Solitary psoas muscle metastasis from renal cell carcinoma

We report a case of a very unusual presentation of a colonic carcinoma. Seven years after ileal conduit urinary diversion, a 50-yearold patient was referred to us with the symptoms of extreme diarrhea combined with recurrent infections of the upper urinary tract. Because the patient had taken antibiotics for the recurrent infections for a rather long time, a colonoscopy was performed with the intention of ruling out a pseudomembranous colitis. The examination showed an exulcerating malignant tumour in the area of the caecum. During colonoscopy, a desufflation of air through the ileal conduit occurred as a sign of the presence of a fistula between caecum and ileal conduit. Besides a right haemicolectomy, a partial resection of the ileal conduit with new implantation of both ureters was performed. As far as we know, the diagnosis of a caecal carcinoma fistulating into an ileal conduit has not yet been described in literature in the context of the assessment of watery diarrhoea combined with recurrent pyelonephritis. Aside from adenocarcinoma of the colon, a primary neoplasia of the ileal conduit is a possible differential diagnosis. There are three case reports in literature on primary adenocarcinomas in an ileal conduit. This differential diagnosis is critical for the therapy to be performed, particulary in respect to the decision whether the ileal conduit has to be completely resected or whether a partial resection is sufficient. Provided that the vascular pedicle does not belong to the perfusion area of the ileocolic artery, the ileal conduit can remain after the resection of the tumour – infiltrated part when a primary colon carcinoma is present. Otherwise, a new ileal conduit is necessary because the ileocolic artery must be ligated radically, according to the surgical oncologic criteria. When dealing with patients with ileal conduit who have experienced pyelonephritis and/or persistent watery diarrhea, it is critical to consider possible less common causes, such as a fistula between the ileal conduit and the colon.