Laparoscopically Resected Ureteric Pseudotumour in a Female Patient

摘要

A 31 year old female presented with left ureteric obstruction in the absence of any detectable stones. She was discovered to have a distal ureteric mass. This was successfully resected laparoscopically and the ureter re-implanted with a psoas hitch vesicoplasty. The resected specimen was confirmed to be an inflammatory myofibroblastic pseudotumour. To the authors' knowledge this is the first description of this condition in a female patient and the first to be resected laparoscopically. Case Report A 31 year old female presented with left renal colic, intravenous Urogram (IVU) showed left ureteric obstruction. A subsequent non-contrast computed tomographic scan (CT) of kidneys, ureter and bladder was performed; no stone was demonstrated on this scan, serum creatinine was 94mg/l (calculated creatinine clearance 85ml/min).The following day cystoscopy revealed a large mass projecting into the bladder from the distal ureter. Following an unsuccessful attempt at retrograde stenting, left percutaneous nephrostomy was performed. A nephrostogram demonstrated distal ureteric obstruction but no stone; subsequent to which an antegrade ureteric stent was inserted.Repeat cystoscopy was performed with biopsy of the ureteric mass; these samples were reported as benign. DMSA scan revealed that the left kidney provided 23% of the renal function. Laparoscopic excision of the ureteric tumour and ureteroneocystostomy was performed. The stented left ureter was mobilised to the vesico-ureteric junction and a flexible cystoscope used to allow simultaneous visualisation of the intra and extra-vesical aspects of the tumour. The bladder wall was incised using an ultrasonic dissector to circumscribe the tumour. The bladder wall defect was closed with interrupted 3/0 Vicryl (Ethicon, USA) and psoas hitch vesicoplasty performed to approximate the bladder and left ureter. After excision of the distal ureter surrounding the tumour, the remaining ureter was spatulated and anastomosed to the dome of the bladder. The procedure was uncomplicated with the patient discharged home on the second post-operative day.The pathological specimen consisted of 60mm of ureter, including the tumour. The tumour was approximately 30mm in diameter, and 50mm in length; it showed a firm, white, whorled cut surface with no lumen and had been completely excised (Fig. 1).