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Ureteral Inflammatory Myofibroblastic Tumor as a Cause of Gross Hematuria in Adults

      At his first urological appointment, a 44-year-old male patient presented with gross hematuria and right lower back pain for one week. He had no history of smoking, occupational risks, trauma, urinary lithiasis, or any other comorbidities. The patient had no family history of malignancies. Laboratory tests revealed normal creatinine clearance, hemogram, coagulation tests, and negative urinary culture. Computed tomography imaging is shown in Figure 1. A diagnostic right ureteroscopy was performed, followed by a biopsy of the visible tumor and a double J stent placement. The histopathological report showed a spindle-cell proliferation associated with myxoid stroma and mixed inflammatory infiltrate (Fig. 2A). The immunohistochemical analysis is shown in Figure 2B.
      Figure 1
      Figure 1Delayed contrast enhanced phase of computed tomography (CT) scans revealing a 1.5 cm enhanced lesion on the major axis (arrows) behind the iliac vessels, and a proximal right ureterohydronephrosis. (A) Coronal plane, (B) Axial plane, (C) Sagittal plane.
      Figure 2
      Figure 2Photomicrographs of the histopathological image (A) and immunohistochemical analysis (B) demonstrating positive expression of anaplastic lymphoma kinase 1 (ALK1). Original magnification: 100x.
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