Atypical retroperitoneal endometriosis and use of tamoxifen

The involvement of the retroperitoneum by endometriosis occurs only sporadically. In the present report, emphasis will be given to the magnetic resonance imaging findings which raised the diagnostic suspicion of periureteral lesion in a patient undergoing tamoxifen therapy, presenting with left upper quadrant pain and hydronephrosis. Histopathological findings obtained by means of computed tomography-guided percutaneous biopsy revealed the diagnosis of periureteral endometriosis.

Endometriosis; Ureter; Tamoxifen; Magnetic resonance imaging; Biopsy

Authorship

Daniel Zambuzzi Naufel Mailing Address: Dr. Daniel Zambuzzi Naufel. Centro Radiológico Campinas - Hospital Vera Cruz. Avenida Andrade Neves, 707, Botafogo. Campinas, SP, Brazil, 13013-161. E-mail: dznaufel00@hotmail.com

MD, Trainee in Radiology and Imaging Diagnosis, Centro Radiológico Campinas - Hospital Vera Cruz, Campinas, SP, Brazil.Centro Radiológico CampinasBrazilCampinas, SP, BrazilMD, Trainee in Radiology and Imaging Diagnosis, Centro Radiológico Campinas - Hospital Vera Cruz, Campinas, SP, Brazil.

Thiago José Penachim

MDs, Radiologists, Centro Radiológico Campinas - Hospital Vera Cruz, Campinas, SP, Brazil.Centro Radiológico CampinasBrazilCampinas, SP, BrazilMDs, Radiologists, Centro Radiológico Campinas - Hospital Vera Cruz, Campinas, SP, Brazil.

Leandro Luiz Lopes de Freitas

PhD, MD, Pathologist at Laboratório Multipat, Campinas, SP, Brazil.Laboratório MultipatBrazilCampinas, SP, BrazilPhD, MD, Pathologist at Laboratório Multipat, Campinas, SP, Brazil.

Patricia Prando Cardia

Adilson Prando

MD, Radiologist, Head of the Department of Radiology and Imaging Diagnosis, Hospital Vera Cruz, Campinas, SP, Brazil.Department of Radiology and Imaging DiagnosisBrazilCampinas, SP, BrazilMD, Radiologist, Head of the Department of Radiology and Imaging Diagnosis, Hospital Vera Cruz, Campinas, SP, Brazil.

Mailing Address: Dr. Daniel Zambuzzi Naufel. Centro Radiológico Campinas - Hospital Vera Cruz. Avenida Andrade Neves, 707, Botafogo. Campinas, SP, Brazil, 13013-161. E-mail: dznaufel00@hotmail.com

SCIMAGO INSTITUTIONS RANKINGS

PhD, MD, Pathologist at Laboratório Multipat, Campinas, SP, Brazil.Laboratório MultipatBrazilCampinas, SP, BrazilPhD, MD, Pathologist at Laboratório Multipat, Campinas, SP, Brazil.

Figures

Figures (3)

Thumbnail

Figure 1
MRI: axial T2-weighted (a), coronal (b) and T1-weighted image with fat-suppression (c) revealing retroperitoneal solid, retractile tissue (arrows) with predominant low signal intensity on T1- and T2-weighted sequences, located in periureteral site at the level of the intersection with iliac vessels, determining ureteral obstruction and hydronephrosis (d).

Thumbnail

Figure 2
a: Percutaneous biopsy of a left retroperitoneal periureteral retractile lesion (arrow). b: Anterior abdominal approach with extrinsic compression of the abdominal wall for bowel loops separation.

Thumbnail

Figure 3
a: Filiform fragment of fibroadipose tissue showing tubular glands intermingled with spindle cell stroma in one of the extremities (hematoxylin-eosin staining, 100× magnification). b: Squamous and cylindrical glandular epithelium with no atypical finding (asterisk) intermingled with spindle cell stroma with foci of hemorrhage, both with appearance resembling endometrium (hematoxylin-eosin staining, 400× magnification). c: Cytological preparation performed during the biopsy specimen collection (in order to evaluate the appropriateness of the specimen) showing a large cluster of epithelial cells with no atypias (panoptic staining, 400× magnification).

Figure 1 MRI: axial T2-weighted (a), coronal (b) and T1-weighted image with fat-suppression (c) revealing retroperitoneal solid, retractile tissue (arrows) with predominant low signal intensity on T1- and T2-weighted sequences, located in periureteral site at the level of the intersection with iliac vessels, determining ureteral obstruction and hydronephrosis (d).

Figure 2 a: Percutaneous biopsy of a left retroperitoneal periureteral retractile lesion (arrow). b: Anterior abdominal approach with extrinsic compression of the abdominal wall for bowel loops separation.

Figure 3 a: Filiform fragment of fibroadipose tissue showing tubular glands intermingled with spindle cell stroma in one of the extremities (hematoxylin-eosin staining, 100× magnification). b: Squamous and cylindrical glandular epithelium with no atypical finding (asterisk) intermingled with spindle cell stroma with foci of hemorrhage, both with appearance resembling endometrium (hematoxylin-eosin staining, 400× magnification). c: Cytological preparation performed during the biopsy specimen collection (in order to evaluate the appropriateness of the specimen) showing a large cluster of epithelial cells with no atypias (panoptic staining, 400× magnification).

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Publicação do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem Av. Paulista, 37 - 7º andar - conjunto 71, 01311-902 - São Paulo - SP, Tel.: +55 11 3372-4541, Fax: 3285-1690, Fax: +55 11 3285-1690 - São Paulo - SP - Brazil
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