Tumours arising at the site of ureterosigmoidostomy are a recognized long-term complication of this operation. Three varieties of tumours have been reported in the literature; adenocarcinoma, benign adenomatous polyps and transitional cell carcinoma. Here we report a case of primary malignant lymphoma that occurred at the site of ureterosigmoidostomy five years after diversion.
Case report
A 40-year-old Caucasian man was referred in February 1975, with severe cystitis, when urinary tuberculosis was diagnosed and appropriate treatment given. IVU revealed a calcified and non-functioning right kidney. The left kidney showed hydronephrosis and hydroureter due to an obstruction at the vesicoureteric junction. Repeated X-rays showed progressive reduction in bladder capacity with increased calcification in its wall. IVU in July demonstrated intraperitoneal leakage and laparotomy showed spontaneous rupture of the bladder; peritoneal biopsy confirmed tuberculosis. A left nephrostomy was created.
In September 1975, his abdomen was reexplored with a view to establishing urinary diversion. A ureterosigmoidostomy was chosen, the ileal loops being adherent with tuberculous lesions. He did well until he presented in January 1981 with large bowel obstruction; laparotomy revealed a sigmoid tumour at the site of the implanted ureter. A sigmoid colostomy was done to relieve the bowel obstruction and the distal end of the sigmoid was brought out as a mucous fistula. Two months later, the abdomen was re-explored; the tumour was resected and the ureter was reimplanted into the descending colon. He was seen by physicians for acute chest pain in March 1982 and died unexpectedly six months later at home.
Post mortem examination showed severe atherosclerotic occlusion of both coronary arteries with some scarring of the myocardium. The urinary tract findings were confirmed and no tumours were found in the abdomen or elsewhere.
The specimen of sigmoid obtained at operation in 1981 (Figure ) measured 17 cm in length, with a 12 x 6cm tumour in its middle third at the site of the implanted ureter. Histology of the tumour showed a malignant lymphoma, of large cell type, with frequent mitosis (Figures and). Immunocytochemistry of the tumour cells showed absence of epithelial membrane antigens and positive membrane staining in many tumour cells with leucocyte common antigen.