ABSTRACTS OF THE 21st ANNUAL MEETING OF THE ITALIAN ...

Abstracts of the 21st Annual Meeting of the Italian Society of Uro-Oncology (SIUrO), 22-24 June, 2011, Naples, Italy
Unità Operativa Complessa di Urologia Ospedale Cardarelli,
Napoli, Italy
Background: Ureteral metastasis is rare, arising usually from
melanoma, breast cancer and colon cancer (1-4). Only a few
cases are described secondary to carcinoma of the prostate (5).
Case Report: An 80-year-old man, who had a diagnosis of
adenocarcinoma of the prostate (cT2N0M0) two years before
and undergoing treatment with a luteinizing hormone-releasing
hormone analog, was admitted to hospital because of gross
hematuria and right renal pain. His PSA value was 5.5 ng/ml.
Abdominal ultrasound showed right hydronephrosis, while a
computerized tomography scan showed a stone in the lumbar
ureter, with only partial obstruction and a stricture about 1-cm
long in the ureter below the stone, with no lymphadenopathy.
The patient’s bone scan was normal. We treated the patient
with ureteropyeloscopy and a biopsy was performed of the
ureteral stenosis, where an irregular and elevated mass was
present. The histological examination revealed clear-cell
adenocarcinoma stained positively for PSA. Discussion: The
case presented had no direct extension of the tumor to the
bladder and ureterovesical junction. A metastatic involvement
of the ureter with no direct extension of prostatic carcinoma
is rare and was probably caused by lymphatic invasion. In the
case presented, ureteral metastasis was the only recurrence of
the disease.
1 Ferrozzi F, Campani R and Garlaschi G: La tomografia
computerizzata nello studio delle metastasi: aspetti e sedi
unusuali. Radiol Med 94: 233-246, 1997.
2 Canossi B, Renzi E and Santini D: Metastasi ureterale da
carcinoma mammario lobulare. Radiol Med 90: 158-160,
1995.
3 Stenner J, Arista-Nasr J, Lenero-Llaca E et al: Adenocarcinoma
of the ampulla of Vater and head of pancreas
metastatic to ureter: report of 2 cases. J Urol 156: 1765-1766,
1996.
4 Straub B, Muller M, Schrader M et al: Recurrent intraluminal
ureteral metastasis of a testicular seminoma. J Urol 164: 443-
444, 2000.
5 Jung YJ, Kim HK and Roh YT: Long-standing ureteral
metastasis secondary to adenocarcinoma of the prostate after
bilateral orchiectomy. J Urol 164: 1298-1299, 2000.
107
PSEUDOLYMPHOMA OF THE KIDNEY
ASSOCIATED WITH HIGH-GRADE
BLADDER UROTHELIAL CARCINOMA
Maria Raffaella Ambrosio 1 , Bruno Jim Rocca 1 ,
Monica Onorati 1 , Cristiana Bellan 1 , Gabriele Barbanti 2 ,
Maria Teresa Del Vecchio 1 and Sergio Tripodi 3
1Dipartimento di Patologia Umana e Oncologia, Sezione di
Anatomia Patologica, Università degli Studi di Siena, Siena,
Italy;
2U.O. Urologia and 3U.O. Anatomia Patologica, AOUS,
Siena, Italy
Background: Pseudolymphoma is an inflammatory response
that results in a lymphomatous-appearing but benign
accumulation of lymphoid cells or histiocytes. It may exhibit
histological and, sometimes, clinical features suggestive of
malignant lymphoma. Unlike lymphomas, pseudolymphomas
usually undergo spontaneous remission. Causes for
pseudolymphoma include idiopathy, drugs, contact allergens,
photosensitivity, insect bites, scabies and infections. Cases of
pseudolymphoma have been reported for the stomach, lung,
skin, orbit, salivary gland, tongue, tonsils, larynx and
intestines. Immunohistochemical and molecular pathological
investigations for B-and T-cell clonality are conventionally
used to differentiate between lymphomas and their mimics (1).
However, interpretation of clonality studies also poses some
difficulties. Clonal B- or T-cell populations have been
encountered, in fact, in clearly benign conditions and cannot
be considered to be synonymous with malignancy. Here, we
report a case of pseudolymphoma of the kidney, associated
with a high-grade bladder urothelial carcinoma. To the best of
our knowledge, this is the second reported case of
pseudolymphoma of the kidney (2) and the first case of such
an association. Patient and Methods: A 70-year-old man
presented at our hospital for the onset of hematuria, back pain
and malaise. Personal and family history, physical
examination, laboratory data and urinalysis were
unremarkable. Ultrasonography revealed a hypoechoic mass
in the left kidney associated with an ulcerative lesion of the
bladder. Post-contrast computed tomography showed an area
of low density in the left kidney. The clinical and radiological
diagnosis was bladder and renal cell carcinoma. Accordingly,
left radical nephrectomy, ureterectomy, cystectomy,
prostatectomy and retroperitoneal lymph node dissection were
performed. Results: Grossly, the kidney was a firm-to-hard,
whitish mass (5-cm in maximum diameter) occupying the
renal sinus, the pelvis and the proximal ureter. In the bladder,
an ulcerate, firm, grayish lesion of the right wall was observed,
infiltrating the bladder wall and the perivesical fat. On
microscopy, the kidney lesion consisted of a proliferation of
small-to-medium size lymphocytes, mostly CD20 + , sometimes
arranged in follicular structures with germinal centers
associated with plasma cells. Mitotic figures, pleomorphism
and nuclear atypia were absent. The bladder lesion was a highgrade
flat urothelial carcinoma infiltrating the perivesical fat
tissue. An acinar adenocarcinoma with Gleason score 6 was
also present in the prostate. GeneScan analyses of multiplex
polymerase chain reaction (PCR)-based evaluation of clonal
IgH rearrangements showed oligopolyclonal IgH
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