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Eosinophilic ureteritis? Regional ureteritis with marked infiltration of eosinophils
EOSINOPHILIC Regional
Ureteritis
TAKESHI
UYAMA,
SHOOSUKE YOICHI AKIHIRO
URETERITIS? with
Infiltration
of Eosinophils
M.D.
MORIWAKI,
AGA,
Marked
M.D.
M.B.
YAMAMOTO,
M. B.
From the Departments of Urology and Pathology, National Cancer Center of Shikoku, Matsuyama City. Japan
Hospital,
ABSTRACT - The case of u thirty-seven-year-old man with eosinophilic granuloma of the ureter is di,scztssed. Preoperative x-ray studies disclosed distal ureteric regional stenosis and moderate hyand vesiccmreteral neostomy were dronephmsis LLrithsmall stone shudows. A segmental ureterectomy performed Pathologic examination of the removed specimen revealed murkedl’y injltrated cosinophils of the ureteric wall. The literature is reviewed and the causation of’ eosinophilic granulomu discussed. -.
Nonspecific., granulomatous lesion of the ureter is so rarcl that we could find only 21 cases in the English literaturel-x and 36 cases in the Japanese. x’~’ hlost of the reported cases had noncharacteristic pathologic features, but in 4 case:< infiltration of eosinophils, ranging from marked to moderate, was described. In the bladder. eosinophilic granulolnas of unknown origin have been described as “eosinophilic cystitis.” Howe\.er, there has been little information about those in the ureter. \f’e describe a new case of nonspecific, regional granuloma of the ureter with marked eosinophilic infiltration and discuss its origin based on the literature. Case Report A thirty-seven-vear-old Japanese man was admitted with a left flank colic pain following a two-month history of discomfort. He stated that he had not experienced any passing of urinary stones or allergic episodes such as bronchial asthma or hypersensitivity to drugs. foods, or sunlight. A physical examination relrealed no marked findings except for tenderness of the left
flank. Plain x-ray films of the kidney-ureterbladder (KUB) showed several small ston) shadows in the left kidney. E:xcretory pyelography disclosed a strictural portion on the left side of the ureter, measuring 3 cm. from the ureteric orifice, through which the ureteric catheter could not be passed. .A cystoscopic exainination showed no particular lesion. The laboratory data were as follows: urinalysis showed trace proteinuria, slight hematopyuria: urine culture revealed Pseudomonas aeruginosa but no mycobacterium or acid-fast bacillus; stool examination showed no ova or parasites. Red blood cell count, hemoglobin and hematocrit values were within normal limits. White blood cell count was 3,300icu. mtn. with 6 per cent eosinophils. Serum immunoglobulin (Ig) levels were 2,279 mg./dl. of IgG, 334 mg./dl. of IgA, 79 mg./dl. of IgM, and 860 pg./ml. of IgE. The other blood chemical values were within normal limits except for a slight elevation of serum lactate dehydrogenase level. Serologic tests including C-reactive protein. antistreptolysin-0 titer. and tests for syphilis were negative. Cytologic stud!. of sev~~l sp~~ci~riw~s of 11rine
FIGURE 1. Puthologic$ndings of eosinophilic ureteritis. [A) Cross-section of ureter, nmssioe or diffuse injiltration of eosinophils demonstrated. (B) Intuct 7JlllCOSU und eosinophilic injiltrution into submucosul sheet. [C) (0) Eosinophils infdtrated into ureterul wall in high PLtivasculur eosinophilic ir$iltrution tdthtmt wscdaritis. inugnificution.
showed no malignant cells. A segmental ureterectomy including ureteral orifice and \‘esicoureteral neostoniy of the left side was performed. The inspection of the left distal ureter re\:ealed that the portion with thickened wall above the bladder wall, which apbegan 3 cm. peared to continue into the bladder wall. The postoperative course was uneventful, and postoperative pyelograph!~ disclosed thr impro\.eThe reslllts of ment of h~dronephrosis. pathologic examination of the renlo\Ted specimen were as follows: the ureteral mucosa was massive eosinophils infiltrated into the intact; sheet to ad\.enureteral wall from sul~mucosal any evidence of parasites; lymtitia, without phocyte, Iyniphatic follicles, and \-asclilitis \Vere hardly demonstrated. Tile llistopathologic findings resembled origin ~mknown c&nophilic granuloma (Fig. I).
Comment Origin unknown eosinophilic granuloma is well known to arise from soft tissue, bone, or intestinal tracts and also the urinary bladder, blit it rarely occurs in upper urinary tracts. These lesions ha\re lxen classified into three categories: eosinophilic granuloma of the soft tissue (Kimura disease), eosinophilic granuloma X), and eosinophilic of the bone (histiocytosis granuloma of the internal organs. l1 The histopathologic differentiation could he summarized as follows: Kimura disease has been characterized by increase in number of lymphatic follicles with hyperplasia and marked eosinophilic infiltration with slight collagen fibrils but absence of histiocytes. Histiocytosis 3; has heen characterized by marked infiltration of histiocytes with slight proliferation of both
Ureteritis
TAKESHI
UYAMA,
SHOOSUKE YOICHI AKIHIRO
URETERITIS? with
Infiltration
of Eosinophils
M.D.
