Ureteric endometriosis masquerading as ureteric neoplasm

Shreya Goel, Teerthnath Srinivas, Shubha P. Bhat, Vartika Singh
In: International Journal of Research in Medical Sciences · 2020 · vol. 8(9) , pp. 3377 · doi:10.18203/2320-6012.ijrms20203697 · W3081748020
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This case report describes a postmenopausal woman whose ureteric endometriosis was radiologically misdiagnosed as a ureteric neoplasm, highlighting its diagnostic challenges.

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This case report describes a postmenopausal female presenting with lower backache who was initially radiologically diagnosed with a neoplastic ureteric stricture. The patient’s condition was ultimately identified as ureteric endometriosis, highlighting the diagnostic difficulty when this rare presentation mimics malignancy. Ureteric involvement in pelvic endometriosis is uncommon, occurring in only 1% of cases, and can lead to severe renal complications such as hydroureteronephrosis or irreversible failure if not correctly identified. This paper is centrally about endometriosis — specifically the rare and challenging presentation of ureteric endometriosis that masquerades as a ureteric neoplasm.

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Abstract

Endometriosis is a disease seen in 10-15% of reproductive age women, which involves the pelvic cavity. The urinary tract is affected in 1% cases of pelvic endometriosis, while 0.1-0.4% of ureteric endometriosis which is extremely rare. Ureteric endometriosis poses a diagnostic challenge, as it can be asymptomatic or can present as renal colic. It can lead to a severe burden on kidneys like hydroureteronephrosis, renal atrophy, and irreversible renal failure. Authors report an extremely rare case of ureteric endometriosis in a postmenopausal female, who presented with complaints of lower backache. Radiologically diagnosed as neoplastic ureteric stricture.
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Ureteric endometriosis masquerading as ureteric neoplasm DOI: https://doi.org/10.18203/2320-6012.ijrms20203697Keywords: Endometriosis, Hydronephrosis, Ureteric neoplasm, Ureteric obstructionAbstract Endometriosis is a disease seen in 10-15% of reproductive age women, which involves the pelvic cavity. The urinary tract is affected in 1% cases of pelvic endometriosis, while 0.1-0.4% of ureteric endometriosis which is extremely rare. Ureteric endometriosis poses a diagnostic challenge, as it can be asymptomatic or can present as renal colic. It can lead to a severe burden on kidneys like hydroureteronephrosis, renal atrophy, and irreversible renal failure. Authors report an extremely rare case of ureteric endometriosis in a postmenopausal female, who presented with complaints of lower backache. Radiologically diagnosed as neoplastic ureteric stricture. Metrics References Parasar P, Ozcan P, Terry K. Endometriosis: epidemiology, diagnosis and clinical management, Curr Obstet Gynecol Rep 2017; 6(1): 34-41. Acién P, Velasco I. Endometriosis: a disease that remains enigmatic. ISRN Obstet Gynecol. 2013:1-12. Kumar S, Tiwari P, Sharma P, Goel A, Singh JP, Vijay MK, et al. Urinary tract endometriosis: review of 19 cases. Urol Ann. 2012;4(1):6-12. Vrettos A, Prasinou M, Frymann R. Ureteral endometriosis: an uncommon cause of ureteral stricture. Quant Imaging Med Surg. 2016;6(2):231-2. Palla VV, Karaolanis G, Katafigiotis L, Anastasiou L. Ureteral endometriosis: a systematic literature review. Indian J Urol. 2017;33:276-82. Oxholm D, Knudsen UB, Kryger-Baggesen N, Ravn P. Postmenopausal endometriosis. Acta Obstet Gynecol. 2007;86:1158-64. Tanaka K, Amoako AA, Gray K, Baartaz D. Unilateral ureteric endometriosis at the pelvic brim resulting in complete loss of renal function. Case Reports Obstet Gynecol. 2019:1-6. Ponticelli C, Graziani G, Montanari E. Ureteral endometriosis: a rare and underdiagnosed cause of kidney dysfunction. Nephron Clin Pract. 2010;114:89-94. Maccagnano C. Ureteral endometriosis: proposal for a diagnostic and therapeutic algorithm with a review of the literature. Urol Int. 2013;91:1-9. Nezhat C, Paka C, Gomaa M, Schipper E. Silent loss of kidney secondary to ureteral endometriosis. JSLS 2012;16(3):451-5.

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