Endometriosis in ectopic kidney: A rare case report and literature review

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Endometriosis in the kidney is extremely rare, and to the best of our knowledge, this article reports the first case of endometriosis in the ectopic kidney. Case presentation: We describe a case of a 19-year-old girl with occasional mild abdominal pain, who was admitted to hospital due to the discovery of an ectopic left kidney. SPECT-CT showed no abnormal radioactive distribution was found in the left pelvis, suggesting that the left ectopic kidney was not functioning. Laparoscopic left ectopic kidney resection was subsequently performed. Histopathology revealed endometriosis of the ectopic left kidney. Conclusions: In female patients with clinical manifestations of abdominal pain and gross hematuria, the possibility of renal endometriosis should be considered. Endometriosis Renal Endometriosis Ectopic kidney Figures Figure 1 Figure 2 Figure 3 1. Background Endometriosis, the presence of ectopic endometrial tissue outside the uterus, is the second most common pelvic disorder and the most common cause of pelvic pain in women of reproductive age[1]. It is usually within the reproductive system, but rarely occurs outside the pelvis, especially in the kidney[2]. Endometriosis is an estrogen dependent process, the clinical symptoms are dysmenorrhea, dyspareunia, and profuse bleeding[3]. Endometriosis in ectopic kidney is very rare, and we report a case of ectopic renal endometriosis. To the author's knowledge, it is the first case reported in the literature. We report our experience about clinical and imaging manifestations to raise awareness of this rare disease. 2. Case Presentation A 19-year-old girl was admitted to hospital due to the discovery of an ectopic left kidney during physical examination. She noted occasional mild pain around her abdomen. 2.1Physical examination and family history Her vital signs on admission were: temperature, 36.5 °C; heart rate,78 beats/min; blood pressure, 108/75 mm Hg; respiratory rate, 18 breaths/min. Physical examination was normal. She denied a family history of cancer and genetic diseases. 2.2Radiographic findings An ultrasound of the urinary system was recommended first. There was no left renal echo in the left renal region. On the left side of the pelvis, a substantial inhomogeneous echogenic structure was detected, with a size of about 7.3×4.6 cm, a clear boundary, and an irregular shape. The left ureter is not shown clearly (Figure 1A). Abdominal computed tomography (CT) was then performed. There is no indication of kidney in the left renal area(Figure 1B,H), however, a large and heterogeneous hypodense mass was seen in the pelvic cavity. After contrast injection, the solid areas showed mild enhancement, and the cystic components remained unenhanced(Figure 1C-F). In addition, the ureter can be seen as dilated and hydrous(Figure 1G). The patient also underwent 99mTc-DTPA renal scan (Figure 2) .Immediately after intravenous "bolus" injection of 99mTc-DTPA, posterior biphasic renal artery imaging was collected and GFR was measured. Renal artery perfusion phase: the abdominal aorta was visualized for 2 seconds, the left kidney was not visualized, and the right kidney was clearly visualized. The renal cortical function phase: no abnormal radioactive distribution was found in the left pelvis; no obvious radioactive distribution was found in the left kidney; The position, size and shape of the right kidney were normal, the radioactivity was evenly distributed, and there was no abnormal radioactive concentration or defect. Clearance phase: the radioactivity of the right kidney reached a peak at 6 minutes, and then gradually decreased with time; the bladder was gradually developed at about 7 minutes. Nephrogram curve: No obvious abnormality was found in the right nephrogram curve. 2.3Surgical Procedure and pathological findings Laparoscopic left ectopic kidney resection was subsequently performed at our hospital. After the anesthesia took effect, the supine position was taken, the buttocks were raised, sterile towels and sterile hole sheets were laid for routine disinfection, and urinary tubes were indwelled. The operator took 2cm above the navel as the puncture point, put in the pneumoperitoneum needle, and the 10mm Trocar after establishing the pneumoperitoneum. A 12mm and 10mm Trocar was inserted at the lateral edge of the rectus abdominis muscle 3.0 cm below the navel on the left and right sides, respectively. A 5 mm Trocar was placed at 1/3 of the line between the left and right anterior superior iliac spine and the navel. After entering the pelvic cavity, the hydrous kidney and dilated ureter are located on the left side of the pelvic cavity and adhered to the surrounding tissue. The uterus is seen in the center. Ovaries and fallopian tubes are seen on the right side of the pelvic cavity. No obvious left fallopian tubes and ovaries are seen. During the operation, the gynecologist was consulted, and no obvious left accessory was found after examination. It was considered that the left ectopic kidney of the pelvic cavity combined with unilateral accessory (right side). The gap between the ectopic kidney and the surrounding adhesive tissue was bluntly separated by ultrasonic knife and aspirator, and the arteries and veins were dissociated and clipped with HEM-O-LOK. The edge dissociation continued, and the ureter was visible after clipping with HEM-O-LOK. At this point, the kidney and the surrounding tissue has been completely free. The left rectus abdominis outer margin incision was extended and the specimen was removed. Resected specimens were examined by family members and then sent for pathological examination. The resected mass was approximately 6.5 × 4.5 × 3.5cm, and the cut surface of the mass was several capsular spaces containing brown fluid. Microscopic examination confirmed the diagnosis of ectopic renal endometriosis characterized by endometrial glands and tubal component(Figure 3). 3. Material And Methods Renal endometriosis was first reported by Marshall in 1943[4] .It is very rare in the past 30 years, and only 17 cases of renal endometriosis have been reported[5-20]. To our knowledge, this is the first report of endometriosis within ectopic kidney. 3.1 Literature review A total of 17 patients (age range, 23–53 years) with pathologically proven renal endometriosis from 1970 to 2021 were included in our retrospective review. Patients were identified in PubMed using the keywords: “renal endometriosis”. Clinical features, endometrial history, tumor size, diagnosis method, treatment, and outcome were recorded. 3.2. Statistical analysis Continuous variables were expressed as mean±standard deviation, and categorical variables as number (percentage). 4. Results Demographic and clinical findings of the renal endometriosis reported in the literature are summarized in Table 1. Approximately half of the patients (47.1%) were found in the left kidney, 9 patients (52.9%) in the right kidney(Table2). Abdominal pain was the most frequent presenting symptom (61.9%), followed by gross hematuria (23.8%), other uncommon symptoms (4.8%) (Table 2). The mean age of the patients was 38.5±8.7years (range,23–53 years). The average tumor size was 5.5 ± 6.9 cm (range, 1-25 cm) (no data for 2 patients) in greatest diameter. 