[IgG4-related lesion of the retroperitoneum, ureter, and kidney, mimicking infiltrating endometriosis]

I.V. Barinova, S G Radenska-Lopovok, D V Suslikova, O V Girya, T.A. Glebov, Yu.I. Sopova, E A Mamedov, А.А. Popov
Arkhiv patologii · 2026 · vol. 88(5) , pp. 74 · doi:10.17116/patol20268805174 · PMID:42885423 · W7222500190
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This case report highlights the diagnostic challenge of distinguishing IgG4-related lesions in the retroperitoneum and ureter from infiltrating endometriosis, which can cause similar obstructive complications.

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This case report describes a patient initially diagnosed with infiltrating ureteral endometriosis who was found to have an IgG4-related retroperitoneal lesion involving the ureter and kidney. The misdiagnosis led to nephrectomy due to hydronephrosis, highlighting the difficulty in distinguishing between these two conditions clinically and radiologically. The authors emphasize that extragenital endometriosis is rare and often asymptomatic until it causes severe obstruction or renal loss, necessitating careful differential diagnosis against other infiltrative processes like IgG4-related disease. This paper is centrally about endometriosis — specifically, it discusses urinary tract endometriosis as a critical differential diagnosis for retroperitoneal masses that may actually be IgG4-related lesions.