MORIWAKI,
AGA,
Marked
M.D.
M.B.
YAMAMOTO,
M. B.
From the Departments of Urology and Pathology, National Cancer Center of Shikoku, Matsuyama City. Japan
Hospital,
ABSTRACT - The case of u thirty-seven-year-old man with eosinophilic granuloma of the ureter is di,scztssed. Preoperative x-ray studies disclosed distal ureteric regional stenosis and moderate hyand vesiccmreteral neostomy were dronephmsis LLrithsmall stone shudows. A segmental ureterectomy performed Pathologic examination of the removed specimen revealed murkedl’y injltrated cosinophils of the ureteric wall. The literature is reviewed and the causation of’ eosinophilic granulomu discussed. -.
Nonspecific., granulomatous lesion of the ureter is so rarcl that we could find only 21 cases in the English literaturel-x and 36 cases in the Japanese. x’~’ hlost of the reported cases had noncharacteristic pathologic features, but in 4 case:< infiltration of eosinophils, ranging from marked to moderate, was described. In the bladder. eosinophilic granulolnas of unknown origin have been described as “eosinophilic cystitis.” Howe\.er, there has been little information about those in the ureter. \f’e describe a new case of nonspecific, regional granuloma of the ureter with marked eosinophilic infiltration and discuss its origin based on the literature. Case Report A thirty-seven-vear-old Japanese man was admitted with a left flank colic pain following a two-month history of discomfort. He stated that he had not experienced any passing of urinary stones or allergic episodes such as bronchial asthma or hypersensitivity to drugs. foods, or sunlight. A physical examination relrealed no marked findings except for tenderness of the left
flank. Plain x-ray films of the kidney-ureterbladder (KUB) showed several small ston) shadows in the left kidney. E:xcretory pyelography disclosed a strictural portion on the left side of the ureter, measuring 3 cm. from the ureteric orifice, through which the ureteric catheter could not be passed. .A cystoscopic exainination showed no particular lesion. The laboratory data were as follows: urinalysis showed trace proteinuria, slight hematopyuria: urine culture revealed Pseudomonas aeruginosa but no mycobacterium or acid-fast bacillus; stool examination showed no ova or parasites. Red blood cell count, hemoglobin and hematocrit values were within normal limits. White blood cell count was 3,300icu. mtn. with 6 per cent eosinophils. Serum immunoglobulin (Ig) levels were 2,279 mg./dl. of IgG, 334 mg./dl. of IgA, 79 mg./dl. of IgM, and 860 pg./ml. of IgE. The other blood chemical values were within normal limits except for a slight elevation of serum lactate dehydrogenase level. Serologic tests including C-reactive protein. antistreptolysin-0 titer. and tests for syphilis were negative. Cytologic stud!. of sev~~l sp~~ci~riw~s of 11rine
FIGURE 1. Puthologic$ndings of eosinophilic ureteritis. [A) Cross-section of ureter, nmssioe or diffuse injiltration of eosinophils demonstrated. (B) Intuct 7JlllCOSU und eosinophilic injiltrution into submucosul sheet. [C) (0) Eosinophils infdtrated into ureterul wall in high PLtivasculur eosinophilic ir$iltrution tdthtmt wscdaritis. inugnificution.
showed no malignant cells. A segmental ureterectomy including ureteral orifice and \‘esicoureteral neostoniy of the left side was performed. The inspection of the left distal ureter re\:ealed that the portion with thickened wall above the bladder wall, which apbegan 3 cm. peared to continue into the bladder wall. The postoperative course was uneventful, and postoperative pyelograph!~ disclosed thr impro\.eThe reslllts of ment of h~dronephrosis. pathologic examination of the renlo\Ted specimen were as follows: the ureteral mucosa was massive eosinophils infiltrated into the intact; sheet to ad\.enureteral wall from sul~mucosal any evidence of parasites; lymtitia, without phocyte, Iyniphatic follicles, and \-asclilitis \Vere hardly demonstrated. Tile llistopathologic findings resembled origin ~mknown c&nophilic granuloma (Fig. I).
Comment Origin unknown eosinophilic granuloma is well known to arise from soft tissue, bone, or intestinal tracts and also the urinary bladder, blit it rarely occurs in upper urinary tracts. These lesions ha\re lxen classified into three categories: eosinophilic granuloma of the soft tissue (Kimura disease), eosinophilic granuloma X), and eosinophilic of the bone (histiocytosis granuloma of the internal organs. l1 The histopathologic differentiation could he summarized as follows: Kimura disease has been characterized by increase in number of lymphatic follicles with hyperplasia and marked eosinophilic infiltration with slight collagen fibrils but absence of histiocytes. Histiocytosis 3; has heen characterized by marked infiltration of histiocytes with slight proliferation of both