A case of bladder cancer with bilateral ureteral carcinoma in situ

A case of bladder cancer with bilateral ureteral carcinoma in situ (CIS) is presented. A 55-year-old male had gross hematuria and urinary retention. Cystoscopy revealed diffuse broad-based papillary tumors, which proved to be transitional cell carcinoma (G2) with CIS and submucosal invasion microscopically. Excretory urography showed normal upper urinary tracts except stasis of bilateral lower ureters. Neither lymph node swelling nor distant metastasis was found by computed tomography. Therefore the patient underwent total cystourethrectomy, pelvic lymph-adenectomy, and construction of an ileal conduit. Histological examination of the specimens demonstrated CIS on bilateral ureteral stumps on the renal side, which, however, was not continuous to that of the bladder. Much attention should be paid to upper urinary tracts for ureteral lesions before cystectomy in such bladder tumors and the proximal stump of the ureter should be examined using frozen section at the operation, but these were not sufficient in the present case in which skip lesions of the ureters were seen apart from the bladder.