Ennaciri Soufiane, Omana Jean Paul
Service d'Urologie, Centre Hospitalier Universitaire Hassan II, Fès, Maroc.
Pan Afr Med J. 2018 Nov 22;31:201. doi: 10.11604/pamj.2018.31.201.16181. eCollection 2018.
The association between tumor of the urinary tract and hydronephrosis caused by a syndrome of the pyelo-ureteral junction is rare. Indeed, tumors of the upper urinary tract and hydronephrosis have generally a cause-effect relationship. This last is due, more often, to an obstruction caused by a tumor of the ureter or of the pyelo-ureteral junction. We report the case of a 66-year old patient with a history of smoking and right pyelonephritis, presenting with right lumbar pain intermittently evolving over several months without haematuria. Ultrasound showed a dilation of the pyelocaliceal cavities with major reduction of the corticomedullary index of the right kidney. Uroscan was in favor of cystic dysplasia of the right kidney as well as of right hydronephrosis associated with syndrome of pyelo-ureteral junction with budding intrarenal images leading to the suspicion of pyelic tumor. The assessment was completed by urinary cytology which was positive. Right laparoscopic nephroureterectomy was performed and pathologic examination confirmed the diagnosis of urothelial carcinoma of the upper urinary tract.
肾盂输尿管连接部综合征所致的尿路肿瘤与肾积水之间的关联较为罕见。实际上，上尿路肿瘤与肾积水通常存在因果关系。后者更多是由输尿管或肾盂输尿管连接部肿瘤引起的梗阻所致。我们报告一例66岁患者，有吸烟史及右肾盂肾炎病史，间歇性出现右腰痛数月，无血尿。超声显示肾盂肾盏腔扩张，右肾皮质髓质指数大幅降低。尿路造影支持右肾囊性发育异常以及与肾盂输尿管连接部综合征相关的右肾积水，肾内有芽状影像，导致怀疑肾盂肿瘤。通过尿细胞学检查完成评估，结果呈阳性。实施了右侧腹腔镜肾输尿管切除术，病理检查确诊为上尿路尿路上皮癌。
