title: Signet-ring cell carcinoma of the urinary bladder mimicking retroperitoneal fibrosis.
abstract: We present the case of a 77-year-old white woman with a past medical history of transitional cell carcinoma of the urinary bladder that presented with symptoms of acute renal failure and duodenal obstruction and posed a diagnostic dilemma. Initially, she presented with bilateral ureteral strictures and eventually required bilateral nephrostomy tubes. Later, the patient developed intractable nausea and vomiting secondary to a duodenal stricture. The finding of a "stranding appearance" on computed tomography imaging of the retroperitoneal space raised the suspicion of retroperitoneal fibrosis. Subsequent endoscopic placement of metal stents to relieve the duodenal obstruction failed to relieve her symptoms. The patient's poor general condition precluded an exploratory laparotomy. The patient expired shortly thereafter and an autopsy was performed. The autopsy results revealed full wall thickness signet-ring cell carcinoma of the urinary bladder with extensive metastasis to the retroperitoneum.
authors.affiliation: Department Internal of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA.
authors.forename: M Asif
authors.initials: MA
authors.lastname: Iqbal
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Lawatsch
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Coyle
authors.forename: J Jordi
authors.initials: JJ
authors.lastname: Rowe
authors.forename: Rongshan
authors.initials: R
authors.lastname: Li
authors.forename: Kulwinder S
authors.initials: KS
authors.lastname: Dua
authors.forename: Mahendar S
authors.initials: MS
authors.lastname: Kochar
mesh_terms: D000368:Aged; D001706:Biopsy; D018279:Carcinoma, Signet Ring Cell / Q000175:diagnosis* / Q000473:pathology; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D012185:Retroperitoneal Fibrosis / Q000175:diagnosis / Q000473:pathology; D015607:Stents; D014057:Tomography, X-Ray Computed; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000473:pathology