慢性淋巴细胞白血病导致输尿管梗阻

 慢性淋巴细胞白血病累及输尿管作为首发临床表现极为罕见，既往文献中仅有2例报道，故而经常被忽视，对诊断及治疗造成困难。本文报道1例83岁高龄男性，确诊慢性淋巴细胞白血病伴幼淋巴细胞增多（CLL/PL），临床表现为反复尿路感染，超声及泌尿系核磁共振水成像（MRU）提示右侧低位输尿管梗阻及输尿管和肾盂扩张。观察9个月后排尿困难、尿频等症状加重，采用氟达拉滨联合利妥昔单抗方案进行化疗。化疗后CLL达完全缓解，复查MRU及超声提示输尿管梗阻减轻。治疗前后前列腺大小无明显改变。随访17个月病情无复发。因此，对于不明原因的输尿管梗阻，应考虑淋巴系统恶性疾病的可能；在患有淋巴系统疾病的患者中，出现输尿管梗阻也应警惕原发病累及情况。

Ureteral Obstruction Caused by Chronic Lymphocytic Leukemia

Chronic lymphocytic leukemia in the ureter is rare in primary clinical observations. There were only 2 cases in the reported literature, thereby, it is often ignored, which would make its diagnosis and treatment difficult., An 83-years-old male patient with known chronic lymphatic leukemia accompanied with prolymphocytic increase (CLL/PL) is reported in this paper. Repeated urinary tract infection was the clinical presentation. Ultrasound and urinary system magnetic nuclear Resonance Water Imaging (MRU) indicate the obstruction of low right ureter and dilation of ureter and renal pelvis. After 10 months of dynamic observations, the symptoms such as dysuria, frequent urination, among others,l were aggravated. Then, the patient accepted the chemotherapy of RF (Fludarabine and Rituximab). After the therapy, CLL evaluation of the curative effect shows to be complete remission. Review MRU and ultrasonic sound show that the obstruction was alleviated, and the prostate sizes before and after treatment had no significant change. The patient condition saw no recurrence in 17-month follow-up visit after the therapy. This case reminds us that the possibility of malignant lymphoma of the lymphocytic system should be considered in cases of ureter obstruction when the cause is uncertain. And the condition of original disease involvement should be paid attention if ureteral obstruction appears in patients suffering from diseases of the lymphatic system.