Diagnosis of Upper Urinary Tract Urothelial Cell Carcinoma by Urine Cytology in a Patient with Valvular Heart Disease: A Case Report

A 58-year-old male was admitted to the hospital with severe gross hematuria and many comorbidities such as rheumatic heart disease and severe mitral valve stenosis. Because of atrial fibrillation, the patient took anticoagulant drug for stroke prevention. The patient was requested to stop anticoagulant agents and received blood replacement therapy for blood loss after hospitalization. Ureterorenoscopy was unable to visualize or biopsy the mass due to a massive blood clot. Urine cytology of left and right ureter showed high-grade urothelial carcinoma (HGUC) and few suspicious cells, respectively. Computed tomography angiography (CTA) of the whole abdomen revealed blood clot in the upper pole calyx and renal pelvis of the left kidney as well as the urinary bladder, but no abnormal enhancing lesion. The patient underwent the standard treatment for upper tract urothelial carcinoma (UTUC) with laparoscopic radical nephroureterectomy (RNU) with bladder cuff excision because the consulted cardiologist suggested to start anticoagulant agents as soon as possible. Surgical pathology analysis revealed high-risk tumors with multiple low grade papillary urothelial carcinoma. The patient required long term follow-up. Here, the authors reported a case of UTUC with valvular heart disease, earlier diagnosed by using only positive urinary cytology, rather than by radiological examinations and/or related symptoms before definite treatment.

Keywords: Urine Cytology; Upper tract; Ureter; Ureteroscopy; Urothelial carcinoma; False positive; Nephroureterectomy