RESUMO
BACKGROUND: Hutch diverticulum arises from the compromised muscular development at the ureteral orifice. It is a congenital disease and extremely rare in adult, only accounting for about 3% occurrence worldwide. It can be either symptomatic or asymptomatic, and relies on image tools for diagnosis and preoperative planning. Indications for surgery are dependent on the complications from the diverticulum. Metaplasia is about 10% among those with hutch diverticulum, and it still has chances turning into malignancy, especially urothelial cell carcinoma. CASE SUMMARY: A 27-year-old man was presented with frequently recurrent urinary tract infection for one year, and had suffered from intermittent right flank pain for 3 mo. No past medical histories were recorded before. No obvious abnormalities on laboratory data and urine examination were found. Under ultrasound, right hydronephrosis was seen and an anatomical abnormality was observed on intravenous pyelography. Further computed tomography urogram showed one diverticulum seated at superolateral side of right ureteral orifice. Cystoscopy was done and biopsy results showed focal metaplasia. After discussing with him, robotic-assisted diverticulectomy with reconstruction was performed. Right hydronephrosis was greatly improved after surgery. He has completed his 1.5-year follow-ups, and no malignancies were seen from urine cytology and image of intravenous pyelography. CONCLUSION: Robotic-assisted diverticulectomy and reconstruction to hutch diverticulum is a safe and efficient operation, providing several advantages over open and laparoscopic ones.
RESUMO
BACKGROUND: Urinary tract lymphoepithelioma-like carcinoma is rarely seen. Although it is termed after lymphoepithelioma at the nasopharynx, it behaves more like high grade urothelial carcinoma by immunohistochemical features. Most published literatures focused on its rarity but few discussed results of long-term follow-ups. As no available guidelines are applicable, we postulated that principles should be similar to that of urothelial carcinoma at urinary tract. As of now, this work features the longest follow-up of this cancer at the upper urinary tract. CASE SUMMARY: A 63-year-old female had a chief complaint of intermittent left flank pain for 2 mo, along with accompanying symptoms including vomiting and body weight loss, about 7 kg over 2 mo. Laboratory data showed normocytic anemia, mildly poor renal function, and hyperparathyroidism. Urine analysis showed mild hematuria. Computed tomography showed a 4.2-cm-width irregular mass over left renal pelvic and enlarged lymph node at the left renal hilum. Whole-body bone scan was negative of active bone lesions. Biopsy from ureteroscopy showed urothelial carcinoma. Specimen from laparoscopic nephroureterectomy with bladder cuff resection showed lymphoepithelioma-like carcinoma with muscular invasion (pT3). She took adjuvant chemotherapies of 2 cycles and full courses of radiation therapy. No recurrence was observed with designed investigative programs. CONCLUSION: Locally advanced urinary tract lymphoepithelioma-like carcinoma could benefit from nephroureterectomy and bladder cuff excision in terms of recurrence-free survival.