5. Discussion And Conclusions Endometriosis is the second most common pelvic disorder and the most common cause of pelvic pain in women of reproductive age[1]. The main site of the disease is ovary，and the urinary tract involvement is rare, mainly the bladder(80%), followed by ureters(15%) and kidneys(＜5%) [21]. It is very rare in the past 30 years, up to now, only 17 cases of renal endometriosis have been reported, the first case was reported by Marshall in 1943[4]. To our knowledge , this is the first report of endometriosis within ectopic kidney. Therefore, this article mainly describes the patient's admission diagnosis and treatment process, and reviews the cases reported in the past 30 years, so as to raise awareness of this rare disease. The clinical presentation of renal endometriosis is diverse and atypical. The absence of typical clinical manifestations may be due to the fact that the renal endometriosis is confined to the renal cortex without involvement the renal calyces. According to previous reports, most of the clinical manifestations of renal endometriosis are abdominal pain and gross hematuria. Long-term periodic bleeding may lead to the gradual increase of hemorrhagic cysts in the kidney tissue and even invasion into the renal calyces, which can result in ureteral obstructions, and that is the main cause of abdominal pain and hematuria[22]. The pathogenesis of endometriosis that occurs outside the reproductive system remains controversial. The main theories can be divided into migration, embryonic and immunology[18][16, 19] [8, 10-12, 14, 23] and previous studies have suggested that renal endometriosis is mostly related to embryonic theory[9, 14, 18]. Because renal endometriosis is so rare, there are currently no treatment guidelines[11]. Clinical treatment mainly includes symptom relief and radical treatment. Therefore, the treatment of renal endometriosis should be carried out according to the patient's clinical symptoms, the characteristics of the lesion, and the patient's reproductive plan[21]. If an asymptomatic patient has no change in the lesions on follow-up review, no definitive renal therapy is usually required[8]. In addition, for patients of reproductive age, hormone therapy, such as oral contraceptives can relieve abdominal pain and is the best treatment option in the short-term[24]. Although renal endometriosis is a benign condition, surgery is usually considered, laparoscopic management in particular, as the feasibility of this treatment has been widely proven to reduce the length of hospital stay[24, 25]. Surgical intervention is required if there is a potential risk of ureteral obstruction and even loss of renal function due to repeated bleeding from endometriosis of the kidneys[26]. This article reports the first case of endometriosis in ectopic kidney, and analyzes the clinical features of renal endometriosis. Although imaging features are helpful in renal endometriosis, the final diagnosis relies on pathological findings. Declarations Ethics approval and consent to participate All subjects signed the informed consent form, and this study was approved by the Ethics Committee of the Second Affiliated Hospital of Kunming Medical University (Code: FEY-BG-39-2.0). Consent for publication Written informed consent for publication of their clinical details and clinical images was obtained from the patient. Availability of data and materials The datasets used during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding None. Authors' contributions CML and YYM designed the study. CML drafted the manuscript and ZXX contributed to editorial changes. All authors read and approved the final manuscript. Acknowledgements Not applicable. References Olive D L, Schwartz L B. Endometriosis[J]. N Engl J Med, 1993,328(24):1759-1769. Eisenberg V H, Weil C, Chodick G, et al. Epidemiology of endometriosis: a large population-based database study from a healthcare provider with 2 million members[J]. BJOG: An International Journal of Obstetrics & Gynaecology, 2018,125(1):55-62. Vercellini P, Vigano P, Somigliana E, et al. Endometriosis: pathogenesis and treatment[J]. Nat Rev Endocrinol, 2014,10(5):261-275. Marshall V F. The Occurrence of Endometrial Tissue in the Kidney. Case Report and Discussion[J]. The Journal of Urology, 1943,50(6):652-656. Yang Y, Zhao X, Huang Y. Renal Endometriosis Mimicking Cystic Renal Tumor: Case Report and Literature Review[J]. Frontiers in Medicine, 2021,8. Umair M, Nawaz M, Murtaza B, et al. Renal endometriosis mimicking a renal tumor in a pregnant patient[J]. Urology Case Reports, 2020,33:101374. Badri A V, Jennings R, Patel P, et al. Renal Endometriosis: The Case of an Endometrial Implant Mimicking a Renal Mass[J]. Journal of Endourology Case Reports, 2018,4(1):176-178. Giambelluca D, Albano D, Giambelluca E, et al. Renal endometriosis mimicking complicated cysts of kidney: report of two cases[J]. G Chir, 2017,38(5):250-255. Cheng C, Kuo H, Su B. Endometriosis in a kidney with focal xanthogranulomatous pyelonephritis and a perinephric abscess[J]. BMC Research Notes, 2015,8(1). Yang J, Song R, Xu C, et al. Renal Endometriosis Tends to Be Misdiagnosed as Renal Tumor: A Rare Case Report[J]. International Surgery, 2015,100(2):376-380. Jiang Y, Kuo H, Hsu Y. Renal endometriosis mimicking an angiomyolipoma[J]. Urological Science, 2013,24(1):24-26. Dirim A, Celikkaya S, Aygun C, et al. Renal endometriosis presenting with a giant subcapsular hematoma: case report[J]. Fertility and Sterility, 2009,92(1):391-395. Yaqub U, Hassan S, Yusaf Z, et al. Endometriosis in the renal area[J]. Journal of the College of Physicians and Surgeons--Pakistan, 2008,18(3):174. Dutta P, Bhat M H, Bhansali A, et al. A young woman with endometriosis of kidney[J]. Saudi medical journal, 2006,27(2):244. Gupta K, Rajwanshi A, Srinivasan R. Endometriosis of the kidney: Diagnosis by fine-needle aspiration cytology[J]. Diagnostic Cytopathology, 2005,33(1):60-61. Benchekroun A, Nouini Y, Zennoud M, et al. Endométriose rénale. À propos d'un cas[J]. Annales d'Urologie, 2001,35(5):266-269. HELLBERG D, FORS B, BERGQVIST C. Renal endometriosis treated with a gonadotrophin releasing hormone agonist. Case report[J]. BJOG: An International Journal of Obstetrics and Gynaecology, 1991,98(4):406-407. Bazaz-Malik G, Saraf V, Rana B S. Endometrioma of the Kidney: Case Report[J]. The Journal of Urology, 1980,123(3):422-423. Gauperaa T, Stalsberg H. Renal endometriosis. A case report[J]. Scand J Urol Nephrol, 1977,11(2):189-191. Hajdu S I, Koss L G. Endometriosis of the kidney[J]. Am J Obstet Gynecol, 1970,106(2):314-315. Maccagnano C, Pellucchi F, Rocchini L, et al. Ureteral endometriosis: proposal for a diagnostic and therapeutic algorithm with a review of the literature[J]. Urol Int, 2013,91(1):1-9. Shook T E, Nyberg L M. Endometriosis of the urinary tract[J]. Urology, 1988,31(1):1-6. Cheng C, Kuo H, Su B. Endometriosis in a kidney with focal xanthogranulomatous pyelonephritis and a perinephric abscess[J]. BMC research notes, 2015,8(1):591. Bolze P A, Paparel P, Golfier F. [Urinary tract involvement by endometriosis. Techniques and outcomes of surgical management: CNGOF-HAS Endometriosis Guidelines][J]. Gynecol Obstet Fertil Senol, 2018,46(3):301-308. Van Gorp T, Amant F, Neven P, et al. Endometriosis and the development of malignant tumours of the pelvis. A review of literature[J]. Best Pract Res Clin Obstet Gynaecol, 2004,18(2):349-371. Nezhat C, Paka C, Gomaa M, et al. Silent loss of kidney seconary to ureteral endometriosis[J]. JSLS, 2012,16(3):451-455. Tables Table 1 Case reports of renal endometriosis Reporting year Location Age Clinical features Endometrial history Tumor size(cm) Diagnosis method Treatment Outcome Reference 1970 Left kidney 49 Low back pain and gross hematuria No 1.5x1.0 Microscopic examination No Die [20] 1977 Right kidney 23 Tender to palpation in the region of the right kidney Not mentioned 2 Histopathology Nephrectomy Recovery [19] 1980 Upper pole of the right kidney 40 Dull aching pain in the right loin Not mentioned 2 Histopathology Nephrectomy Not mentioned [18] 1991 Upper pole of the left kidney 25 Macroscopic hematuria and back-pain Endometriotic cyst of left ovary 4 Ultrasound-guided FNA GnRha Effective [17] 2001 Left kidney 35 Fever and pyuria Not mentioned Not mentioned Histopathology Nephrectomy Not mentioned [16] 2005 Right kidney 40 Pain in the lower abdomen Endometriotic cyst of right ovary 2 Ultrasound-guided FNA Not mentioned Not mentioned [15] 2006 Right kidney 38 Abdominal pain Endometriotic cyst of left ovary 1 FNA GnRha The lesions regressed slowly [14] 2008 Left