A silver lining … in the ureter: Keratinizing squamous metaplasia with a metallic twist.

Silver or metallic-appearing urinary tract mucosa is exceedingly rare and typically attributed to exogenous metal exposure. We report a case of a diffusely silver-appearing ureter in a 65-year-old man with a history of squamous cell carcinoma of the bladder and chronic intermittent self-catheterization. Imaging revealed no metallic or calcified material, and histopathology demonstrated extensive squamous metaplasia with marked hyperkeratosis. We hypothesize that dense keratin accumulation produced a pseudo-metallic appearance without true metal deposition. This case highlights a novel gross ureteral appearance likely related to chronic inflammation-induced keratinizing changes, expanding the differential for "silver" urothelial mucosa.