Periureteric Mass in a Treated Case of Papillary Carcinoma of Thyroid: A Diagnostic Dilemma

Sushil Panbude, Archi Agrawal, Shubhada Kane, Anil D’Cruz, Supreeta Arya
In: Journal of Gastrointestinal and Abdominal Radiology · 2019 · vol. 02(01) , pp. 058–063 · doi:10.1055/s-0039-1677773 · W2953605712
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This case report describes a diagnostic challenge posed by periureteral endometriosis in a patient with a history of papillary thyroid carcinoma, highlighting the importance of clinical history and imaging in differentiating extrapelvic endometriosis from malignancy.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 ⓘ

This paper reports a rare diagnostic dilemma in a 41-year-old woman with a history of papillary thyroid carcinoma treated by total thyroidectomy who developed urinary frequency and left lower abdominal pain; imaging (ultrasound and multidetector CT/MRI) showed an ill-defined medial periureteric mass causing narrowing of the distal left ureter and mild upstream hydronephrosis, with a differential including relapsed tuberculosis, fibromatosis/desmoid tumor, and even remote metastatic disease. PET-CT demonstrated FDG uptake limited to the two nodular components (SUV 7–8), while CT-guided FNAC yielded scant material where glandular cells were confirmed as Müllerian (ER, PAX8, WT1 positive, TTF1 negative), leading the pathologist to favor ureteral/periureteric endometriosis. A multidisciplinary preoperative radiopathologic diagnosis of deep pelvic endometriosis causing extrinsic ureteral compression was reached, but the patient lacked a typical endometriosis history and the gyne-oncologist did not concur; final postoperative histopathology supported endometriosis. This paper is centrally about endometriosis — specifically deep pelvic (periureteric) endometriosis mimicking metastatic or other masses in a treated patient.

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Abstract

Abstract Endometriosis is the presence of normal endometrial glands and stroma outside the endometrium, seen in women in the reproductive age group. Endometriosis is common in the pelvis in the pouch of Douglas, rectum, urinary bladder, and uterosacral ligaments. Although extrapelvic endometriosis is uncommon, endometriosis at extrapelvic sites such as the gastrointestinal tract, urinary tract, lung, skin, brain, and scar site has been reported and can mimic other benign and malignant lesions. It is a difficult diagnosis when patients have a preexisting neoplasm as metastasis can be a differential. The clinical history, imaging features, and a strong suspicion of this entity in the reproductive age group help accurate diagnosis of this entity. We present a rare case of deep pelvic (periureteral) endometriosis in a 41-year-old woman with history of papillary carcinoma of the thyroid gland causing diagnostic dilemma on imaging and histopathology and also discuss briefly the imaging findings of endometriosis.

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endometriosis

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