HISTORY:
A female in her 80s with past medical history of chronic diastolic heart failure, atrial fibrillation, type 2 diabetes who presented to our facility from home with weakness and fatigue. A computed tomography (CT) scan of the abdomen/pelvis without contrast was obtained in the emergency department with an incidental finding of right ureteral mass with layering calculi versus mural calcification concerning for neoplasm leading to ureteral obstruction and right sided hydronephrosis. A further workup was recommended.
Blood work was significant for leukocytosis, and normocytic anemia. Urinalysis with large leukocyte esterase, numerous WBC and urine culture grew E. coli. She had an elevated She underwent a diagnostic ureteroscopy with biopsy and stent placement.
GROSS:
What is the most likely diagnosis?
- Primary amyloidosis of the ureter
- Urothelial carcinoma with invasion
- Atypical reactive cells
- Carcinoma in situ
Primary amyloidosis of the ureter