Ureteral spread of a primary cutaneous diffuse large B-cell lymphoma, leg type
A 76-year-old male patient presented with 2 months history of progressing, non-specific, right flank pain without any other accompanying symptoms. He had no history of urolithiasis, but he had presented 1 year earlier with a mass of the right knee measuring 5 cm in its greatest diameter. Histological examination showed lymphoid diffuse large cells proliferation, which stained diffusely with anti CD20, anti Bcl2 but was CD10 negative in the immunohistochemical study. A diagnosis of primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL-LT) was then made. No others lymphomas were found at the time of diagnosis. The patient had no others skin conditions, especially no history of infections.\nFor the current symptoms, he underwent ultrasonography of the abdomen which revealed right hydronephrosis. Abdomino-pelvic computed tomography scan showed pyelo-calyceal dilatation with continuous obstruction, 8 cm in length, of the distal portion of the right ureter []. No retroperitoneal or mesenteric lymphadenopathy was found. The diagnosis of ureteral tumor of urothelial origin was then suspected and the patient underwent a right radical nephroureterectomy.\nMacroscopic examination showed a kidney measuring 10 × 6 × 3 with a ureter measuring 12 cm of length. On sectioning the ureter, a white, firm, concentric thickness of the pelvic portion of the right ureteral wall was found. The abdominal portion of the ureter as well as the pelvi-calyceal swystem was dilated.\nHistological examination showed infiltration of the ureteral wall by a lymphoid diffuse large cells proliferation that spared the urothelium []. The tumoral cells were medium to large size centrocytes with a variable proportion of centroblasts and immunoblasts mixed with small reactive lymphocytes []. On immunohistochemical study, the large cells stained diffusely and intensely with anti CD20, anti Bcl2 and were CD10 and Bcl6 negatives [Figure –].\nThe diagnosis of ureteral spread of the cutaneous diffuse large B-cell lymphoma, leg type was then made.