摘要
目的 总结继发性输尿管霍奇金淋巴瘤的临床病理特点、诊断、鉴别诊断、治疗方法及预后. 方法 回顾性分析1例腹膜后霍奇金淋巴瘤侵及右输尿管患者的资料,男,63岁.因便秘、排便困难行腹部彩色多普勒超声检查发现右肾积水15 d于2013年1月22日入院.患者无泌尿系统症状主诉.泌尿系CT检查：右侧肾盂及输尿管中上段积水扩张,右侧输尿管下段管壁增厚、管腔狭窄,腹主动脉周围多发肿大淋巴结,考虑为输尿管癌并淋巴结转移可能.临床诊断：右侧输尿管肿瘤并淋巴结转移,右肾积水.全麻下行右侧输尿管镜检查,输尿管镜进入15 cm后见管腔明显狭窄,进入困难,改为开放右侧输尿管探查术.术中见下段输尿管周围结节状增生,管壁增厚,横断切除输尿管狭窄段约1 cm,送快速冷冻病理检查,结果回报为黏膜慢性炎症.输尿管内留置6F双J管,3-0可吸收线缝合输尿管,结束手术. 结果 术后病理诊断为腹膜后霍奇金淋巴瘤侵及右输尿管.术后40d患者出现发热、盗汗、全身多发淋巴结肿大,临床分期为ⅡEB期（预后不良组）,行吡柔比星20 mg/m2＋博来霉素10 mg/m2＋长春新碱1.4 mg/m2＋达卡巴嗪375 mg/m2方案化疗8个周期.化疗结束后随访3个月,患者一般状况良好,血生化检查均正常,复查PET/CT未见明显浓聚灶,病情达到临床完全缓解. 结论 继发性输尿管霍奇金淋巴瘤发病隐匿,临床表现无特异性,诊断和鉴别诊断困难,确诊主要依靠病理学检查,以化疗为主的联合治疗可以显著提高治愈率.如果临床上出现不明原因的肾积水和输尿管管壁增厚、管腔狭窄,应想到本病的可能.
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 exami
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2014年第5期333-336,共4页
Chinese Journal of Urology
关键词
输尿管肿瘤
恶性淋巴瘤
霍奇金淋巴瘤
诊断
治疗
Ureteral cancer
Malignant lymphoma
Hodgkin＇s lymphoma
Diagnosis
Therapy
