benign “cap” and a malignant “leg”.

Scientists from the N. Lopatkin Scientific Research Institute of Urology and Interventional Radiology conducted an analysis of one of the largest databases on a global scale – PUBMED, which indexes all leading journals, including Russian ones, and it turned out that since 1908, only 8 such cases have been described worldwide!

Such a unique case in world practice did not seem to discourage the Institute’s staff, because such experience improves the provision of care to cancer patients.

An operation was performed during which the patient underwent resection of the ureter and bladder, the resection margin was controlled and the pelvic lymph nodes from the affected side were removed, and the physiological outflow of urine from the kidney was restored by replacing the ureter with the bladder wall. Experienced doctors managed to save the kidney and restore normal urination. The operation lasted an hour and a half and was successful! The patient was discharged after two weeks.

Doctors hope for a good prognosis that will prolong the life of the patient and maintain the quality of her life. She has already returned home and feels well.

“This is an invaluable experience for clinical practice,” summarizes Dr. Perepechin. — Such cases will accumulate. Not quickly, but they will, and each of them needs to be discussed on any available medical resource, in the professional community. This will help people who find themselves in an unclear situation to read about our experience and contact the center’s specialists at any time.

Press Service of National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation