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Case report

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A 41-year-old woman presented with right flank pain. Excretory urography showed moderate hydronephrosis; retrograde pyelography and CT detected narrowing of the proximal third of the right ureter, caused by a soft-tissue mass of the ureteric wall with a maximum diameter of 2.5 cm and ≈6 cm long (Fig. 1). No other abnormality was found; most notably, there was no adenopathy. Right ureteroscopy revealed partial obstruction encircled by bulging lesions with a slightly uneven surface but intact mucosa. A ureteroscopic biopsy was taken with 5 F cup forceps; the histological examination showed non-Hodgkin lymphoma of the diffuse large B-cell type (Fig. 2). A bone marrow specimen was normal, establishing stage 1E of the Ann Arbor classification. The entire soft-tissue mass surrounding the ureter, detected by CT, completely disappeared after four courses of systemic chemotherapy followed by radiotherapy. A subsequent ureteroscopy and biopsy yielded no positive findings.

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Figure 1. a, Retrograde pyelogram reveals the extent of the ureteric lesion (arrows). b, CT shows the ureteric soft-tissue mass without contiguous adenopathy.

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Figure 2. Histology shows submucosal infiltrating lymphoma cells, mainly large-cell type. Haematoxylin and eosin, reduced from ×100.

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Comment

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  2. Case report
  3. Comment
  4. References

Although detection of extranodal non-Hodgkin lymphoma has been improved with the use of CT, primary lymphoma involving the ureteric wall without contiguous lymphadenopathy is an unusual occurrence. Only four other such cases have been reported [1[2][3]–4]. Soft-tissue masses of the ureteric wall commonly represent primary neoplasms of the ureter or metastases to the ureter. In differentiating such lesions ureteroscopy provides more definitive findings than radiography. To our knowledge, this is the first case in which malignant lymphoma was diagnosed by ureteroscopic biopsy and the kidney was preserved successfully by chemotherapy combined with radiotherapy.

References

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  2. Case report
  3. Comment
  4. References