kidney 25 Lower abdominal pain Not mentioned 25x15 Histopathology Nephrectomy Recovery [13] 2009 Lower pole of the left kidney 46 Left lumbar pain and lumbar mass No 15x9.7x9.5 Histopathology The renal capsule was incised and excised after hematoma drainage Recovery [12] 2013 Middle and lower of the right kidney 42 Right flank pain and hematuria No 13.5x12x12 Histopathology Nephrectomy, GnRHa Recovery [11] 2015 Lower pole of the right kidney 37 Dull pain in the right lower back Not mentioned 7.5x5x3.5 Histopathology Nephrectomy Not mentioned [10] 2015 Right kidney 53 Intermittent recurrent right flank pain Not mentioned Not mentioned Histopathology Nephrectomy after drainage Recovery [9] 2017 Upper and lower pole of the left kidney 40 No Ovarian endometriosis 1.8 Histopathology No No clinical changes [8] 2017 Middle pole of the left kidney 39 No Ovarian endometriosis ＜1.0 Histopathology No No clinical changes [8] 2018 Upper pole of the left kidney 45 Flank pain and intermittent gross hematuria No 2.8x2.6x1.7 Histopathology Partial nephrectomy Not mentioned [7] 2020 Right kidney 30 Dull pain in the right lower back Not mentioned 6.5x5.9x5.7 Histopathology Nephrectomy Not mentioned [6] 2021 lower pole of the right kidney 48 intermittent gross hematuria No 1.8 ×1.5 × 1.4 Histopathology Nephrectomy Recovery [5] Table 2 Features characterizing renal endometriosis presentation in literature review n(%) Location Left kidney 8(47.1%) Right kidney 9(52.9%) Symptoms Pain 13(61.9%) Gross hematuria 5(23.8%) Others 1(4.8%) No symptoms 2(9.5%) Endometrial history Ovarian endometriosis 5(29.4%) No 6(35.3%) Not mentioned 6(35.3%) Tumor size(in greatest diameter) 5.5±6.9 Age 38.5±8.7 Diagnosis method Histopathology 13(76.5%) Other 4(23.5%) Outcome Recovery 6(35.3%) Died 1(5.9%) No mentioned 6(35.3%) Others 4(23.5%) Note:4 cases presented with clinical manifestations of both pain and hematuria. 2 cases no data for size. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 28 Apr, 2023 Read the published version in BMC Women's Health → Version 1 posted Editorial decision: Major revision 13 Mar, 2023 Reviews received at journal 01 Mar, 2023 Reviewers agreed at journal 01 Mar, 2023 Reviewers invited by journal 01 Mar, 2023 Editor assigned by journal 27 Feb, 2023 Editor invited by journal 27 Feb, 2023 Submission checks completed at journal 27 Feb, 2023 First submitted to journal 10 Feb, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2571350","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":179374003,"identity":"130f3290-8fff-4965-a8da-14af9dc687a5","order_by":0,"name":"MengLin Chen","email":"","orcid":"","institution":"The second Affiliated Hospital of Kunming Medical University","correspondingAuthor":false,"prefix":"","firstName":"MengLin","middleName":"","lastName":"Chen","suffix":""},{"id":179374004,"identity":"8f7d394b-d013-4be9-8689-eeaec09cfe81","order_by":1,"name":"YuanMeng Yu","email":"","orcid":"","institution":"The First People ’ s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"YuanMeng","middleName":"","lastName":"Yu","suffix":""},{"id":179374006,"identity":"d95f0320-e63e-4617-9038-b058df63360e","order_by":2,"name":"XinXiang Zhao","email":"data:image/png;base64,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","orcid":"","institution":"The second Affiliated Hospital of Kunming Medical University","correspondingAuthor":true,"prefix":"","firstName":"XinXiang","middleName":"","lastName":"Zhao","suffix":""}],"badges":[],"createdAt":"2023-02-10 05:44:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2571350/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2571350/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12905-023-02343-x","type":"published","date":"2023-04-28T20:36:48+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":33696620,"identity":"41ab6181-b5ae-4ecb-9893-38e9ae8d8b14","added_by":"auto","created_at":"2023-03-02 16:33:35","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":104429,"visible":true,"origin":"","legend":"\u003cp\u003e(A):Ultrasound of the left side of the pelvis showed a substantial inhomogeneous echogenic structure with clear boundary, and an irregular shape.\u003c/p\u003e\n\u003cp\u003e(B,H):Computed tomography (CT) showed no indication of kidney in the left renal area.\u003c/p\u003e\n\u003cp\u003eCT showed a hypodense mass of 1.6 ×2.2 cm in the left ectopic kidney. (C) :Unenhanced images. (D): Renal cortical phase. (E) :Renal corticomedullary phase. (F):Renal excretory phase.\u003c/p\u003e\n\u003cp\u003e(G): the ureter can be seen as dilated and hydrous in the left ectopic kidney.\u003c/p\u003e","description":"","filename":"figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2571350/v1/e304103cd0bdf2a3a98b1bfe.jpg"},{"id":33696621,"identity":"f2f81664-4a76-4f97-a45e-7da57749fee7","added_by":"auto","created_at":"2023-03-02 16:33:35","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":58929,"visible":true,"origin":"","legend":"\u003cp\u003e99mTc-DTPA renal scan showed the left kidney was not visualized, and the right kidney was clearly visualized.\u003c/p\u003e","description":"","filename":"figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2571350/v1/87f432ede2be8946dcbcf094.jpg"},{"id":33696619,"identity":"11542ac5-29eb-45f8-89cf-8a6f16b5dbf7","added_by":"auto","created_at":"2023-03-02 16:33:35","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":87673,"visible":true,"origin":"","legend":"\u003cp\u003eThe microscopic pathology proved the diagnosis of renal endometrios was characterized by endometrial glands [hematoxylin and eosin stain (H and E), × 200 magnification].\u003c/p\u003e","description":"","filename":"figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2571350/v1/99d45b2be523ad3233e4a13b.jpg"},{"id":44727761,"identity":"389e92ee-851f-4700-b5b2-fb1dc3cd1f86","added_by":"auto","created_at":"2023-10-16 20:54:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":481432,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2571350/v1/301e6467-f0cc-4626-81a2-7f6c81fb9aec.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eEndometriosis in ectopic kidney: A rare case report and literature review\u003c/p\u003e","fulltext":[{"header":"1. Background","content":"\u003cp\u003eEndometriosis, the presence of ectopic endometrial tissue outside the uterus, is the second most common pelvic disorder and the most common cause of pelvic pain in women of reproductive age[1]. It is usually within the reproductive system, but rarely occurs outside the pelvis, especially in the kidney[2]. Endometriosis is an estrogen dependent process, the clinical symptoms are dysmenorrhea, dyspareunia, and profuse bleeding[3].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEndometriosis in ectopic kidney is very rare, and we report a case of ectopic renal endometriosis. To the author\u0026apos;s knowledge, it is the first case reported in the literature. We report our experience about clinical and imaging manifestations to raise awareness of this rare disease. \u0026nbsp;\u003c/p\u003e"},{"header":"2. Case Presentation","content":"\u003cp\u003eA 19-year-old girl was admitted to hospital due to the discovery of an ectopic left kidney during physical examination. She noted occasional mild pain around her abdomen.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.1Physical examination and family history\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHer vital signs on admission were: temperature, 36.5 \u0026deg;C; heart rate,78 beats/min; blood pressure, 108/75 mm Hg; respiratory rate, 18 breaths/min. Physical examination was normal. She denied a family history of cancer and genetic diseases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2Radiographic findings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn ultrasound of the urinary system was recommended first. There was no left renal echo in the left renal region. On the left side of the pelvis, a substantial inhomogeneous echogenic structure was detected, with a size of about 7.3\u0026times;4.6 cm, a clear boundary, and an irregular shape. The left ureter is not shown clearly (Figure 1A).