Oncology Case Reports - Occult transitional cell carcinoma and Lynch syndrome incidentally revealed after laparoscopic hysterectomy and cystoscopy during staging for endometrial cancer

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Highlights

► Lynch syndrome involves many rare cancers, such as urothelial carcinoma (ureter, kidney, renal pelvis).
► The case describes incidental urothelial carcinoma associated with Lynch syndrome.
► Clinical suspicion of rare cancers must be maintained in certain patients.

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Introduction

Cystoscopy can be performed during hysterectomy for many reasons, especially for suspicion of urologic injury (Ribeiro et al., 1999). Though it is debated whether routine cystoscopy should be performed at every hysterectomy, especially with regard to cost-effectiveness, routine cystoscopy is still commonly performed.

Although not cost-effective in the general population, another potential use of routine cystoscopy is to evaluate for non-iatrogenic ureteral abnormalities. Additionally, some surgeons at large academic institutions take advantage of universal or selective post-operative cystoscopy as an opportunity to teach trainees this important surgical skill. At the time of hysterectomy, most urologic findings (e.g. hematuria or lack of ureteral efflux) are due to bladder and/or ureteral injuries. Many of these findings are due to idiopathic and self-resolving causes (Wilson and Merkur, 2008). However, urologic findings in certain gynecologic oncology patients should raise concern about the possibility of synchronous malignancies. For instance, Lynch syndrome (hereditary non-polyposis colorectal cancer, HNPCC) is a rare but significant risk factor for ureteral transitional cell carcinoma (TCC). Whereas there have been reports of intraoperatively-found incidental lymphoepithelial ureteral carcinomas (Ma et al., 2008), a Pubmed search using the terms “transitional cell carcinoma” (or ureteral tumor), “incidental” and “hysterectomy” revealed no prior reports of incidentally-found ureteral TCCs associated with and leading to the diagnosis of Lynch syndrome........