輸尿管泌尿上皮不良化生合併雙套輸尿管– 病例報告

徐則中、薛又仁、黃建榮、賴昱維、蕭毅君、李淑文、陳修聖、邱文祥

臺北市立聯合醫院仁愛院區  外科部 泌尿科

Ureteral urothelial dysplasia with duplication of the ureter – a case report

Tze-Jung Shiu, Thomas Y. Hsueh¹, Andy C. Huang, Yu-Wei Lai, Yi-Chun Hsiao, Shu-Wen Li, Shiou-Sheng Chen, Allen W. Chiu

Division of Urology, Department of Surgery, Taipei City Hospital renai Branch, Taipei, Taiwan

Introduction: The 2004 World Health Organization classification system for urothelial neoplasia identifies urothelial dysplasia (low-grade intraurothelial neoplasia) as a premalignant lesion of the urothelium. And ureteral urothelial dysplasia combined with ureteral duplication is quite rare, and few individual case has been reported on document. We present a case of 75-year-old woman with urothelial dysplasia and ureteral duplication diagnosed via ureteroscopic biopsy.

Case presentation:  A 75-year-old woman had underlying disease of hypertension. She had bloody urine for 3 months. Blood clot while urination was found since 2023/9/7 and lower abdominal dull pain was also noticed, so she visited Tri-Service General Hospital Songshan branch for help initially. Abdomen CT was arranged, which showed right duplicated ureter and hydronephroureter. Then she came to our urological department for second opinion afterwards.
     The patient denied general weakness, body weight loss, decreased appetite, nausea, vomiting and fever. Physical examination revealed mild lower abdominal tenderness without bilateral costovertebral angle knocking tenderness. K.U.B. X-ray presented no obvious stone, and urine analysis reported gross hematuria, proteinuria, and pyuria (WBC: 6-9/HPF). Lab data reported AKI (creatinine 1.6 mg/dL in 2023/09, compared with creatinine 0.8 in 2019). Diagnostic ureteroscope and ureteral biopsy if necessary was suggested. After well explanation and discussion, the patient agreed. As a result, right ureteroscope was performed on 9/21. Right torturous and incomplete duplication with bifid ureter at lower third and right hydronephrosis were seen, and ureteral tumor at right medial upper third ureter was also found. Tumor biopsy was done smoothly and 2 sets of urine cytology were obtained from the two different ureter system respectively. Then, the patient was discharged on 9/22.

      The 2 sets of urine cytology reported a few clusters of atypical cells with mild pleoeomorphism and hyperchromatism, in favor of reactive change. The pathological report disclosed urothelial dysplasia. On microscopic examination, the specimen showed tissue with moderate neutrophilic and lymphoplasmocytic infiltrating. Scattered dysplastic urothelial cells are noted in fibrinoid exudate. These cells are characterized by mild pleomorphism and high N/C ratio. And no subepithelial invasion is seen. Besides, the dysplastic cells are positive for CK and GATA-3; focally positive for CK20, P53 and Ki-67.

Discussion: 

The case amount of urothelial dysplasia with duplicated ureter is rare.