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Ureteral Marginal Zone Lymphoma of Mucosa-Associated Lymphoid Tissue, Chronic Inflammation, and Renal Artery Atherosclerosis.

Lee H, Joo JE, Hong YO, Lee WM, Kim EK, Woo JJ, Gong SJ, Huh J - J Pathol Transl Med (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea.

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Malignant lymphoma of the upper urinary tract including the renal pelvis and ureter is extremely rare... MALT lymphoma arising in the stomach, skin, thyroid, and salivary gland is associated with chronic inflammation caused by pathogenic microorganisms or autoimmune disorder ; however, the pathogenesis of MALT lymphoma in the upper urinary tract is unknown... Infiltrating lymphocytes were mainly CD4+ T cells, and CD20+ B cells were rare... Neither IgG4-positive plasma cells nor anaplastic lymphoma kinase–stained cells were noted, excluding the possibility of IgG4-associated disease or an inflammatory myofibroblastic tumor... In contrast, lymphoma of the upper urinary tract is extremely rare... While MALT lymphoma of the urinary bladder is frequently associated with chronic cystitis and female predominance, MALT lymphoma of the upper urinary tract typically affects middle-aged or elderly males with unknown preceding conditions... Despite its widespread extent, the primary origin in the urinary system of this case was supported by the growth pattern within the renal pelvis and ureter walls... Thus, the chronic inflammatory infiltrates seen in the peripelvic area in the present case may have provided the appropriate conditions for growth of a malignant clone... On the other hand, atherosclerosis is defined as a chronic inflammatory response of the arterial wall to endothelial injury triggered by a variety of insults including lipid accumulation... Many inflammatory cells, mostly monocytes and CD4+T cells, are recruited into the arterial intima, forming atheromatous plaques and accompanied by high blood levels of acute phase reactants such as CRP, as in the present case... Renal artery atherosclerosis in our patient may be a coincidental lesion considering his old age... However, the patient’s laboratory and pathologic findings indicated that the inflammatory process was concurrently ongoing within the renal artery and peripelvic adipose tissue.

No MeSH data available.


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(A) Contrast-enhanced axial computed tomography scan of the abdomen shows thickening with enhancement of the right renal pelvis wall with perinephric soft tissue infiltration (arrows) and hydroureteronephrosis. (B) Positron emission tomography computed tomography reveals hypermetabolic lesions in multiple neck, axillary, mediastinal, and pelvic lymph nodes as well as the chest, abdominal wall, left parotid gland, and right thigh.
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f1-jptm-49-4-339: (A) Contrast-enhanced axial computed tomography scan of the abdomen shows thickening with enhancement of the right renal pelvis wall with perinephric soft tissue infiltration (arrows) and hydroureteronephrosis. (B) Positron emission tomography computed tomography reveals hypermetabolic lesions in multiple neck, axillary, mediastinal, and pelvic lymph nodes as well as the chest, abdominal wall, left parotid gland, and right thigh.

Mentions: A 73-year-old male patient was admitted to the emergency room with a chief complaint of right flank pain for one week. Laboratory tests showed an elevated white blood cell count of 13.21×103 /µL (neutrophilic leukocytes, 85%; lymphocytes, 5%) and high C-reactive protein (CRP) level of 23.71 mg/dL. Urine analysis was unremarkable, and no microbial growth was observed in blood or urine cultures. Abdominal computed tomography (CT) showed diffuse thickening of the right ureteropelvic wall with hydroureteronephrosis (Fig. 1A). Urine cytology and washing cytology of the right ureter revealed no atypical cells. Right nephroureterectomy was performed for histologic diagnosis, and the intraoperative diagnosis of lymphoid malignancy was made. Positron emission tomography/CT revealed multiple hypermetabolic lesions throughout the neck, chest, and abdomen, suggesting lymphoma seeding (Fig. 1B). The resected specimen showed an elongated, concentric, whitish yellow solid lesion along the walls of the renal pelvis and proximal ureter (Fig. 2). This lesion also surrounded the atherosclerotic renal artery (Fig. 2, upper inset).


