Primary Papillary Mucinous Adenocarcinoma of the Ureter Mimicking Genitourinary Tuberculosis

Primary adenocarcinomas of the renal pelvis and ureter are rare and account for less than 1% of all malignancies at this site. We report a case of primary papillary mucinous adenocarcinoma of the ureter that clinically mimicked genitourinary tuberculosis. Early diagnosis is important for the better outcome. 1. Introduction Primary adenocarcinomas of the renal pelvis and ureter are rare and have been reported mainly in the form of single cases or small series. Most of these arise as a result of glandular metaplasia. The predisposing factors include nephrolithiasis and repeated infections. Associated malignancies are high grade and widely invasive at presentation [1]. We hereby present an unusual case report of primary papillary mucinous adenocarcinoma of the ureter that clinically mimicked genitourinary tuberculosis. 2. Case Report A 54-year-old male patient presented to the Urology Department of Bhopal Memorial Hospital and Research Centre with right flank pain for last two weeks. There were no complaints of hematuria and pyuria. 3. Radiological Investigations Ultrasound examination revealed moderately hydronephrotic right kidney with dilated right ureter. The dilatation involved lower rd of the ureter suggesting stricture. No calculus or mass was seen in the right kidney. Bulb ureterogram revealed complete ureteric block. Renal function tests were deranged. On LUT endoscopy, the right ureteric orifice, urethra, bladder neck, and bladder were within normal limits. The left kidney and ureter were also unremarkable. A clinical diagnosis of genitourinary tuberculosis associated with right-sided hydronephrosis and hydroureter was made. Perioperatively, right ureteric lumen was narrowed and occluded in its lower one third. The wall was mildly edematous. Patient refused to undergo nephrectomy; therefore, the stricture was relieved and ureteric reimplantation was achieved using Boari flap with psoas hitch. Biopsy was taken from right ureteral stricture and sent for histopathological examination. 4. Pathology Findings Routinely stained sections from the ureteric biopsy revealed a papillary adenocarcinoma filling the lumen. The tumor was occupying nearly two thirds of the ureteric mucosa and rest one third of the ureteric mucosa was lined by attenuated transitional epithelium with focal ulceration (Figure 1(a)). The tumor had papillary projections with a central fibrovascular core. The papillae were lined by tall columnar stratified epithelium and several of the epithelial cells contained mucin. In other areas tumor had glandular pattern and the glands were