Primary ureteral lymphoma presenting as bilateral obstructive uropathy

Area of Science:

• Urology
• Oncology
• Pathology

Background:

• Primary ureteral lymphomas are exceptionally rare entities.
• Extranodal involvement of the ureter by lymphoma is uncommon, often presenting diagnostic challenges.

Observation:

• A 34-year-old male presented with asymptomatic bilateral ureteral obstruction and severe hydronephrosis.
• Initial investigations failed to identify the cause of the obstructive uropathy.
• Percutaneous nephroureteral stents were placed to manage the bilateral hydronephrosis.

Findings:

• Histopathological analysis of the excised ureter revealed a CD20+, CD5-, CD10- B-cell lymphoma with aggressive features.
• The diagnosis was extranodal B-cell lymphoma of the ureter.

Implications:

• This case underscores the importance of considering rare diagnoses like primary ureteral lymphoma in cases of unexplained obstructive uropathy.
• Successful management with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy demonstrates a viable treatment option.
• Early diagnosis and appropriate chemotherapy can lead to favorable outcomes in patients with primary ureteral lymphoma.