Ureteral endometriosis and coexistent urethral leiomyoma in a postmenopausal woman

Abstract

We report the case of a postmenopausal woman with a synchronous obstructing intrinsic endometrioma of the left ureter and a coexistent periurethral leiomyoma. Endometriosis in postmenopausal women is a rare clinical entity usually associated with exogenous estrogen use. Urethral leiomyomas are also rare, with only 40 cases reported in the literature. Ovarian hormones are believed to influence the growth of leiomyomas. We report the genitourinary presentation of 2 separate disease entities with known hormonal influence in a postmenopausal woman receiving estrogen replacement therapy. We believe the patient's hormonal milieu affected the development of her concurrent pathology.

Ureteral endometriosis: clinicopathological and immunohistochemical study of 7 cases

“…Rare cases of ureteral endometriosis in postmenopausal women are reported, and in most of these women, there is a history of prolonged estrogen therapy or excessive production of estrogen by the adrenals or pituitary gland [9][10][11][12]. It has been proposed that delayed presentation of ureteral endometriosis associated with extensive renal scarring, with onset well IT IT IT IT IT IT IT IT IT IT before menopause, accounts for most cases of endometriosis in postmenopausal women [3].…”

Leiomyomas of the female urethra and bladder: a report of five cases and review of the literature

“…The cases of leiomyoma developing before puberty are rare; it mainly occurs in the 30s and 40s when female hormones are released most actively, and the size of leiomyoma may be decreased after menopause. Hence, it may be influenced by female hormone [29,30].…”

“…This is due to numerous studies on the association with female hormone that showed evidence contradictory to each other [16,26,29,30]. Therefore, leiomyoma may be developed by other causes.…”

“…The Cornella's report, presenting a total of 23 cases of bladder and urethral leiomyoma, consisting of 16 of bladder and seven of urethral leiomyomas, had the most numerous cases reported by a single institution [5]. Except seven cases of bladder leiomyoma reported by Suhler et al, all studies reported only three cases [27][28][29].…”

Endometriosis in postmenopausal women without previous hormonal therapy: report of three cases

“…The prevalence of pelvic endometriosis is high, affecting approximately 6-10% of women of reproductive age 1 ; intestinal disease incidence varies from 3 to 34% 2 . Although endometriosis has been associated with the occurrence of menstrual cycles, it can affect between 2 and 5% of postmenopausal patients [3][4][5] , and generally occurs as a side-effect of hormone use [6][7][8][9] . In these cases, differential diagnosis with malignancies is critical.…”