\u003c/p\u003e\n\u003cp\u003eAbdominal computed tomography (CT) was then performed. There is no indication of kidney in the left renal area(Figure 1B,H), however, a large and heterogeneous hypodense mass was seen in the pelvic cavity. After contrast injection, the solid areas showed mild enhancement, and the cystic components remained unenhanced(Figure 1C-F). In addition, the ureter can be seen as dilated and hydrous(Figure 1G).\u003c/p\u003e\n\u003cp\u003eThe patient also underwent 99mTc-DTPA renal scan (Figure 2) .Immediately after intravenous \u0026quot;bolus\u0026quot; injection of 99mTc-DTPA, posterior biphasic renal artery imaging was collected and GFR was measured. Renal artery perfusion phase: the abdominal aorta was visualized for 2 seconds, the left kidney was not visualized, and the right kidney was clearly visualized. The renal cortical function phase: no abnormal radioactive distribution was found in the left pelvis; no obvious radioactive distribution was found in the left kidney; The position, size and shape of the right kidney were normal, the radioactivity was evenly distributed, and there was no abnormal radioactive concentration or defect. Clearance phase: the radioactivity of the right kidney reached a peak at 6 minutes, and then gradually decreased with time; the bladder was gradually developed at about 7 minutes. Nephrogram curve: No obvious abnormality was found in the right nephrogram curve.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3Surgical Procedure and pathological findings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLaparoscopic left ectopic kidney resection was subsequently performed at our hospital. After the anesthesia took effect, the supine position was taken, the buttocks were raised, sterile towels and sterile hole sheets were laid for routine disinfection, and urinary tubes were indwelled. The operator took 2cm above the navel as the puncture point, put in the pneumoperitoneum needle, and the 10mm Trocar after establishing the pneumoperitoneum. A 12mm and 10mm Trocar was inserted at the lateral edge of the rectus abdominis muscle 3.0 cm below the navel on the left and right sides, respectively. A 5 mm Trocar was placed at 1/3 of the line between the left and right anterior superior iliac spine and the navel. After entering the pelvic cavity, the hydrous kidney and dilated ureter are located on the left side of the pelvic cavity and adhered to the surrounding tissue. The uterus is seen in the center. Ovaries and fallopian tubes are seen on the right side of the pelvic cavity. No obvious left fallopian tubes and ovaries are seen. During the operation, the gynecologist was consulted, and no obvious left accessory was found after examination. It was considered that the left ectopic kidney of the pelvic cavity combined with unilateral accessory (right side). The gap between the ectopic kidney and the surrounding adhesive tissue was bluntly separated by ultrasonic knife and aspirator, and the arteries and veins were dissociated and clipped with HEM-O-LOK. The edge dissociation continued, and the ureter was visible after clipping with HEM-O-LOK. At this point, the kidney and the surrounding tissue has been completely free. The left rectus abdominis outer margin incision was extended and the specimen was removed. Resected specimens were examined by family members and then sent for pathological examination.\u003c/p\u003e\n\u003cp\u003eThe resected mass was approximately 6.5 \u0026times; 4.5 \u0026times; 3.5cm, and the cut surface of the mass was several capsular spaces containing brown fluid. Microscopic examination confirmed the diagnosis of ectopic renal endometriosis characterized by endometrial glands and tubal component(Figure 3).\u003c/p\u003e"},{"header":"3. Material And Methods","content":"\u003cp\u003eRenal endometriosis was first reported by Marshall in 1943[4] .It is very rare in the past 30 years, and only 17 cases of renal endometriosis have been reported[5-20]. To our knowledge, this is the first report of endometriosis within ectopic kidney.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.1 Literature review\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 17 patients (age range, 23\u0026ndash;53 years) with pathologically proven renal endometriosis from 1970 to 2021 were included in our retrospective review. Patients were identified in PubMed using the keywords: \u0026ldquo;renal endometriosis\u0026rdquo;. Clinical features, endometrial history, tumor size, diagnosis method, treatment, and outcome were recorded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2. Statistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eContinuous variables were expressed as mean\u0026plusmn;standard deviation, and categorical variables as number (percentage).\u0026nbsp;\u003c/p\u003e"},{"header":"4. Results","content":"\u003cp\u003eDemographic and clinical findings of the renal endometriosis reported in the literature are summarized in Table 1.\u003c/p\u003e\n\u003cp\u003eApproximately half of the patients (47.1%) were found in the left kidney, 9 patients (52.9%) in the right kidney(Table2). Abdominal pain was the most frequent presenting symptom (61.9%), followed by gross hematuria (23.8%), other uncommon symptoms (4.8%) (Table 2). The mean age of the patients was 38.5\u0026plusmn;8.7years (range,23\u0026ndash;53 years). The average tumor size was 5.5 \u0026plusmn; 6.9 cm (range, 1-25 cm) (no data for 2 patients) in greatest diameter.\u003c/p\u003e"},{"header":"5. Discussion And Conclusions","content":"\u003cp\u003eEndometriosis is the second most common pelvic disorder and the most common cause of pelvic pain in women of reproductive age[1]. The main site of the disease is ovary，and the urinary tract involvement is rare, mainly the bladder(80%), followed by ureters(15%) and kidneys(＜5%) [21]. It is very rare in the past 30 years, up to now, only 17 cases of renal endometriosis have been reported, the first case was reported by Marshall in 1943[4]. To our knowledge , this is the first report of endometriosis within ectopic kidney. Therefore, this article mainly describes the patient\u0026apos;s admission diagnosis and treatment process, and reviews the cases reported in the past 30 years, so as to raise awareness of this rare disease.\u003c/p\u003e\n\u003cp\u003eThe clinical presentation of renal endometriosis is diverse and atypical. The absence of typical clinical manifestations may be due to the fact that the renal endometriosis is confined to the renal cortex without involvement the renal calyces. According to previous reports, most of the clinical manifestations of renal endometriosis are abdominal pain and gross hematuria. Long-term periodic bleeding may lead to the gradual increase of hemorrhagic cysts in the kidney tissue and even invasion into the renal calyces, which can result in ureteral obstructions, and that \u0026nbsp; is the main cause of abdominal pain and hematuria[22].\u003c/p\u003e\n\u003cp\u003eThe pathogenesis of endometriosis that occurs outside the reproductive system remains controversial. The main theories can be divided into migration, embryonic and immunology[18][16, 19] [8, 10-12, 14, 23] and previous studies have suggested that renal endometriosis is mostly related to embryonic theory[9, 14, 18].\u003c/p\u003e\n\u003cp\u003eBecause renal endometriosis is so rare, there are currently no treatment guidelines[11]. Clinical treatment mainly includes symptom relief and radical treatment. Therefore, the treatment of renal endometriosis should be carried out according to the patient\u0026apos;s clinical symptoms, the characteristics of the lesion, and the patient\u0026apos;s reproductive plan[21]. If an asymptomatic patient has no change in the lesions on follow-up review, no definitive renal therapy is usually required[8]. In addition, for patients of reproductive age, hormone therapy, such as oral contraceptives can relieve abdominal pain and is the best treatment option in the short-term[24]. Although renal endometriosis is a benign condition, surgery is usually considered, laparoscopic management in particular, as the feasibility of this treatment has been widely proven to reduce the length of hospital stay[24, 25]. Surgical intervention is required if there is a potential risk of ureteral obstruction and even loss of renal function due to repeated bleeding from endometriosis of the kidneys[26].