ABSTRACT
Objective: To analyze the efficiency of ureteroscope and biopsy in the diagnosis of tumor grade, muscle-invasiveness and multifocality in suspected upper tract urinary carcinoma (UTUC) patients in order to find out whether it can be used in the risk stratification of UTUC patients.Methods: A retrospective study of 76 UTUC patients who underwent preoperative ureteroscope and/or biopsy and received radical nephroureterectomy in Peking University Third Hospital during January 2014 to December 2016 was undertaken.Results: In this study, 76 patients were included.There were 31 males (40.8%), and 45 females (59.2%).The median age was 64.5 years (31-88), and 51 patients had the symptom of hematuresis.The tumor was located in renal pelvis in 39 patients, and in ureter in 37 patients.Post-operative pathology confirmed that all the 76 patients included in this study suffered from UTUC, of whom 21 (21.6%) were of low-grade, 51 (67.1%) were of high-grade, 4 (5.3%) were undetermined, and 47 (61.9%) patients were muscle-invasive, and 27 (35.5%) were not, and 2 (2.6%) were undetermined.Among the 50 patients, in whom the grade of the tumor could be diagnosed by biopsy, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value for low-grade tumor was 88.2%, 69.7%, 76.0%, 60.0% and 92.0%, respectively.Among the 27 patients, in whom the muscle-invasiveness could be diagnosed by biopsy, 5 patients were diagnosed with muscle-invasiveness, all confirmed by pathology after surgery and 22 patients were diagnosed with none muscle-invasiveness, turned out to be 50% muscle-invasive and 50% none-muscle invasive after surgery.The accuracy was 59.3%.The accuracy of ureteroscopic biopsy to diagnosis multifocality was 61.0%.On univariate ana-lysis, biopsy grade was associated with postoperative pathology (P=0.001), while gender, age, side, body mass index (BMI), hematuresis, preoperative estimated glomerular filtration rate (eGFR), hydronephrosis, tumor size, location, multifocality and sessile were not associated with postoperative pathology grade.Biopsy grade (P=0.02), preoperative eGFR<90 mL/(min·1.73 m2)(P=0.025) and tumor located in pelvis (P=0.049) were associated with muscle invasiveness.Gender, age, side, BMI, hematuresis, hydronephrosis, tumor size, multifocality and sessile were not significantly associated with muscle invasiveness.Conclusion: Ureteroscope and biopsy can assist risk stratification in upper tract urothelial carcinoma patients.
ABSTRACT
Lymphangioma is a rare, benign mesenchymal neoplasm, which is characterized by nume-rous intercommunicating cystic spaces containing lymphatic fluid.It is considered a congenital disease resulting from the obstruction of regional lymph drainage during the developmental period.Lymphangioma frequently occurs in the cervical neck and axilla, also in the retroperitoneum, mediastinum, mesentery, omentum, colon, and pelvis, rarely in the perirenal space.These tumors usually present in childhood, but infrequently, these also present in adults.Patients often complain of hematuria, flank pain, or abdominal pain.Complications of lymphangioma have been reported to include infection, ruputure, or he-morrhage.There are three types of lymphangioma commonly identified: capillary, cavernous, and cystic.Cystic type is the one commonly found intra-abdominally or retroperitoneally, and may be uniloculated or multiloculated.All these perirenal tumors have a very low incidence, make it difficult to diagnose.Differential diagnosis must be performed with the primary renal lymphoma, urinoma, polycystic kidney, te-ratoma, both benign and malignant tumors, etc.Endoscopic ultrasound guided fine needle aspiration is recommended in some literatures, which may help make diagnosis and further guide subsequent therapeutic strategy.Regarding treatment, surgical excision can be performed via either laparotomy or laparoscopy.And injection of sclerosants into lympahgioma has been described in the literature in nonsurgical candidates.The optimal definitive treatment is total surgical excision.Despite being rare, the tumor has an excellent prognosis.Here, we report a case of a 48-year-old woman with a left renal mass found in an abdominal ultrasonography during a health checkup.In the case presented, abdominal ultrasonography and magnetic resonance urography (MRU) revealed an approximately 11.3 cm×10.6 cm×12.8 cm multilocular cystic mass in the left perirenal space.There was no history of bowel or bladder complaint, either previous illness episodes.Full blood count and kidney function tests were within normal limits.Laparoscopic surgical removal of the cyst was accomplished without incident.A benign cystic perirenal lymphangioma was diagnosed on histology and confirmed with immunohistochemical stains.One month after the surgery the ureteral stent was removed.The patient was free of disease after a 3-month follow-up pe-riod.We report the case and discuss the management of perirenal lymphangiomatosis with a literature review.