title: Contralateral ureteral metastasis 4 years after radical nephrectomy.
abstract: BACKGROUND
  Metastasis of renal cell carcinoma to the contralateral ureter is extremely rare. To date, only 50 cases of metastatic RCC to the ureter have been reported, among whom 6 cases occur at the contralateral site. We herein report a rare case of metastatic RCC in the contralateral ureter 4 years after radical nephrectomy.
  
  
  METHODS
  A 74-year-old man presented with gross, painless hematuria for one month. Computed tomography scan confirmed that a 1.5 cm × 0.5 cm tumor occurred in the contralateral distal ureter. A 3.5 cm segment of ureter was resected and a uretero-vesical anastomosis with psoas hitch was accomplished.
  
  
  CONCLUSIONS
  The reappearance of hematuria after radical nephrectomy is the most common manifestation of the metastasis to the bladder or ureter. The mechanism of metastasis is not clear. In pathology, vimentin and cytokeratins might help to differentiate between metastatic clear cell renal cell carcinoma and clear cell transitional cell carcinoma.
  
  
  CONCLUSIONS
  Metastasis of renal cell carcinoma to the contralateral ureter is rare. Early recognition is extremely important in protecting the remaining renal function and prolonging life-expectancy for post-nephrectomy patients. Complete metastectomy suitable anastomosis have been shown to improve survival.
authors.affiliation: Department of Urology, Huadong Hospital, Fudan University, 221 West Yan'an Road, Shanghai 200040, PR China.
authors.forename: Hao-Jie
authors.initials: HJ
authors.lastname: Zhang
authors.forename: Lu
authors.initials: L
authors.lastname: Sheng
authors.forename: Zhen-Wang
authors.initials: ZW
authors.lastname: Zhang
authors.forename: Zhong-Quan
authors.initials: ZQ
authors.lastname: Sun
authors.forename: Wei-Qing
authors.initials: WQ
authors.lastname: Qian
authors.forename: Jian-da
authors.initials: JD
authors.lastname: Song