CARCINOMA UROTELIAL DE URETER DISTAL SIMULANDO LITÍASE URETERAL: RELATO DE CASO

Abstract

Upper tract urothelial carcinoma is a rare neoplasm compared with bladder tumors, representing a small proportion of urothelial carcinomas. When located in the distal ureter, it may present with non-specific clinical manifestations, such as hematuria, flank pain, renal colic, and hydronephrosis, mimicking ureteral lithiasis and delaying diagnostic suspicion . This study aims to report the case of a 68-year-old male patient, a former smoker, who presented with right renal colic and hematuria. Initial ultrasonography suggested a 12.8 mm calculus, but persistent symptoms led to the identification of ureteral thickening at the ureterovesical junction . Urinary cytology was negative, but urethrocystoscopy revealed a vegetative lesion at the right ureteral orifice, confirmed by biopsy. Computed tomography showed a 2.8 × 2.0 cm parietal thickening without signs of dissemination. The patient underwent distal ureterectomy with Boari flap reconstruction. Histopathology revealed high-grade papillary urothelial carcinoma (pT1 pN0), with a focal 0.8 mm margin involvement. After three years of rigorous follow-up, the patient remains recurrence-free. This case highlights that clinical suspicion should prevail over isolated tests and that the Boari technique is an effective kidney-sparing alternative for distal lesions, provided that strict oncological surveillance is maintained.