Jibril Alexis, Stevens Andrew C
School of Medicine, St. Matthew's University, Grand Cayman, Cayman Islands.
Department of Internal Medicine, Florida Hospital Orlando, Orlando, FL, USA.
Am J Case Rep. 2018 Feb 13;19:158-162. doi: 10.12659/ajcr.906679.
BACKGROUND Plasmacytoid is a rare histological variant of urothelial carcinoma (UC). Since the first reported case of plasmacytoid urothelial carcinoma (PUC), in 1991, only about 100 cases have since been reported, with most cases involving the bladder. Urothelial carcinomas of the upper urinary tract represent only 5% of urothelial cancers. To the best of our knowledge, there has only been 1 reported case of PUC of the ureter. PUC is a highly aggressive disease, with a poor prognosis. We present a rare biopsy-proven case of PUC of the ureter with retroperitoneal metastasis. CASE REPORT A 60-year-old man came into the hospital with complaints of a 5-day history of generalized abdominal pain, nausea, and vomiting, with no associated urinary symptoms prior to admission. CT demonstrated small bowel obstruction (SBO) and obstructive uropathy due to a right ureteric mass. Exploratory laparotomy, small bowel resection, gastrostomy tube placement, and umbilical hernia repair were all done. Histology and immunohistochemistry were compatible with plasmacytoid variant of urothelial cancer. He underwent a cystouretoscopy and a right ureteral stent placement with a right ureteroscopy. Final CT abdomen/pelvis revealed recurrent SBO before the ileocecal valve, possibly due to carcinomatosis. Ileocecal resection with end ileostomy placement was done. Systemic treatment will begin as an outpatient. CONCLUSIONS PUC arising from the ureter is rare, and retroperitoneal metastatic disease has not been reported previously. Here, we compare the clinical manifestations of the more common PUC of the bladder with our case. From this we are able to learn more about the disease and its presentation.
背景 浆细胞样是尿路上皮癌（UC）一种罕见的组织学变体。自1991年首例浆细胞样尿路上皮癌（PUC）病例报告以来，此后仅报告了约100例病例，大多数病例累及膀胱。上尿路尿路上皮癌仅占尿路上皮癌的5%。据我们所知，仅报告过1例输尿管PUC病例。PUC是一种侵袭性很强的疾病，预后较差。我们报告1例罕见的经活检证实的输尿管PUC伴腹膜后转移病例。病例报告 一名60岁男性因主诉有5天的全腹痛、恶心和呕吐病史入院，入院前无相关泌尿系统症状。CT显示因右侧输尿管肿块导致小肠梗阻（SBO）和梗阻性尿路病。进行了剖腹探查、小肠切除、胃造瘘管置入和脐疝修补术。组织学和免疫组化结果与尿路上皮癌的浆细胞样变体相符。他接受了膀胱尿道镜检查、右侧输尿管支架置入术和右侧输尿管镜检查。最终的腹部/盆腔CT显示回盲瓣之前复发性SBO，可能是由于癌转移。进行了回盲部切除和末端回肠造口术。全身治疗将作为门诊治疗开始。结论 输尿管来源的PUC罕见，此前尚未报道过腹膜后转移疾病。在此，我们将膀胱更常见的PUC的临床表现与我们的病例进行比较。由此我们能够更多地了解该疾病及其表现。
