Ureteral metastasis as the first manifestation of asymptomatic gastric cancer

Ureteral metastasis from gastric cancer is rare. It is usually diagnosed in the setting of an advanced gastric cancer or on postmortem examination. Isolated ureteral metastasis without involvement of other sites is extremely rare. We describe a 67-year-old man with gastric cancer and right ureteral metastasis. The patient was from Ardabil Province, a high incidence area for gastric cancer in Iran. He presented with right flank pain which was found to be due to ureteral obstruction. Surgical relief of the obstruction was sought and the surgical biopsy specimens showed metastatic undifferentiated carcinoma in the ureteral wall. A search for the primary lesion revealed gastric cancer. He denied any symptoms referable to his upper GI tract. The patient is doing well on chemotherapy 6 months after the initial diagnosis.