Xanthogranulomatous Ureteritis: A Diagnostic Challenge in a Patient with Bladder Cancer.

Xanthogranulomatous ureteritis is a very rare process characterized by the presence of foamy histiocytes in a background of chronic active inflammation affecting the ureteral wall. Herein, we describe a case of a 64-year-old man with bladder cancer affecting the left posterolateral wall of the bladder. Radiologically, there was a suspicion of multifocal involvement of the ureteral wall. The patient underwent a radical cystectomy with bilateral pelvic lymphadenectomy and a laparoscopic left nephroureterectomy. Histopathologic examination of the radical cystectomy revealed an invasive high-grade urothelial carcinoma. The wall of the left ureter was replaced by abundant foamy histocytes and a mixed inflammatory infiltrate with lymphocytes and plasma cells consistent with xanthogranulomatous ureteritis. In this report, we highlight the importance of awareness of this benign process when observing a ureteral mass in cancer patients.

Colonic infiltration of chronic lymphocytic leukemia with Hodgkin Reed Sternberg-like cells.

A 72-year-old man was diagnosed with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) and signet ring cell carcinoma in a gastric biopsy. He underwent a subtotal gastrectomy + lymphadenectomy + chemotherapy + radiotherapy. He did not receive treatment for the lymphoma. Eight years after the diagnosis, he presented with alternating diarrhea and constipation. Physical examination revealed bilateral laterocervical, axillary, and inguinal lymphadenopathies. The laboratory results showed LDH: 286 UI/l and Beta-2-microglobulin: 6.4 mg/L. CT scan showed a mass that seems to involve the cecum and terminal ileum with multiple locoregional, retroperitoneal, and mesenteric lymphadenopathies. He underwent a right hemicolectomy. Macroscopically, we identified an ulcerated mass of approximately 7 x 6 x 5 cm. in the cecum. The microscopic findings were consistent with chronic lymphocytic leukemia (CD20+ and CD5+) with scattered Hodgkin reed Sternberg-like cells CD30 and EBER+ (Epstein-Barr virus-encoded RNA) by in situ hybridization (ISH) positive (Fig. 1). The patient received treatment with mini-CHOP chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisolone) plus rituximab with partial response after the third cycle.