# Multiple synchronous primary malignant neoplasms of renal, ureter and urinary bladder: a case report

## TL;DR

A 57-year-old man was diagnosed with three rare, simultaneous kidney and urinary tract cancers, offering new insights into complex cancer cases.

## Contribution

The case presents a rare combination of three distinct histopathological malignancies in the upper urinary tract.

## Key findings

- A patient had three concurrent malignancies: papillary renal cell carcinoma, verrucous carcinoma of the renal pelvis, and low-grade invasive urothelial carcinoma.
- Post-surgery metastasis occurred rapidly to adrenal, retroperitoneal, and peritoneal regions within four months.
- The case highlights the clinical and biological complexity of synchronous multiple primary malignant neoplasms.

## Abstract

Synchronous multiple primary malignant neoplasms (MPMNs) involving distinct histopathological entities within the upper urinary tract represent a rare clinical phenomenon. We present a novel case of a 57-year-old male presenting with asymptomatic gross hematuria, subsequently diagnosed with three concurrent malignancies: papillary renal cell carcinoma(T1bN0M0), verrucous carcinoma of the renal pelvis (T1N0M0), and low-grade invasive urothelial carcinoma of the ureter (T2N0M0). Comprehensive imaging evaluation revealed a 5.7*5.2cm renal mass and 12cm ureteral tumor extending into the bladder. Following radical nephroureterectomy, histopathological confirmation of three distinct primary malignancies was achieved. Postoperative surveillance identified metastatic progression to adrenal, retroperitoneal, and peritoneal regions within four months, with subsequent development of bladder urothelial carcinoma. The unusual coexistence of three histologically distinct upper urinary tract malignancies, particularly the rare verrucous carcinoma variant, provides novel insights into tumor biology and clinical management paradigms for genitourinary MPMNs.