Hydronephrosis associated with ureteral wall thickness: Answer

Abstract

Ureteroscopy with bilateral ureteral wall biopsy was performed. Pathologic examination of ureteral tissue samples showed infiltration of atypical giant lymphoid cells with irregular nuclear contours (Fig. 1). Immunohistochemistry demonstrated that these cells were CD20-positive and their Ki67 indices were higher than 80 %. A diagnosis of diffuse giant B-cell lymphoma was confirmed in the light of all these findings. No atypical cells were found in bone marrow aspiration performed to differentiate primary ureteral lymphoma from secondary involvement. Abdominal computed tomography (CT) imaging performed to find associated lymphadenopathies showed no lymph node involvement, but disclosed left ureteral wall thickening in addition to right ureteral wall thickening (Fig. 2). No extra-ureteral involvement was demonstrated in positron emission tomography (PET) leading to the diagnosis of primary grade 3, non-Hodgkin lymphoma of the ureters. The patient has been given the initial course of systemic chemotherapy.