1台北醫學大學附設雙和醫院 泌尿科，2台北醫學大學 泌尿科
Mimicking Urothelial Carcinoma: Bilateral Peri-ureter Atypical Lymphoid Hyperplasia
Shao-Wei Dong1, Kai-Yi Tzou1,2
1Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
2Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
A 56-year-old man with underlying of type II diabetes, hypertension and coronary artery disease status post coronary artery bypass surgery presented with appetite loss since a year ago accompanied by mouth dryness, intermittent abdominal pain and weight loss of 6kg in one month. Besides, bilateral flank soreness and micturition pain also noted in recent month.
He visited our out-patient department and Computed Tomography(CT) showed bilateral renal pelvis tumor suspected urothelial carcinoma with obstructive uropathy and suspect multiple metastatic lymphadenopathy at retrocural, paraaortic and bilateral pelvic region.
We performed bilateral diagnostic ureteroscopy with biopsy. Intra-operation showed no intraluminal lesion and pathology only revealed chronic inflammation. Then we performed laparoscopy left peri-ureter tumor excision and pathology revealed atypical lymphoid hyperplasia with necrosis & aggregate macrophages. No malignancy is seen.
Atypical lymphoid hyperplasia is a descriptive term used when it is not possible for the pathologist to differentiate between the benign and the malignant nature of a given lymphoid infiltrate. Nevertheless, sometimes Atypical lymphoid hyperplasia are not necessarily premalignant and may very well represent a fully benign situation mimicking malignancy. When confronted with a challenging lymphoproliferative lesion, the pathologist should marshall all resources available to interpret it as precisely as possible and therefore place it into one of the two categories: unequivocally benign condition or malignant lymphomas.
In our patient, we discussed with pathologist and they favor it was fully benign tumor, only need to follow up. After the surgery, our patient’s condition was well and was kept follow up at our out-patient department.