Case Report: Fatal convergence of two confirmed and one radiologically suspected synchronous urological malignancies in a young patient: ultra-late clear cell renal cell carcinoma recurrence, contralateral renal tumor, and metastatic prostate cancer

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Introduction: The simultaneous presentation of multiple primary urological malignancies in a single patient is exceedingly rare and poses significant diagnostic and therapeutic challenges. We report the case of a 48-year-old man presenting two histologically confirmed synchronous urological malignancies and one radiologically suspected contralateral renal mass. Case presentation: The patient had undergone right radical nephrectomy for pT1 ISUP grade 2 ccRCC fourteen years prior. Surveillance imaging revealed a recurrence at the right nephrectomy bed (12 cm) and an incidentally discovered left renal mass (4 cm). CT imaging additionally identified extensive abdominal dissemination of indeterminate origin. Histological confirmation was obtained for the right renal recurrence by CT-guided biopsy and for the prostate cancer by systematic biopsy; the contralateral left renal mass fulfilled imaging criteria for ccRCC but could not be biopsied prior to the patient's death, representing a diagnostic limitation acknowledged throughout this report. Biochemical workup simultaneously revealed a markedly elevated PSA of 50 ng/ml. Prostate biopsy confirmed Gleason 9 (5 + 4) adenocarcinoma with bone scintigraphy demonstrating four skeletal metastatic foci. The patient died at home one month after diagnosis, before initiation of treatment. Conclusion: This case illustrates the exceptional convergence of three synchronous urological conditions-two histologically confirmed and one radiologically suspected-with a fatal outcome, highlighting the importance of extended post-nephrectomy surveillance, integrated PSA monitoring in ccRCC survivors, and early germline evaluation in young patients with multiple urological primaries. synchronous multiple primary malignancies, ultra-late renal cell carcinoma recurrence, metastatic prostate cancer, post-nephrectomy surveillance, hereditary cancer predisposition.

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