Retroperitoneal Hodgkin's lymphoma involving right ureter misdiagnosed as right ureteral carcinoma with lymphadenopathy: a case report and review of literature / 中华泌尿外科杂志

ABSTRACT

Objective To investigate the clinical and pathological features,diagnosis,differential diagnosis,treatment and prognosis of secondary Hodgkin's lymphoma of ureter.Methods We retrospectively analyzed one case with retroperitoneal Hodgkin's lymphoma involving right ureter.A 63-year-old male patient was referred to our hospital on January 22th,2013 with right hydronephrosis for 15 days,detected by abdominal color Doppler ultrasound due to constipation and difficult defecation without any urinary symptoms.Urinary CT scan revealed that there were dilation and hydrops of right pelvic and ureter in the middle and upper segment.The distal portion of ureteral wall was thick with a stenosis lumen.There was multiple larged lymph nodes surrounding the abdominal aorta.So,it was clinically diagnosed as right ureteral carcinoma with lymphadenopathy and right hydronephrosis.The patient was then performed ureteroscopic inspection under general anesthesia.There was too narrow to go through smoothly the proximal ureter when the ureteroscope ascended 15 cm.Then,the exploratory surgery of right ureter was subsequently undergone.During operation,periureteral nodular mass and thickened wall were seen in the distal segment of ureter.Then the ureter lesion was partially excised with 1 cm and fast frozen pathology was undergone during operation.The result suggested chronic inflammation of ureteral.A 6Fr double J stent was left in the ureter.Then,the ureter was closed by 3-0 monocryl suture.Results The final pathological diagnosis was retroperitoneal Hodgkin's lymphoma with the lymph node involving the right ureter.After 40 days,the patient manifested high fever,night sweat,general lymphoadenomegalies.So,the clinical stage was classified as stage Ⅱ EB and poor prognosis group.Then,the patient received regular chemotherapy according to the ABVD (pirarubicin 20 mg/m2,bleomycin 10 mg/m2,vinblastine 1.4 mg/m2,dacarbazine 375 mg/m2) regimen over 8 cycles.Finally the symptomatology and diagnostic reassessment (hemato-chemical examinations and PET/CT) showed a clinical complete recovery after the follow-up period of 3 months.The follow-up plan is ongoing.Conclusions Because secondary Hodgkin's lymphoma of ureter is rare with concealed onset feature,lacking of characteristic clinical manifestations,it is relatively difficult to achieve the diagnosis and differential diagnosis.Therefore,pathology and immunohistochemistry should be assigned to confirm the diagnosis.It is stressed that physicians should be aware of the possibility of malignant lymphoma when unexplained hydronephrosis and thickness of the ureteral wall are found clinically.Generally it has a good prognosis and combination therapy for the treatment is given priority to with chemotherapy.