Endometrioid adenocarcinoma in the native ureter of a renal transplant patient: case report and review of the literature.
Endometriosis is characterized by endometrial-like tissue outside the uterus, primarily on the pelvic peritoneum, ovaries, and rectovaginal septum, and, in rare cases, within the urinary tract (1-3%). Although endometriosis is a benign condition, malignant transformation of endometriosis is a well-described phenomenon. Malignancies arising in endometriosis are uncommon at extragonadal pelvic sites. A case of endometrioid adenocarcinoma in the native ureter of a postmenopausal renal transplant patient presented with painless gross hematuria and hydroureteronephrosis. The patient had a history of total abdominal hysterectomy and bilateral salpingo-oophrectomy 14 years prior for menorrhagia and had since been on unopposed estrogen replacement therapy. Workup revealed a filling defect in the native left mid-ureter secondary to a large 2.5-cm ureteral tumor. Endoscopic biopsies of the native left ureteral mass showed endometrioid adenocarcinoma, grade II-III. The patient ultimately underwent an open native left nephroureterectomy and temporary diverting colostomy. Final pathology confirmed endometrioid adenocarcinoma, grade II-III, arising in a background of endometriosis with negative perirectal lymph nodes. This case of ureteral endometrioid adenocarcinoma highlights the importance of obtaining a careful history and maintaining a high index of suspicion for malignant degeneration, especially in the context of hyperestrogenism.
Healy
Kelly A
KA
Department of Urology, Emory University School of Medicine, Atlanta, GA, USA. khealy@emory.edu
Carney
Kenneth J
KJ
Osunkoya
Adeboye O
AO
D018269:Carcinoma, Endometrioid / Q000150:complications / Q000175:diagnosis*; D016889:Endometrial Neoplasms / Q000150:complications / Q000175:diagnosis*; D004715:Endometriosis / Q000150:complications; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008875:Middle Aged; D014513:Ureter / Q000473:pathology*