2016 Volume 68 Issue 3 Pages 243-247
Retroperitoneal fibrosis is characterized by fibrosis of retroperitoneal cavity and causes the ureteral stricture and obstruction, and hydronephrosis is caused by impaired ureteral peristalsis. We report a case of cervical adenocarcinoma, which was diagnosed after detection of bilateral hydronephrosis caused by retroperitoneal fibrosis. The patient was a 35-year-old non-gravida woman with no past history. She was reffered to another physician, with a compliant of right abdominal pain. Bilateral hydronephrosis and high serum creatinine level (3.8 mg/dl) were detected. She underwent bilateral ureteral stent placement, but renal function did not improve, so she was reffered to the Department of Urology at our hospital. She underwent bilateral nephrostomy and reffered to our Department. No cervical tumor was detected by ultrasonography, but uterine cervix cytology was SCC suspected and colposcopy detected a small tumorous lesion of the cervix. Cervical biopsy was performed and the histology showed mucinous adenocarcinoma. Magnetic resonance imaging revealed no cervical tumor and no lymph node swelling in the pelvis. Computed tomography did not reveal any metastasis. She was diagnosed with cervical cancer stage I B1 and we performed radical hysterectomy and bilateral salpingo-oophorectomy. Intraoperatively, we found marked retroperitoneal fibrosis and harden, inflexible urinary ducts, so retroperitoneal fibrosis was suspected. Macroscopically, there was a mass of 5 mm diameter in the uterine cervix, but no lymph node swelling in the pelvis. Histopathological examination revealed usual-type endocervical adenocarcinoma, with bilateral parametrial invasion, bilateral ovarian metastasis, and retroperitoneal lymph node metastasis, and retroperitoneal infiltrate around bilateral ureters. We considered that this case was cervical adenocarcinoma complicated with bilateral hydronephrosis caused by retroperitoneal fibrosis. She received adjuvant chemotherapy, but she died of the disease 17 months after initial treatment and showed a poor prognosis. This case suggests that we should consider a diagnosis of retroperitoneal fibrosis, when hydronephrosis without obvious organic dysfuncion is detected. [Adv Obstet Gynecol, 68 (3) : 243-247, 2016 (H28.8)]
