# Metastatic Adenocarcinoma of Intestinal Origin in Reconstructed Ureters

## TL;DR

A patient with a reconstructed ureter developed metastatic intestinal adenocarcinoma, highlighting risks of using bowel segments in urinary tract reconstruction.

## Contribution

This case report documents a rare instance of metastatic adenocarcinoma in a ureter reconstructed with small intestinal segments.

## Key findings

- A 49-year-old patient with Eagle-Barrett syndrome developed metastatic adenocarcinoma in a reconstructed ureter.
- Liver lesions were found to be poorly differentiated adenocarcinoma with small intestinal origin confirmed via immunohistochemistry.
- Treatment with chemotherapy, microwave ablation, and chemoradiation led to resolution of all lesions.

## Abstract

In patients with long ureteral defects, the use of bowel segments for reconstruction is an effective but suboptimal alternative because the bowel is not resistant to the potential carcinogenic effects of urine. Primary malignancies in reconstructed conduits have been scarcely described in the literature. This case report elaborates on a case of metastatic adenocarcinoma arising in ureters reconstructed using small intestinal segments. A 49-year-old with Eagle-Barrett syndrome presented with abdominal pain and was found to have irregular enhancement of the right ureteropelvic junction and small, non-specific liver lesions. Biopsy of the liver lesions showed poorly differentiated adenocarcinoma with immunohistochemistry staining consistent with small intestinal origin. The patient was treated as a tumor of GI origin with chemotherapy and subsequently underwent microwave ablation of his liver metastases. He also received concurrent chemoradiation for residual disease at the ureteral conduit. PET scan images done after completion of treatment showed resolution of all lesions. Further research into alternative structures that could be used to create conduits and screening methods for these patients is imperative to reduce the incidence of such malignancies.