\u003c/p\u003e\n\u003cp\u003eThis article reports the first case of endometriosis in ectopic kidney, and analyzes the clinical features of renal endometriosis. Although imaging features are helpful in renal endometriosis, the final diagnosis relies on pathological findings.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll subjects signed the informed consent form, and this study was approved by the Ethics Committee of the Second Affiliated Hospital of Kunming Medical University (Code: FEY-BG-39-2.0).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent for publication of their clinical details and clinical images was obtained from the patient.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCML and YYM designed the study. CML drafted the manuscript and ZXX contributed to editorial changes.\u0026nbsp;All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eOlive D L, Schwartz L B. Endometriosis[J]. N Engl J Med, 1993,328(24):1759-1769.\u003c/li\u003e\n \u003cli\u003eEisenberg V H, Weil C, Chodick G, et al. Epidemiology of endometriosis: a large population-based database study from a healthcare provider with 2 million members[J]. BJOG: An International Journal of Obstetrics \u0026amp; Gynaecology, 2018,125(1):55-62.\u003c/li\u003e\n \u003cli\u003eVercellini P, Vigano P, Somigliana E, et al. Endometriosis: pathogenesis and treatment[J]. Nat Rev Endocrinol, 2014,10(5):261-275.\u003c/li\u003e\n \u003cli\u003eMarshall V F. The Occurrence of Endometrial Tissue in the Kidney. Case Report and Discussion[J]. The Journal of Urology, 1943,50(6):652-656.\u003c/li\u003e\n \u003cli\u003eYang Y, Zhao X, Huang Y. Renal Endometriosis Mimicking Cystic Renal Tumor: Case Report and Literature Review[J]. Frontiers in Medicine, 2021,8.\u003c/li\u003e\n \u003cli\u003eUmair M, Nawaz M, Murtaza B, et al. Renal endometriosis mimicking a renal tumor in a pregnant patient[J]. Urology Case Reports, 2020,33:101374.\u003c/li\u003e\n \u003cli\u003eBadri A V, Jennings R, Patel P, et al. Renal Endometriosis: The Case of an Endometrial Implant Mimicking a Renal Mass[J]. Journal of Endourology Case Reports, 2018,4(1):176-178.\u003c/li\u003e\n \u003cli\u003eGiambelluca D, Albano D, Giambelluca E, et al. Renal endometriosis mimicking complicated cysts of kidney: report of two cases[J]. G Chir, 2017,38(5):250-255.\u003c/li\u003e\n \u003cli\u003eCheng C, Kuo H, Su B. Endometriosis in a kidney with focal xanthogranulomatous pyelonephritis and a perinephric abscess[J]. BMC Research Notes, 2015,8(1).\u003c/li\u003e\n \u003cli\u003eYang J, Song R, Xu C, et al. Renal Endometriosis Tends to Be Misdiagnosed as Renal Tumor: A Rare Case Report[J]. International Surgery, 2015,100(2):376-380.\u003c/li\u003e\n \u003cli\u003eJiang Y, Kuo H, Hsu Y. Renal endometriosis mimicking an angiomyolipoma[J]. Urological Science, 2013,24(1):24-26.\u003c/li\u003e\n \u003cli\u003eDirim A, Celikkaya S, Aygun C, et al. Renal endometriosis presenting with a giant subcapsular hematoma: case report[J]. Fertility and Sterility, 2009,92(1):391-395.\u003c/li\u003e\n \u003cli\u003eYaqub U, Hassan S, Yusaf Z, et al. Endometriosis in the renal area[J]. Journal of the College of Physicians and Surgeons--Pakistan, 2008,18(3):174.\u003c/li\u003e\n \u003cli\u003eDutta P, Bhat M H, Bhansali A, et al. A young woman with endometriosis of kidney[J]. Saudi medical journal, 2006,27(2):244.\u003c/li\u003e\n \u003cli\u003eGupta K, Rajwanshi A, Srinivasan R. Endometriosis of the kidney: Diagnosis by fine-needle aspiration cytology[J]. Diagnostic Cytopathology, 2005,33(1):60-61.\u003c/li\u003e\n \u003cli\u003eBenchekroun A, Nouini Y, Zennoud M, et al. Endom\u0026eacute;triose r\u0026eacute;nale. \u0026Agrave; propos d\u0026apos;un cas[J]. Annales d\u0026apos;Urologie, 2001,35(5):266-269.\u003c/li\u003e\n \u003cli\u003eHELLBERG D, FORS B, BERGQVIST C. Renal endometriosis treated with a gonadotrophin releasing hormone agonist. Case report[J]. BJOG: An International Journal of Obstetrics and Gynaecology, 1991,98(4):406-407.\u003c/li\u003e\n \u003cli\u003eBazaz-Malik G, Saraf V, Rana B S. Endometrioma of the Kidney: Case Report[J]. The Journal of Urology, 1980,123(3):422-423.\u003c/li\u003e\n \u003cli\u003eGauperaa T, Stalsberg H. Renal endometriosis. A case report[J]. Scand J Urol Nephrol, 1977,11(2):189-191.\u003c/li\u003e\n \u003cli\u003eHajdu S I, Koss L G. Endometriosis of the kidney[J]. Am J Obstet Gynecol, 1970,106(2):314-315.\u003c/li\u003e\n \u003cli\u003eMaccagnano C, Pellucchi F, Rocchini L, et al. Ureteral endometriosis: proposal for a diagnostic and therapeutic algorithm with a review of the literature[J]. Urol Int, 2013,91(1):1-9.\u003c/li\u003e\n \u003cli\u003eShook T E, Nyberg L M. Endometriosis of the urinary tract[J]. Urology, 1988,31(1):1-6.\u003c/li\u003e\n \u003cli\u003eCheng C, Kuo H, Su B. Endometriosis in a kidney with focal xanthogranulomatous pyelonephritis and a perinephric abscess[J]. BMC research notes, 2015,8(1):591.\u003c/li\u003e\n \u003cli\u003eBolze P A, Paparel P, Golfier F. [Urinary tract involvement by endometriosis. Techniques and outcomes of surgical management: CNGOF-HAS Endometriosis Guidelines][J]. Gynecol Obstet Fertil Senol, 2018,46(3):301-308.\u003c/li\u003e\n \u003cli\u003eVan Gorp T, Amant F, Neven P, et al. Endometriosis and the development of malignant tumours of the pelvis. A review of literature[J]. Best Pract Res Clin Obstet Gynaecol, 2004,18(2):349-371.\u003c/li\u003e\n \u003cli\u003eNezhat C, Paka C, Gomaa M, et al. Silent loss of kidney seconary to ureteral endometriosis[J]. JSLS, 2012,16(3):451-455.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 Case reports of renal endometriosis\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"993\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.969788519637461%\"\u003e\n \u003cp\u003eReporting year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.157099697885196%\"\u003e\n \u003cp\u003eLocation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"4.632426988922457%\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.178247734138973%\"\u003e\n \u003cp\u003eClinical features\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.185297079556898%\"\u003e\n \u003cp\u003eEndometrial history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.372608257804632%\"\u003e\n \u003cp\u003eTumor size(cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.091641490433032%\"\u003e\n \u003cp\u003eDiagnosis method\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.983887210473313%\"\u003e\n \u003cp\u003eTreatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.365558912386707%\"\u003e\n \u003cp\u003eOutcome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.06344410876133%\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.969788519637461%\"\u003e\n \u003cp\u003e1970\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.157099697885196%\"\u003e\n \u003cp\u003eLeft kidney\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"4.632426988922457%\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.178247734138973%\"\u003e\n \u003cp\u003eLow back pain and gross hematuria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.185297079556898%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.372608257804632%\"\u003e\n \u003cp\u003e1.5x1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.091641490433032%\"\u003e\n \u003cp\u003eMicroscopic examination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.983887210473313%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.365558912386707%\"\u003e\n \u003cp\u003eDie\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.06344410876133%\"\u003e\n \u003cp\u003e[20]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.969788519637461%\"\u003e\n \u003cp\u003e1977\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.157099697885196%\"\u003e\n \u003cp\u003eRight kidney\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"4.632426988922457%\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.178247734138973%\"\u003e\n \u003cp\u003eTender to palpation in the region of the right kidney\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.185297079556898%\"\u003e\n \u003cp\u003eNot mentioned\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.372608257804632%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.091641490433032%\"\u003e\n \u003cp\u003eHistopathology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.983887210473313%\"\u003e\n \u003cp\u003eNephrectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.365558912386707%\"\u003e\n \u003cp\u003eRecovery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.06344410876133%\"\u003e\n \u003cp\u003e[19]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.969788519637461%\"\u003e\n \u003cp\u003e1980\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.157099697885196%\"\u003e\n \u003cp\u003eUpper pole of the right kidney\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"4.632426988922457%\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.178247734138973%\"\u003e\n \u003cp\u003eDull aching pain in the right loin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.185297079556898%\"\u003e\n \u003cp\u003eNot mentioned\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.372608257804632%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.091641490433032%\"\u003e\n \u003cp\u003eHistopathology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.983887210473313%\"\u003e\n \u003cp\u003eNephrectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.365558912386707%\"\u003e\n \u003cp\u003eNot mentioned\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.06344410876133%\"\u003e\n \u003cp\u003e[18]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.969788519637461%\"\u003e\n \u003cp\u003e1991\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.157099697885196%\"\u003e\n \u003cp\u003eUpper pole of the left kidney\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"4.632426988922457%\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.178247734138973%\"\u003e\n \u003cp\u003eMacroscopic hematuria and back-pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.185297079556898%\"\u003e\n \u003cp\u003eEndometriotic cyst of left ovary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.372608257804632%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.091641490433032%\"\u003e\n \u003cp\u003eUltrasound-guided FNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.983887210473313%\"\u003e\n \u003cp\u003eGnRha\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.365558912386707%\"\u003e\n \u003cp\u003eEffective\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.06344410876133%\"\u003e\n \u003cp\u003e[17]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.969788519637461%\"\u003e\n \u003cp\u003e2001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.157099697885196%\"\u003e\n \u003cp\u003eLeft kidney\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"4.632426988922457%\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.178247734138973%\"\u003e\n \u003cp\u003eFever and pyuria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.185297079556898%\"\u003e\n \u003cp\u003eNot mentioned\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.372608257804632%\"\u003e\n \u003cp\u003eNot mentioned\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.091641490433032%\"\u003e\n \u003cp\u003eHistopathology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.983887210473313%\"\u003e\n \u003cp\u003eNephrectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.365558912386707%\"\u003e\n \u003cp\u003eNot mentioned\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.06344410876133%\"\u003e\n \u003cp\u003e[16]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.969788519637461%\"\u003e\n \u003cp\u003e2005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.157099697885196%\"\u003e\n \u003cp\u003eRight kidney\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"4.632426988922457%\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.178247734138973%\"\u003e\n \u003cp\u003ePain in the lower abdomen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.185297079556898%\"\u003e\n \u003cp\u003eEndometriotic cyst of right ovary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.372608257804632%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.091641490433032%\"\u003e\n \u003cp\u003eUltrasound-guided FNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.983887210473313%\"\u003e\n \u003cp\u003eNot mentioned\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.365558912386707%\"\u003e\n \u003cp\u003eNot mentioned\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.06344410876133%\"\u003e\n \u003cp\u003e[15]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.969788519637461%\"\u003e\n \u003cp\u003e2006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.157099697885196%\"\u003e\n \u003cp\u003eRight kidney\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"4.632426988922457%\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.178247734138973%\"\u003e\n \u003cp\u003eAbdominal pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.185297079556898%\"\u003e\n \u003cp\u003eEndometriotic cyst of left ovary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.372608257804632%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.091641490433032%\"\u003e\n \u003cp\u003eFNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.983887210473313%\"\u003e\n \u003cp\u003eGnRha\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.365558912386707%\"\u003e\n \u003cp\u003eThe lesions regressed slowly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.06344410876133%\"\u003e\n \u003cp\u003e[14]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.969788519637461%\"\u003e\n \u003cp\u003e2008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.157099697885196%\"\u003e\n \u003cp\u003eLeft kidney\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"4.632426988922457%\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.178247734138973%\"\u003e\n \u003cp\u003eLower abdominal pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.185297079556898%\"\u003e\n \u003cp\u003eNot mentioned\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.372608257804632%\"\u003e\n \u003cp\u003e25x15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.091641490433032%\"\u003e\n \u003cp\u003eHistopathology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.983887210473313%\"\u003e\n \u003cp\u003eNephrectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.365558912386707%\"\u003e\n \u003cp\u003eRecovery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.06344410876133%\"\u003e\n \u003cp\u003e[13]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.969788519637461%\"\u003e\n \u003cp\u003e2009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.157099697885196%\"\u003e\n \u003cp\u003eLower pole of the left kidney\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"4.632426988922457%\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.178247734138973%\"\u003e\n \u003cp\u003eLeft lumbar pain and lumbar mass\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.185297079556898%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.372608257804632%\"\u003e\n \u003cp\u003e15x9.7x9.