Parametrial tumour causing hydronephrosis and hydroureter due to IgG4 mediated retroperitoneal fibrosis; A laparoscopic resection.

Dhammike Silva,Chandu De Silva,Prabath Randombage,Rukshani Edirisinghe,Wedisha Gankanda,Janani Mathanamohan

doi:10.4038/cmj.v66i1.9360

Abstract

Ceylon Medical Journal (CMJ) is a peer-reviewed, open access journal published quarterly by the Sri Lanka Medical Association in the last week of March, June, September and December each year. The mission of the CMJ is to promote the science and art of medicine and betterment of public health. The Journal publishes original papers and commentaries which have relevance to medicine and allied sciences. The CMJ is committed to maintaining and conforming to the editorial and ethical standards recommended by the International Committee of Medical Journal Editors.

Highlights

Retroperitoneal fibrosis (RPF) is a rare disease characterized by the development of inflammation and fibrosis in the soft tissues of the retroperitoneum and other abdominal organs
IgG4 mediated retroperitoneal fibrosis demonstrates a range of clinical manifestations such as lower back pain, abdominal pain or flank pain with urinary symptoms, which may mimic a renal colic and exhibit systemic symptoms such as fever, malaise, nausea, vomiting, weight
This paper presents the very rare presentation of IgG4-related RPF of the parametrium resulting in hydronephrosis and hydroureter which resulted in laparoscopic resection

Summary

Introduction

Retroperitoneal fibrosis (RPF) is a rare disease characterized by the development of inflammation and fibrosis in the soft tissues of the retroperitoneum and other abdominal organs. IgG4 mediated retroperitoneal fibrosis demonstrates a range of clinical manifestations such as lower back pain, abdominal pain or flank pain with urinary symptoms, which may mimic a renal colic and exhibit systemic symptoms such as fever, malaise, nausea, vomiting, weight. Urine cytology for malignant cells was negative invoking a provisional diagnosis of an invasive left ovarian malignancy or an endometriotic nodule with ureteric compression Both of the aforementioned conditions are expected to result in an elevated CA-125 level, which was normal in this patient, at 28 U/mL. The ureteric stent was kept for about six weeks and continuous follow-up care was provided She had good clinical response, as demonstrated by gradually declining levels of inflammatory markers such as ESR and CRP performed every four weeks and is currently being managed on low dose steroid therapy without the need for additional corticosteroid-sparing agents to control the disease. The patient was counselled on natural disease progression, the benefits and adverse effects of the treatment being given and the importance of drug compliance in order to prevent complications

Discussion

Conclusion