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Abstract

Urinary tract endometriosis is rare, and ureteral involvement is particularly insidious due to its asymptomatic nature. The absence of symptoms can lead to ureteral stricture, hydronephrosis, chronic kidney disease up to end-stage renal failure, and irreversible loss of kidney function. Diagnosis requires imaging methods to assess the degree of obstruction, while treatment involves surgical release of the ureter from endometriotic infiltrates to preserve organ function. Our observation illustrates the difficulty of establishing the etiology of a retroperitoneal tumor-like infiltrate leading to ureteral obstruction and hydronephrosis, as well as the need for differential diagnosis of endometriosis with other infiltrative processes.
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IgG4-связанное поражение забрюшинного пространства, мочеточника и почки, имитирующее инфильтративный эндометриоз Резюме В представленном наблюдении за предполагаемым инфильтративным эндометриозом мочеточника скрывалось IgG4-связанное поражение забрюшинной клетчатки с вовлечением мочеточника, приведшее к гидронефрозу и потере почки. Эндометриоз мочевыводящих путей встречается редко, а в связи с отсутствием симптомов может привести к стриктуре мочеточника, гидронефрозу, хронической почечной недостаточности вплоть до терминальной стадии и необратимой потере функции почки. Наше наблюдение иллюстрирует сложность установления этиологии забрюшинного опухолеподобного инфильтрата, приведшего к обструкции мочеточника и гидронефрозу, а также необходимость дифференциальной диагностики эндометриоза с другими инфильтративными процессами. Ключевые слова - IgG4-связанное заболевание - забрюшинное пространство - нефрэктомия - экстрагенитальный эндометриоз - болезнь Ормонда Дата поступления: 14.05.2026 Дата принятия в печать: 24.06.2026 Дата публикации: 16.10.2026 - Казанцева И.А., Лищук С.В. Новая системная патология — IgG4-связанная склерозирующая болезнь. Клиническая и экспериментальная морфология. 2013;6(2):12-17. - Сокол Е.В. IgG4-связанное заболевание: что мы знаем 20 лет спустя. Терапевтический архив. 2020;92(5):104-109. https://doi.org/10.26442/00403660.2020.05.000632 - Deshpande V, Zen Y, Chan JK, Yi EE, Sato Y, Yoshino T, Klöppel G, Heathcote JG, Khosroshahi A, Ferry JA, et al. Consensus statement on the pathology of IgG4-related disease. Mod Pathol. 2012;25(9):1181-1192. https://doi.org/10.1038/modpathol.2012.72 - Лищук С.В., Казанцева И.А., Дубова Е.А., Павлов К.А., Катунина О.Р., Борбат А.М., Удалов Ю.Д. Морфологические особенности IgG4-связанных поражений различных локализаций. Архив патологии. 2019;81(5):22-29. https://doi.org/10.17116/patol20198105122 - Василенко ВВ, Виноградов ДЛ, Бурлакова АС. IGG4-сопряженная патология: состояние проблемы. Архивъ внутренней медицины. 2017;7(2): 95-106. https://doi.org/10.20514/2226-6704-2017-7-2-95-106 - Лищук С.В., Дубова Е.А., Павлов К.А., Борбат А.М., Удалов Ю.Д. Клинико-морфологические особенности IgG4-связанного забрюшинного фиброза. Альманах клинической медицины. 2020;48(2):110-6. https://doi.org/10.18786/2072-0505-2020-48-010 - Gustilo-Ashby AM, Paraiso MF. Treatment of urinary tract endometriosis. J Minim Invasive Gynecol. 2006;13(6):559-65. https://doi.org/10.1016/j.jmig.2006.07.012 - Nezhat C, Modest AM, King LP. The role of the robot in treating urinary tract endometriosis. Curr Opin Obstet Gynecol. 2013; 25(4):308-11. https://doi.org/10.1097/GCO.0b013e3283630dfc - Bosev D, Nicoll LM, Bhagan L, Lemyre M, Payne CK, Gill H, Nezhat C. Laparoscopic management of ureteral endometriosis: the Stanford University hospital experience with 96 consecutive cases. J Urol. 2009 Dec;182(6):2748-52. https://doi.org/10.1016/j.juro.2009.08.019 - Shook TE, Nyberg LM. Endometriosis of the urinary tract. Urology. 1988;31(1):1-6. https://doi.org/10.1016/0090-4295(88)90560-2 - Nezhat C, Paka C, Gomaa M, Schipper E. Silent loss of kidney seconary to ureteral endometriosis. JSLS. 2012;16:451-455. https://doi.org/10.4293/108680812X13462882736213 - Fedele L, Bianchi S, Zanconato G, Bergamini V, Berlanda N, Carmignani L. Long-term follow-up after conservative surgery for bladder endometriosis. Fertil Steril. 2005;83(6):1729-33. https://doi.org/10.1016/j.fertnstert.2004.12.047 - Guntupalli SR, Doo DW, Guy M, Sheeder J, Omurtag K, Kondapalli L, Valea F, Harper L, Muffly TM. Preparedness of Obstetrics and Gynecology Residents for Fellowship Training. Obstet Gynecol. 2015;126(3):559-568. https://doi.org/10.1097/AOG.0000000000000999 - Sekulic M, Sekulic SP, Movahedi-Lankarani S. IgG4-related Disease of the Ovary: A First Description. International Journal of Gynecological Pathology. 2017; 36(3): 300-303, https://doi.org/10.1097/PGP.0000000000000320 - Alorjani MS, Obeidat NA, Ababneh EI, Salem AA, Matalka I. A 47-Year-Old Woman with Immunoglobulin G4 (IgG4)-Related Disease Involving the Right Ovary. Am J Case Rep. 2020; 21:e926803-1-e926803-5. https://doi.org/10.12659/AJCR.926803 - Akyol S, Atalay FÖz, Hasdemir S, Yerci Ö. IgG4-Related Disease of the Ovary. Turkish Journal of Pathology. 2021;37(1):063-066. https://doi.org/10.5146/tjpath.2020.01500 - Stearns K, Vuppuluri B, Lininger R, Berry LK. IgG4-related disease in the pelvis: A mimicker of gynecologic malignancy. Gynecologic Oncology Reports. 2024; 54:101428. https://doi.org/10.1016/j.gore.2024.101428 - Rujiwetpongstorn R, Sukswai N, Tantbirojn P, Asawanonda P. Vaginal mass: a rare manifestation of IgG4-related disease. JAAD Case Rep. 2022;6:21:6-9. https://doi.org/10.1016/j.jdcr.2021.12.027 - Румянцев П.О., Чухачева О.С., Козлов И.Г., Колпакова Е.А., Коренев С.В., Гончаров А.Г., Уланова Е.Ю. IgG4-ассоциированные заболевания в эндокринологии. Проблемы эндокринологии. 2020;66(2):24-32. https://doi.org/10.14341/probl12285 - Wallace ZS, Zhang Y, Perugino CA, et al. Clinical phenotypes of IgG4-related disease: an analysis of two international cross-sectional cohorts. Ann Rheum Dis. 2019;78(3):406-412. https://doi.org/10.1136/annrheumdis-2018-214603 - Kamisawa T, Zen Y, Pillai S, et al. IgG4-related disease. Lancet. 2015;385(9976):1460-1471. https://doi.org/10.1016/S0140-6736(14)60720-0 Рекомендуем статьи по данной теме: Клинико-морфологическое наблюдение ретроперитонеальной малакоплакии.Архив патологии. 2025;87(4):58-61 Эндометриоз передней брюшной стенки после родоразрешения. Причины развития, лечение и профилактика.Российский вестник акушера-гинеколога. 2025;25(4):80-85 Эндометриоз промежности после родоразрешения: причины развития, лечение, профилактика.Российский вестник акушера-гинеколога. 2025;25(3):79-83 Урогенитальный эндометриоз.Российский вестник акушера-гинеколога. 2025;25(2):61-67 Экстрагенитальный эндометриоз без железистого компонента с поражением диафрагмы и плевры.Архив патологии. 2025;87(2):59-63

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Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Adult Adult Adult Adult Adult

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