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.091641490433032%\"\u003e\n \u003cp\u003eHistopathology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.983887210473313%\"\u003e\n \u003cp\u003eThe renal capsule was incised and excised after hematoma drainage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.365558912386707%\"\u003e\n \u003cp\u003eRecovery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.06344410876133%\"\u003e\n \u003cp\u003e[12]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.969788519637461%\"\u003e\n \u003cp\u003e2013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.157099697885196%\"\u003e\n \u003cp\u003eMiddle and lower of the right kidney\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"4.632426988922457%\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.178247734138973%\"\u003e\n \u003cp\u003eRight flank pain and hematuria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.185297079556898%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.372608257804632%\"\u003e\n \u003cp\u003e13.5x12x12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.091641490433032%\"\u003e\n \u003cp\u003eHistopathology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.983887210473313%\"\u003e\n \u003cp\u003eNephrectomy, GnRHa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.365558912386707%\"\u003e\n \u003cp\u003eRecovery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.06344410876133%\"\u003e\n \u003cp\u003e[11]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.969788519637461%\"\u003e\n \u003cp\u003e2015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.157099697885196%\"\u003e\n \u003cp\u003eLower pole of the right kidney\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"4.632426988922457%\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.178247734138973%\"\u003e\n \u003cp\u003eDull pain in the right lower back\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.185297079556898%\"\u003e\n \u003cp\u003eNot mentioned\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.372608257804632%\"\u003e\n \u003cp\u003e7.5x5x3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.091641490433032%\"\u003e\n \u003cp\u003eHistopathology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.983887210473313%\"\u003e\n \u003cp\u003eNephrectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.365558912386707%\"\u003e\n \u003cp\u003eNot mentioned\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.06344410876133%\"\u003e\n \u003cp\u003e[10]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.969788519637461%\"\u003e\n \u003cp\u003e2015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.157099697885196%\"\u003e\n \u003cp\u003eRight kidney\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"4.632426988922457%\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.178247734138973%\"\u003e\n \u003cp\u003eIntermittent recurrent right flank pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.185297079556898%\"\u003e\n \u003cp\u003eNot mentioned\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.372608257804632%\"\u003e\n \u003cp\u003eNot mentioned\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.091641490433032%\"\u003e\n \u003cp\u003eHistopathology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.983887210473313%\"\u003e\n \u003cp\u003eNephrectomy after drainage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.365558912386707%\"\u003e\n \u003cp\u003eRecovery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.06344410876133%\"\u003e\n \u003cp\u003e[9]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.969788519637461%\"\u003e\n \u003cp\u003e2017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.157099697885196%\"\u003e\n \u003cp\u003eUpper and lower pole of the left kidney\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"4.632426988922457%\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.178247734138973%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.185297079556898%\"\u003e\n \u003cp\u003eOvarian endometriosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.372608257804632%\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.091641490433032%\"\u003e\n \u003cp\u003eHistopathology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.983887210473313%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.365558912386707%\"\u003e\n \u003cp\u003eNo clinical changes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.06344410876133%\"\u003e\n \u003cp\u003e[8]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.969788519637461%\"\u003e\n \u003cp\u003e2017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.157099697885196%\"\u003e\n \u003cp\u003eMiddle pole of the left kidney\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"4.632426988922457%\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.178247734138973%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.185297079556898%\"\u003e\n \u003cp\u003eOvarian endometriosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.372608257804632%\"\u003e\n \u003cp\u003e＜1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.091641490433032%\"\u003e\n \u003cp\u003eHistopathology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.983887210473313%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.365558912386707%\"\u003e\n \u003cp\u003eNo clinical changes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.06344410876133%\"\u003e\n \u003cp\u003e[8]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.969788519637461%\"\u003e\n \u003cp\u003e2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.157099697885196%\"\u003e\n \u003cp\u003eUpper pole of the left kidney\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"4.632426988922457%\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.178247734138973%\"\u003e\n \u003cp\u003eFlank pain and intermittent gross hematuria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.185297079556898%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.372608257804632%\"\u003e\n \u003cp\u003e2.8x2.6x1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.091641490433032%\"\u003e\n \u003cp\u003eHistopathology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.983887210473313%\"\u003e\n \u003cp\u003ePartial nephrectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.365558912386707%\"\u003e\n \u003cp\u003eNot mentioned\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.06344410876133%\"\u003e\n \u003cp\u003e[7]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.969788519637461%\"\u003e\n \u003cp\u003e2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.157099697885196%\"\u003e\n \u003cp\u003eRight kidney\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"4.632426988922457%\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.178247734138973%\"\u003e\n \u003cp\u003eDull pain in the right lower back\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.185297079556898%\"\u003e\n \u003cp\u003eNot mentioned\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.372608257804632%\"\u003e\n \u003cp\u003e6.5x5.9x5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.091641490433032%\"\u003e\n \u003cp\u003eHistopathology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.983887210473313%\"\u003e\n \u003cp\u003eNephrectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.365558912386707%\"\u003e\n \u003cp\u003eNot mentioned\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.06344410876133%\"\u003e\n \u003cp\u003e[6]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.969788519637461%\"\u003e\n \u003cp\u003e2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.157099697885196%\"\u003e\n \u003cp\u003elower pole of the right kidney\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"4.632426988922457%\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.178247734138973%\"\u003e\n \u003cp\u003eintermittent gross hematuria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.185297079556898%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.372608257804632%\"\u003e\n \u003cp\u003e1.8 \u0026times;1.5 \u0026times; 1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.091641490433032%\"\u003e\n \u003cp\u003eHistopathology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.983887210473313%\"\u003e\n \u003cp\u003eNephrectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.365558912386707%\"\u003e\n \u003cp\u003eRecovery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.06344410876133%\"\u003e\n \u003cp\u003e[5]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 2 Features characterizing renal endometriosis presentation in literature review\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"54.51263537906137%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"45.48736462093863%\"\u003e\n \u003cp\u003en(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"54.51263537906137%\"\u003e\n \u003cp\u003eLocation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"45.48736462093863%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"54.51263537906137%\"\u003e\n \u003cp\u003eLeft kidney\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"45.48736462093863%\"\u003e\n \u003cp\u003e8(47.