Ureteral Marginal Zone Lymphoma of Mucosa-Associated Lymphoid Tissue, Chronic Inflammation, and Renal Artery Atherosclerosis.

Lee H, Joo JE, Hong YO, Lee WM, Kim EK, Woo JJ, Gong SJ, Huh J - J Pathol Transl Med (2015)

(A) Contrast-enhanced axial computed tomography scan of the abdomen shows thickening with enhancement of the right renal pelvis wall with perinephric soft tissue infiltration (arrows) and hydroureteronephrosis. (B) Positron emission tomography computed tomography reveals hypermetabolic lesions in multiple neck, axillary, mediastinal, and pelvic lymph nodes as well as the chest, abdominal wall, left parotid gland, and right thigh.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4508573&req=5

f1-jptm-49-4-339: (A) Contrast-enhanced axial computed tomography scan of the abdomen shows thickening with enhancement of the right renal pelvis wall with perinephric soft tissue infiltration (arrows) and hydroureteronephrosis. (B) Positron emission tomography computed tomography reveals hypermetabolic lesions in multiple neck, axillary, mediastinal, and pelvic lymph nodes as well as the chest, abdominal wall, left parotid gland, and right thigh.
Mentions: A 73-year-old male patient was admitted to the emergency room with a chief complaint of right flank pain for one week. Laboratory tests showed an elevated white blood cell count of 13.21×103 /µL (neutrophilic leukocytes, 85%; lymphocytes, 5%) and high C-reactive protein (CRP) level of 23.71 mg/dL. Urine analysis was unremarkable, and no microbial growth was observed in blood or urine cultures. Abdominal computed tomography (CT) showed diffuse thickening of the right ureteropelvic wall with hydroureteronephrosis (Fig. 1A). Urine cytology and washing cytology of the right ureter revealed no atypical cells. Right nephroureterectomy was performed for histologic diagnosis, and the intraoperative diagnosis of lymphoid malignancy was made. Positron emission tomography/CT revealed multiple hypermetabolic lesions throughout the neck, chest, and abdomen, suggesting lymphoma seeding (Fig. 1B). The resected specimen showed an elongated, concentric, whitish yellow solid lesion along the walls of the renal pelvis and proximal ureter (Fig. 2). This lesion also surrounded the atherosclerotic renal artery (Fig. 2, upper inset).

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Malignant lymphoma of the upper urinary tract including the renal pelvis and ureter is extremely rare... MALT lymphoma arising in the stomach, skin, thyroid, and salivary gland is associated with chronic inflammation caused by pathogenic microorganisms or autoimmune disorder ; however, the pathogenesis of MALT lymphoma in the upper urinary tract is unknown... Infiltrating lymphocytes were mainly CD4+ T cells, and CD20+ B cells were rare... Neither IgG4-positive plasma cells nor anaplastic lymphoma kinase–stained cells were noted, excluding the possibility of IgG4-associated disease or an inflammatory myofibroblastic tumor... In contrast, lymphoma of the upper urinary tract is extremely rare... While MALT lymphoma of the urinary bladder is frequently associated with chronic cystitis and female predominance, MALT lymphoma of the upper urinary tract typically affects middle-aged or elderly males with unknown preceding conditions... Despite its widespread extent, the primary origin in the urinary system of this case was supported by the growth pattern within the renal pelvis and ureter walls... Thus, the chronic inflammatory infiltrates seen in the peripelvic area in the present case may have provided the appropriate conditions for growth of a malignant clone... On the other hand, atherosclerosis is defined as a chronic inflammatory response of the arterial wall to endothelial injury triggered by a variety of insults including lipid accumulation... Many inflammatory cells, mostly monocytes and CD4+T cells, are recruited into the arterial intima, forming atheromatous plaques and accompanied by high blood levels of acute phase reactants such as CRP, as in the present case... Renal artery atherosclerosis in our patient may be a coincidental lesion considering his old age... However, the patient’s laboratory and pathologic findings indicated that the inflammatory process was concurrently ongoing within the renal artery and peripelvic adipose tissue.

No MeSH data available.


Related in: MedlinePlus