Turkish Journal of Geriatrics 2020 , Vol 23, Issue 2
IMMUNOGLOBULIN G4-RELATED DISEASE PRESENTING AS URETERAL MALIGNANCY AND URETERAL STRICTURE TREATED WITH AZATHIOPRINE AFTER SURGERY IN A GERIATRIC PATIENT WITH A SINGLE FUNCTIONAL KIDNEY: A CASE REPORT
Adem SANCI1, Basak GULPINAR2
1Ankara University Faculty of Medicine, Ibni Sina Hospital, UROLOGY Department, Ankara, TURKEY
2Ankara University Faculty of Medicine, Ibni Sina Hospital, RADIOLOGY Department, Ankara, TURKEY
DOI : 10.31086/tjgeri.2020.163 Immunoglobulin G4-related sclerosing ureteral disease is a rare benign disorder characterised by fibrosis and lymphoplasmacytic infiltration in the ureter. A 70-year-old man with a single functional kidney and left flank pain was diagnosed with IgG4-related ureteral disease that presented as a unilateral ureteral mass. Left hydronephrosis and a 25 × 23 × 26 mm left midureteral mass were found. No malignancy was found on ureteroscopy and urinary cytology did not reveal any neoplastic cells. A 2 cm midureteral stenosis was found in the left ureter on retrograde pyelography. It was not a ureteral stricture but was the result of periureteral inflammation and fibrosis caused by immunoglobulin G4-related sclerosing disease. Initial endoscopic ablation-obliteration therapy was unsuccessful, and after 6 weeks the patient was treated by robotic ureteroureterostomy. Most plasma cells in the excised ureteral segment were IgG4-positive. Serum IgG4 was 273 mg/dL (normal range: 85?120 mg/dL). The histology of the ureteral segment resembled retroperitoneal fibrosis and the histopathology of the stricture included IgG4-positive cells, fibrosis and ureteritis. The patient was treated with oral azathioprine for 6 months. No evidence of recurrence was seen on ureteroscopy or abdominopelvic computed tomography at the 3-month or 1-year follow-up. Keywords : Robotics; Immunoglobulins; Ureter; Neoplasms