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"54.51263537906137%\"\u003e\n \u003cp\u003eRight kidney\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"45.48736462093863%\"\u003e\n \u003cp\u003e9(52.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"54.51263537906137%\"\u003e\n \u003cp\u003eSymptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"45.48736462093863%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"54.51263537906137%\"\u003e\n \u003cp\u003ePain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"45.48736462093863%\"\u003e\n \u003cp\u003e13(61.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"54.51263537906137%\"\u003e\n \u003cp\u003eGross hematuria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"45.48736462093863%\"\u003e\n \u003cp\u003e5(23.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"54.51263537906137%\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"45.48736462093863%\"\u003e\n \u003cp\u003e1(4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"54.51263537906137%\"\u003e\n \u003cp\u003eNo symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"45.48736462093863%\"\u003e\n \u003cp\u003e2(9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"54.51263537906137%\"\u003e\n \u003cp\u003eEndometrial history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"45.48736462093863%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"54.51263537906137%\"\u003e\n \u003cp\u003eOvarian endometriosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"45.48736462093863%\"\u003e\n \u003cp\u003e5(29.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"54.51263537906137%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"45.48736462093863%\"\u003e\n \u003cp\u003e6(35.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"54.51263537906137%\"\u003e\n \u003cp\u003eNot mentioned\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"45.48736462093863%\"\u003e\n \u003cp\u003e6(35.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"54.51263537906137%\"\u003e\n \u003cp\u003eTumor size(in greatest diameter)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"45.48736462093863%\"\u003e\n \u003cp\u003e5.5\u0026plusmn;6.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"54.51263537906137%\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"45.48736462093863%\"\u003e\n \u003cp\u003e38.5\u0026plusmn;8.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"54.51263537906137%\"\u003e\n \u003cp\u003eDiagnosis method\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"45.48736462093863%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"54.51263537906137%\"\u003e\n \u003cp\u003eHistopathology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"45.48736462093863%\"\u003e\n \u003cp\u003e13(76.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"54.51263537906137%\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"45.48736462093863%\"\u003e\n \u003cp\u003e4(23.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"54.51263537906137%\"\u003e\n \u003cp\u003eOutcome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"45.48736462093863%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"54.51263537906137%\"\u003e\n \u003cp\u003eRecovery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"45.48736462093863%\"\u003e\n \u003cp\u003e6(35.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"54.51263537906137%\"\u003e\n \u003cp\u003eDied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"45.48736462093863%\"\u003e\n \u003cp\u003e1(5.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"54.51263537906137%\"\u003e\n \u003cp\u003eNo mentioned\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"45.48736462093863%\"\u003e\n \u003cp\u003e6(35.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"54.51263537906137%\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"45.48736462093863%\"\u003e\n \u003cp\u003e4(23.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote:4 cases presented with clinical manifestations of both pain and hematuria. 2 cases no data for size.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Endometriosis, Renal Endometriosis, Ectopic kidney","lastPublishedDoi":"10.21203/rs.3.rs-2571350/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2571350/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eEndometriosis mainly occurs in the pelvic tissues and organs of women. Endometriosis in the kidney is extremely rare, and to the best of our knowledge, this article reports the first case of endometriosis in the ectopic kidney.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase presentation:\u003c/strong\u003e We describe a case of a 19-year-old girl with occasional mild abdominal pain, who was admitted to hospital due to the discovery of an ectopic left kidney. SPECT-CT showed no abnormal radioactive distribution was found in the left pelvis, suggesting that the left ectopic kidney was not functioning. Laparoscopic left ectopic kidney resection was subsequently performed. Histopathology revealed endometriosis of the ectopic left kidney.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e In female patients with clinical manifestations of abdominal pain and gross hematuria, the possibility of renal endometriosis should be considered.\u003c/p\u003e","manuscriptTitle":"Endometriosis in ectopic kidney: A rare case report and literature review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-03-02 16:33:30","doi":"10.21203/rs.3.rs-2571350/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2023-03-13T07:08:01+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-03-01T09:33:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"428a1ffe-d274-440d-802a-ab5745dab951","date":"2023-03-01T09:25:39+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-03-01T09:14:09+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-02-27T17:24:34+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2023-02-27T16:33:39+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-02-27T16:31:47+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2023-02-10T05:43:40+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"49aa6b02-ff59-4992-9cc6-04a8f382cde6","owner":[],"postedDate":"March 2nd, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-10-16T20:46:11+00:00","versionOfRecord":{"articleIdentity":"rs-2571350","link":"https://doi.org/10.1186/s12905-023-02343-x","journal":{"identity":"bmc-womens-health","isVorOnly":false,"title":"BMC Women's Health"},"publishedOn":"2023-04-28 20:36:48","publishedOnDateReadable":"April 28th, 2023"},"versionCreatedAt":"2023-03-02 16:33:30","video":"","vorDoi":"10.1186/s12905-023-02343-x","vorDoiUrl":"https://doi.org/10.1186/s12905-023-02343-x","workflowStages":[]},"version":"v1","identity":"rs-2571350","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2571350","identity":"rs-2571350","version":["v1"]},"buildId":"B-jG_2CBjPDmsCi4Wdhf-","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}