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TheScientificWorldJOURNAL
Volume 10 (2010), Pages 1714-1722
http://dx.doi.org/10.1100/tsw.2010.166
Case Study

Endometrioid Adenocarcinoma in the Native Ureter of a Renal Transplant Patient: Case Report and Review of the Literature

1Department of Urology Emory, University School of Medicine, Atlanta, GA, USA
2Department of Pathology Emory, University School of Medicine, Atlanta, GA, USA

Received 19 May 2010; Revised 31 July 2010; Accepted 3 August 2010

Academic Editor: Anthony Atala

Copyright © 2010 Kelly A. Healy et al.

Abstract

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.