Chalasani Venu, Macek Petr, O'Neill Gordon F, Barret Wade
Divisions of Urology and Surgical Oncology, University of Western Ontario, London, Ontario, Canada.
Can J Urol. 2010 Feb;17(1):5031-4.
This article describes an unusual finding in a patient who presented with an adenocarcinoma of the prostate and right hydronephrosis. A 68-year-old male presented with right hydronephrosis and a PSA of 96. DRE was consistent with cT3 carcinoma. Cystoscopy showed an exophytic superficial transitional cell carcinoma (TCC) of the bladder and a transrectal biopsy of the prostate confirmed adenocarcinoma Gleason score 4+3. Staging investigations (CT pelvis and bone scan) were negative; androgen deprivation therapy was therefore initiated for the prostatic adenocarcinoma. Upper tract imaging showed multiple filling defects in the proximal ureter. Ureteroscopy showed a stricture at the level of the iliac vessels. With a working diagnosis of upper tract TCC, right open nephroureterectomy was performed. Final histology showed prostatic adenocarcinoma infiltrating the adventitia of the entire ureter up to the level of the renal pelvis. A rare cause of ureteric stricture, contiguous spread of prostatic adenocarcinoma, should be considered in the differential diagnosis of patients presenting with upper tract obstruction and a known history of prostatic adenocarcinoma. Androgen deprivation therapy for several months did not seem to cause resolution of the tumor in the periureteric, ureteric and perihilar tissues.
本文描述了一名患有前列腺腺癌并伴有右肾积水患者的罕见发现。一名68岁男性患者出现右肾积水，前列腺特异性抗原（PSA）为96。直肠指检（DRE）结果与cT3期癌相符。膀胱镜检查显示膀胱有外生性浅表移行细胞癌（TCC），经直肠前列腺活检确诊为 Gleason评分4+3的腺癌。分期检查（盆腔CT和骨扫描）结果为阴性；因此，开始对前列腺腺癌进行雄激素剥夺治疗。上尿路影像学检查显示近端输尿管有多个充盈缺损。输尿管镜检查显示髂血管水平处有狭窄。在初步诊断为上尿路TCC后，实施了右侧开放性肾输尿管切除术。最终组织学检查显示前列腺腺癌浸润整个输尿管直至肾盂水平的外膜。在对上尿路梗阻且有前列腺腺癌已知病史的患者进行鉴别诊断时，应考虑一种罕见的输尿管狭窄病因，即前列腺腺癌的连续性蔓延。几个月的雄激素剥夺治疗似乎并未使输尿管周围、输尿管和肾门周围组织中的肿瘤消退。
