生殖泌尿道侵犯之瀰漫性大型B細胞惡性淋巴癌罕見案例

江衍諭¹、吳俊賢^1、2、林嘉祥^1、2、吳振宇^1、2

¹義大醫療財團法人義大醫院 泌尿科；²義守大學 醫學系

A rare case of ureter invasion by Large B cell lymphoma

Yen-Yu Chiang ¹, Chun-Hsien Wu^1,2, Victor C. Lin^1,2, Richard Wu^1,2

Department of Urology¹, E-Da Hospital, Kaohsiung, Taiwan;

School of Medicine, College of Medicine², I-Shou University, Kaohsiung, Taiwan

Introduction:

Lymphoma can be classified into Hodgkins and Non-Hodgkins lymphoma (NHL). Most commonly diagnosed non-Hodgkin’s lymphoma (NHL) subtype is diffuse large B-cell lymphoma (DLBCL). Extranodal lymphoma account for 25–35% of all NHLs and may arise in almost any organ but genito-urinary involvement by non‐Hodgkin's lymphoma is very rare.

Case Description:

We present the case of a 59-year-old female who had a one-month history of right flank pain. She was initially diagnosed with tumor caused obstructive uropathy under Computed tomography (FigureA-B). The patient planned to received robotic-assisted right ureteroureterostomy and right oophorectomy, and large tumor with Fallopian tube, Right ureter, Colon and Pelvic wall involvement were found during operation. Final pathology showed Diffuse large B-cell lymphoma. Patient was under R-CHOP therapy at hematology department and pass away during 1^st cycle of chemotherapy due to tumor lysis syndrome.

Discussion:

For this patient, primary site of large B cell lymphoma was ovary with ureter encased by it. According to several literature reviewed the initial presentation of ovary and ureter DLBCL may by similar. Fatigue, flank pain, lower abdominal pain with no fever may cause differential diagnosis be a challenge task. Although primary ureter DLBCL was much seen in male patient, we should also keep the possible of ureter DLBCL in mind. Multi-department care and evaluation combine with varies of image survey could benefit such process and avoiding non-necessary operation.

Conclusion: