巨输尿管症的临床诊治分析（附36例报告）

目的：探讨巨输尿管症的临床诊断依据与治疗方案的选择。方法：收集临床资料36例，对其均行B超和放射学检查，确诊后根据患者的个性差异分别采取相应的治疗方案。结果：36例患者中2例保守治疗，余均行相应手术治疗。对患者随访1～5年，定期行B超、IVU等辅助检查，患者病情不同程度的恢复和好转。结论：认为明确巨输尿管症患者的临床诊断对其治疗方案的选择有着重要意义，是患者预后良好的重要影响因素之一。     

双J管治疗妊娠并输尿管结石所致肾绞痛9例报告

目的：探讨放置输尿管双J管治疗妊娠并输尿管结石所致肾绞痛的疗效及安全性。方法：2008～2012年采用膀胱镜或输尿管镜下放置输尿管双J管治疗妊娠并输尿管结石所致肾绞痛患者9例，观察其疗效。结果：9例患者肾绞痛症状均缓解，且均顺利足月分娩。分娩后，2例结石自行排出，3例行输尿管镜下取石术，3例行ESWL治疗，1例行经皮肾取石术。结论：对于保守治疗不能缓解的妊娠并输尿管结石肾绞痛患者，置人输尿管双J管是一种缓解肾绞痛的安全有效的治疗方法。     

原发性输尿管癌的临床特性

目的：提高临床医生对原发性输尿管癌特性的认识水平。方法：回顾性分析39例原发性输尿管癌患者的临床资料：肉眼血尿、腰痛是其最突出的临床表现；术前经B超、IVP、膀胱镜等检查，确诊35例（94．8％），另4例为术后确诊；36例行手术治疗，3例远处转移者放弃治疗。结果：随访0～60个月，5例术后1年内出现膀胱移行细胞癌，18例在5年内死亡，13例存活至今，8例失访。绪论：IVP、膀胱镜检查是诊断原发性输尿管癌的必要检查，输尿管镜检查是早期诊断的有效手段。患肾、输尿管全长加部分膀胱切除是治疗原发性输尿管癌的最主要方法。     

超声观察钬激光碎石术后肾周水肿的临床意义

目的：探讨超声观察钬激光治疗尿路结石术后并发肾周水肿的临床意义。方法：回顾性分析经超声观察输尿管肾镜钬激光治疗113例泌尿系结石患者术后并发症的临床资料。结果：肾结石患者钬激光碎石术后肾周水肿发生率为40．9％，输尿管结石患者为25．8％。结论：超声检查能准确地诊断钬激光治疗泌尿系结石术后肾周水肿，并可动态观察其变化，对临床治疗有指导作用。     

腹膜后纤维化诊治体会（附6例报告）

目的：探讨腹膜后纤维化防治方法。方法：回顾分析我院收治的6例腹膜后纤维化患者的治疗方法。结果：6例患者中有4例行输尿管松解术，术后输尿管梗阻解除，肾积水减轻，肾功能恢复良好。结论：输尿管松解术是治疗腹膜后纤维化的效果良好的手术方法。对泌尿系炎症给予积极的治疗，防止诱发腹膜后纤维化。肾损伤保守治疗期间和治疗后定期作必的检查，了解腹膜后血肿的吸收情况，以便及时防止腹膜后纤维化。     

巨输尿管症的临床特征(附21例报告)

目的：探讨巨输尿管症的临床特征。方法：对21例巨输尿管症患者均行B超和放射学检查；确诊后均行开放手术治疗，其中2例行患肾输尿管切除术，余19例行输尿管下段裁剪整形或折叠后行输尿管膀胱再吻合术。保肾手术者如有输尿管末段(或)端狭窄均于术中先行切除。结果：16例患者获1～3年随访，均行IVU复查，14例肾积水减轻，肾功能较术前有所改善，2例无明显变化。结论：B超、静脉尿路造影(IVU)、逆行尿路造影(RPG)及膀胱尿道造影是诊断巨输尿管症的主要检查手段；输尿管裁剪或折叠加输尿管膀胱吻合术是治疗巨输尿管症的理想手术方式。     

儿童下腔静脉后输尿管的诊断和治疗

目的：探讨儿童下腔静脉后输尿管的诊断与治疗方法。方法：回顾性分析8例下腔静脉后输尿管患者的临床资料。术前经B超等影像学检查确诊,其中7例采用开放性输尿管复位矫形术,1例采用腹腔镜手术。结果：术后6～12个月复查,临床症状均消失,B超及静脉尿路造影（IVU）检查提示输尿管位于正常位置,吻合口无狭窄,肾盂及输尿管积水明显减轻。结论：下腔静脉后输尿管术前通过多种影像学检查均明确诊断。输尿管复位矫形术是目前治疗本病的主要方法,腹腔镜手术可能会成为治疗本病的首选方式。     

输尿管开口异位的诊断和治疗

目的：探讨输尿管开口异位的定位诊断和治疗。方法：对12例输尿管开口异位患者行B超、IVU、逆行性插管造影、膀胱镜及MRU等检查，明确异位开口输尿管所引起肾段的侧别及位置，并手术治疗。结果：术前经B超、IVU、逆行性插管造影、膀胱镜检查确诊10例；B超、IVU、MRU检查确诊1例；1例术中发现异位输尿管侧别与术前诊断相反，因切口选择得当，得到正确处理。结论：在处理重复肾、重复输尿管开口异位畸形时，术前认真参考辅助检查，尽可能取得全面明确的诊断，避免造成不彻底、不恰当的治疗。     

输尿管阴性结石的影像学诊断与钬激光治疗

目的：提高输尿管阴性结石的诊治水平。方法：对35例腹部平片（KUB）检查阴性的输尿管结石患者,在行B超和静脉尿路造影（IVU）检查的基础上再酌情加行输尿管薄层CT扫描,术前均确诊为输尿管阴性结石,并接受输尿管镜钬激光碎石治疗。结果：输尿管镜钬激光碎石术均一次成。术后26例患者随访3个月～1年,3例复发,1例行ESWL术,2例再次行输尿管镜钬激光碎石术,均获成功。结论：术前结合B超、IVU所示,再酌情加行CT扫描,可以提高输尿管阴性结石的确诊率;输尿管镜钬激光碎石术是治疗输尿管阴性结石的较为理想的选择。     

输尿管镜气压弹道碎石治疗输尿管结石(附116例报告)

目的：总结输尿管镜气压弹道碎石治疗输尿管结石的疗效。方法：回顾性分析116例采用输尿管镜气压弹道碎石治疗的输尿管结石患者资料。男49例，女67例；平均年龄43岁。结石位于输尿管上段3例，中段24例，下段68例。肾结石ESWL后形成输尿管石街21例。结果：碎石成功率90％(104／116)，其中一次碎石成功者85％(99／116)。术中置镜失败3例，发生输尿管穿孔4例。94例随访1～18个月，术后1个月内结石排净91例。KUB加IVU检查未发现输尿管狭窄。结论：输尿管镜气压弹道碎石治疗输尿管结石创伤小、成功率高、并发症少。     

Inflammatory pseudotumor of the kidney

Renal inflammatory pseudotumor is a very rare benign condition of unknown etiology characterized by proliferative myofibroblasts, fibroblasts, histiocytes, and plasma cells. We report a case of inflammatory pseudotumor of the kidney. A 42-year-old female was admitted with the complaint of right flank pain. Computerized tomography revealed a tumor, 7 cm in diameter, in the upper pole of the right kidney. Right radical nephrectomy was performed under the diagnosis of renal cell carcinoma. Histological examination demonstrated a tumor composed of spindle-shaped fibroblastic cells infiltrated by variable numbers of plasma cells, small lymphocytes and histiocytes. The pathologic diagnosis was renal inflammotory pseudotumor.     

Inflammatory pseudotumor of the urinary bladder diagnosed using 3D-CT cystoscopy

Inflammatory pseudotumor of the urinary bladder is a rare benign entity of the submucosal stroma that can easily be mistaken for a malignant neoplasm both clinically and histologically. We report a case of an inflammatory pseudotumor of the urinary bladder in which 3D-CT cystoscopy aided in the diagnosis. A 38-year-old man presented with persistent miction pain, penile pain, and dysuria despite symptomatic treatment at another hospital. Cystoscopic examination, MRI and 3D-CT cystoscopy revealed a 3.0 X 3.0 cm wide-based nonpapillary tumor located at the anterior dome of the urinary bladder. Transabdominal biopsy and transurethral resection were performed and the tumor was suspected to be transitional cell carcinoma. A partial cystectomy and urachus excision were then performed for suspected urachal tumor based upon the radiological examinations. Careful examination of the specimen revealed an inflammatory pseudotumor. We discuss 20 cases of inflammatory pseudotumor of the urinary bladder including ours.     

A case of fibrous pseudotumor originating from tunica vaginalis testis

A 32-year-old man presented with a complaint of painless palpable mass of the left scrotal content. Based on the preoperative diagnosis of scrotal or spermatic cordal benign tumor, local excision was performed. The histological diagnosis was scrotal fibrous pseudotumor. In Japan, only 35 cases of fibrous pseudotumor of the scrotum have been reported including our case. Orchiectomy was performed in 15 cases. Fibrous pseudotumor is a benign fibroproliferative lesion with dense hyalinization and sometimes focal calcification. It may be induced by previous intrascrotal inflammatory events such as epididymitis, an infected hydrocele, prior surgery or trauma. Although a relatively rare disease, a fibrous pseudotumor should be considered in the differential diagnosis of testicular and testicular tunica tumors. Our case was of a benign pseudotumor and orchiectomy could have been avoided.     

Inflammatory pseudotumor of the retroperitoneum removed via a retroperitoneoscopic approach

Background:

Inflammatory pseudotumors were mostly encountered in the lung. Retroperitoneal inflammatory pseudotumors are relatively rare. Although laparoscopic surgery with a modified flank position is widely performed for retroperitoneal tumors, we placed the patient in the supine position to maintain the normal anatomical view of the retroperitoneal space. We report a case of retroperitoneal inflammatory pseudotumor extracted via retroperitoneoscopic surgery in the supine position.

Methods and Results:

A 53-year-old man presented with back pain and frequent urination. Ultrasonographic examination revealed a solid tumor above the urinary bladder. This tumor was diagnosed as a primary retroperitoneal tumor by computed tomography, magnetic resonance imaging, and angiography. The retroperitoneoscopic procedure was adopted to remove this tumor. Histopathologic examination revealed an inflammatory pseudotumor. There was no evidence of recurrence 5 years after surgery.

Conclusions:

The diagnosis of the inflammatory pseudotumor is rarely made before histologic examination. Only pathologic examination allows the correct diagnosis. Consequently, most patients undergo surgical treatment. A recurrence rate of 25% has been reported for inflammatory pseudotumors. Thus, radical resection is needed. The retroperitoneal laparoscopic approach with the patient in the supine position is useful for surgically treating these primary retroperitoneal tumors located below the level of the renal vessels.     

Inflammatory pseudotumor of the urinary bladder: a case report

A 65-year-old female was referred to our hospital with a complaint of urinary retention and macrohematuria. Ultrasongraphy, computed tomography, magnetic resonance imaging and cystoscopy revealed a 2 x 2 cm broad-based nonpapillary bladder tumor localized in the anterior wall of the urinary bladder. The clinical diagnosis was an invasive bladder tumor and transurethral resection of bladder tumor carried out for pathological investigation. Finally, we diagnosed it as inflammatory pseudotumor of urinary bladder. No local recurrence was seen 12 months after surgery. Inflammatory pseudotumor of urinary bladder is a relatively rare condition, and this is the 52nd case reported in the Japanese literature.     

Inflammatory myofibroblastic tumor of the left lower lobe invading the upper lobe ahead of fissure

We described a case of pulmonary inflammatory myofibroblastic tumor that was resected video-assisted thoracoscopic surgery (VATS) with safety surgical margin. The legion masqueraded primary lung cancer showing invasion to neighboring lobe. Positron emission tomography (PET) was not helpful in diagnosing whether it was malignant or not. Inflammatory myofibroblastic tumor was called as inflammatory pseudotumor, formerly. Several reports, however, suggested that so called inflammatory pseudotumor was a true neoplasm rather than a proliferating tissue due to inflammatory response. It is not rare that inflammatory myofibroblastic tumor invades neighboring organ or shows relapsing after coarse margin resection. Our case would remind pulmonary physicians of its correct treatment, i.e. surgical resection with adequate safety margin.     

