Mantle cell lymphoma presenting as a pelvi-ureteric junction obstruction: a case report

Abstract

IntroductionMantle cell lymphoma is one of the several subtypes of non-Hodgkin’s lymphoma. Mantle cell lymphoma is the rarest of the subtypes, accounting for about 6% of all non-Hodgkin’s lymphoma cases in the United States and Europe. Lymphoid neoplasms of the urinary tract and male genital organs are relatively rare, accounting for less than 5% of extranodal lymphomas. We present a rare case of mantle cell lymphoma infiltrating the ureter causing pelvi-ureteric junction obstruction on tissue diagnosis.Case presentationA 78-year-old Caucasian woman was referred to our department with right flank pain, pyrexia and features of a urinary tract infection. A nephrostogram revealed a grossly distended right pelvicalyceal system in a pelvi-ureteric junction obstruction pattern. She underwent an elective pyeloplasty after her acute management and the results of histological examination revealed mantle cell lymphoma.ConclusionWe describe a rare presentation of mantle cell lymphoma as a pelvi-ureteric junction obstruction. To the best of our knowledge, there has not been any previously published report of the above finding. Our patient had a history of a previous lymphoma but the aim of this manuscript is to highlight a possible presentation rather than determining whether the mantle cell lymphoma was de novo or a transformation from her previous splenic lymphoma with villous lymphocytes.

Ureteropelvic junction obstruction caused by metastatic cholangiocarcinoma

“…Secondary malignancies causing intrinsic blockage and presenting as isolated UPJ obstructions, on the other hand, are extremely rare in the literature. Naranji et al ( 4 ) reported a case of right-sided UPJ obstruction in a 78-year-old woman who underwent laparoscopic pyeloplasty that showed mantle cell lymphoma on final histology. The only reported observation of malignant infiltration of the UPJ by a solid organ cancer is a case of recurrent breast cancer reported by Shah et al ( 3 ) in 2016.…”

“…Although most commonly observed in pediatric populations, UPJ obstruction in adults can arise from a number of etiologies, including congenital causes, acquired stenosis due to urolithiasis, urothelial malignancy, and other retroperitoneal disease processes (1,2). Intraluminal malignant obstruction due to metastatic involvement of the UPJ, however, is exceedingly rare, with few case reports existing in the literature (3,4). Herein we describe the case of a patient with a history of hilar cholangiocarcinoma treated with a liver transplant, whose systemic recurrence presented as an isolated right UPJ obstruction six years later.…”

Ureteropelvic Junction Obstruction Secondary to Metastatic Relapse of Breast Cancer

“…To date, only a few cases of malignant spread to the upper urothelial collecting system have been described with isolated involvement of the UPJ recognized few-and-far between. 3 , 4 Malignant infiltration of the UPJ and resultant UPJ obstruction as the first sign of systemic recurrence has only been observed in the setting of an underlying hematologic malignancy. 3 Liston et al presented a patient in whom the first indication of relapse of his mantle-cell lymphoma was UPJ obstruction.…”

“… 3 , 4 Malignant infiltration of the UPJ and resultant UPJ obstruction as the first sign of systemic recurrence has only been observed in the setting of an underlying hematologic malignancy. 3 Liston et al presented a patient in whom the first indication of relapse of his mantle-cell lymphoma was UPJ obstruction. Similarly, Schniederjan and Osunkoya identify diffuse large B-cell lymphoma to be the main form of malignancy which demonstrates a pattern of extranodal invasion involving the ureter.…”

“…Few reports exist describing isolated metastatic involvement of the UPJ, particularly by solid organ tumors in the absence of other visceral sites of disease. 3 , 4 …”