易被誤診為膀胱腫瘤的輸尿管腫瘤案例討埨
呂謹亨1, 林子平1,2,3, 鍾孝仁1,2,3, 林登龍1,2,3, 陳光國1,2,3
1臺北榮民總醫院 泌尿部
2國立陽明大學 醫學院 泌尿學科 3書田泌尿科學研究中心
Easily Overlooked Ureter Tumor – Two Cases of Movable Ureter Tumors Mistaken for Bladder Lesions in Initial Images
Chin-Heng Lu1, Tzu-Ping Lin1,2,3, Hsiao-Jen Chung1,2,3, Alex Tong-Long Lin1,2,3, Kuang-Kuo Chen1,2,3
1Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan
2Department of Urology, School of Medicine, and 3Shu-Tien Urological Science Research Center, National Yang-Ming University
Background: Primary ureteral neoplasms account for less than 1% of all genitourinary neoplasms in adults. Benign ureteral masses represent up to 20% of ureteral neoplasms and the mesodermal benign tumor such as Ureteral Fibroepithelial polyp (UFP) is more common. Herein, we report two cases of large benign ureteral tumor including UFP and inflammatory polyp. Both cases presented as a vegetative bladder mass which originated from the ureter and was excised ureteroscopically. Though there have been multiple reports of UFP, the features thattumor elongated into the bladder cavity which mimicked bladder mass and resected ureteroscopically was rare.
Case presentation:
Case 1: A 52-year-old female is a patient of sarcoidosis with enlarged lymph nodes at right para-trachea, pre-carina and right hilum in chest CT. Abdominal CT revealed the segmental edematous swelling of left lower third ureter till vesicoureteral junction (UVJ) as well as an intraluminal space occupying lesion. There was no associating symptoms and signs like fever, fatigue, pain or hematuria.
Case 2: A 66-year-old man has a history of right multicystic renal cell carcinoma, status post laparoscopic partial nephrectomy. Prostate sonogram at health exam showed polypoid lesion about 1 cm in diameter in the bladder. CT revealed filling defect at right middle to lower third ureter. No fever or severe hematuria was noted.
Both cases received operation and operation findings were similar. We could not find the tumor by cystoscope at first. The bladder mucosa was intact without papillary tumor but one of the ureter orifice (UO) was dilated. A polypoid neoplasm protruding from the ureteral orifice.
The vermiform shape neoplasm floated back and force with the peristalsis of the ureter. Then ureteroscopy was performed. The long stripe of ureteral tumor stemed from lower 1/3 ureter was noted. The tumor was resected from the stalk by holmium laser ablation and then DJ was inserted smoothly.
In case 1, a left 6.1 x 0.3 x 0.1 cm greyish white soft polypoid ureteritis was resected. In case 2, a 6 x 0.5 x 0.5 cm greyish white soft fibroepithelial polyp was resected. The pathology showed fibrovascular stroma with overlying benign urothelium in a fingerlike or polypoid configuration. Both of the patients experienced uneventful perioperative course.
Discussion:UFPs are hamartomas derived from ureteral mesenchyme, while most ureteral malignancies arise from transitional epithelium. There were only 2 cases of UFP from January 2005 to February 2016. UFPs are thought to be either congenital slow-growing lesions or lesions that develop as a result of chronic urothelial irritants, such as calculi or infections. UFPs rarely recur once they are treated. Other benign lesions of the ureter include endometriomas, fibromas, leiomyomas, neurofibromas, hemangiomas, and lymphangiomas. In these two cases, the ureter tumors might be neglected by routine sonographic checkup.
Conclusion: The elongated ureteral tumor may be neglected by sonography image survey. If sonography indicated the tumor was near UO or cystoscopy showed UO dilatation, URS laser ablation is effective in treating such lesion.