Periureteral inflammatory pseudotumor: a case report

A 59-year old female presented with right flank pain and hydronephrosis. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) before admission (August 2001), revealed a periureteral mass measuring 11 cm in length along the right ureter. Since the preoperative image examinations could not exclude a malignancy, she was admitted for surgery. After admission, however, she presented no abnormal findings in laboratory investigations including tumor markers, urinalysis, urine cytology and retrograde pyelography. C-reactive protein was normalized. CT after admission (September 2001), showed spontaneous regression of the mass. We cancelled the operation and decided to carefully watch this lesion by CT. The lesion continued to regress thereafter. Judging from the clinical course, we regard the mass as inflammatory pseudotumor although pathological diagnosis was not performed. The possibility of preserving the urinary tract in this disease is discussed by reviewing the previously reported inflammatory pseudotumor of the upper urinary tract.     

Inflammatory pseudotumor of the pancreas resembling pancreatic cancer: clinical, diagnostic and therapeutic considerations

Pancreatic masses could be malignant or benign. Among these latter inflammatory pseudotumor is an uncommon mass rarely located in the pancreas and it must be considered in differential diagnosis with pancreatic cancer. A case report and literature review of inflammatory pseudotumor were recognized to well known this rare pathology regarding its clinical, diagnostic, therapeutic and histopathological feature. Twenty-one cases of inflammatory pseudotumor in the adult were reviewed from the literature; 10 (47.6%) were female, 11 (52.3%) male; mean age 53.3 years (range 23-73). They were solid single mass in 18 cases, with median size of 5.1 cm (range 1.5-13), cystic mass in one case; 18 were located in the head, 1 in the body. In 2 cases it appeared as a volumetric increase of the pancreas. Diagnosis was possible only histologically and surgical treatment was mandatory in 20 cases; only in one patient a corticosteroid treatment was performed. Pancreatic inflammatory pseudotumor is a rare lesion of the pancreas but it must be distinguished from pancreatic cancer. Pancreatic resectioning is mainly due to the preoperative diagnostic difficulties that must be resolved surely only with histopathological examination of the specimen.     

Myocbacterium-Avium Intracellulare Associated Inflammatory Pseudotumor of the Anterior Nasal Cavity

In this case report, we describe an unusual case of mycobacterial associated inflammatory pseudotumor that occurred in a patient with a previous history of cocaine abuse. We discuss inflammatory pseudotumor (IPT) in general and emphasize the rare entity where an associated mycobacterial infection is seen. The histogenesis is not yet completely understood. The lesion can pose challenges for practicing pathologists and a misdiagnosis of malignancy can occur at multiple facets. A discussion about the differential diagnosis and clues to make the distinction is presented. In addition to spindle cell proliferation, the presence of a background of mixed inflammatory cell infiltrate and foamy macrophages are clues to make the diagnosis. In the case of mycobacteria associated IPT, Acid Fast Bacilli (AFB) stains will easily highlight the organisms confirming the diagnosis.     

Inflammatory pseudotumor of the prostate: a case report

We report a rare case of inflammatory pseudotumor of the prostate. A 42-year-old man with a history of hematospermia and chronic prostatitis presented with difficulty in voiding. Cystoscopy demonstrated a large non-papillary tumor occupying the prostatic urethra along with two bladder stones. Magnetic resonance imaging (MRI) demonstrated a 7-cm prostatic mass protruding toward the bladder and the rectum. Transrectal biopsy of the prostate demonstrated a fibrous lesion containing inflammatory cells without evidence of malignancy. We performed transurethral resection of the prostatic lesion to release the bladder outlet obstruction, followed by cystolithotripsy. Histopathological examination of the surgical specimen demonstrated a benign fibromuscular lesion with spindle cell proliferation, leading to a diagnosis of inflammatory pseudotumor. Postoperatively, the patient voided normally without any signs of recurrence on follow-up at five months. Inflammatory pseudotumor is an unusual benign lesion of unknown etiology. Only 10 previous cases of the disease involving the prostate have been reported in English and Japanese literature. Prostatic involvement of inflammatory pseudotumor may show a presentation similar to malignant prostatic sarcoma. Thus, accurate identification of this benign process is important in order to avoid unnecessary radical surgery.