Perirenal (Gerota’s) Fascitis

The Pathology of Fibrotic Lesions

“…Many authors believe that the size and shape of the fully developed lesion are determined by the limits of the renal fascial compartment of Gerota and, indeed, some refer to the condition as perirenal or Gerota's fasciitis (Hutch et al, 1959). The boundaries and internal subdivisions of this space are controversial subjects; whereas Mitchell (1950) was able not only to show that there was such a space but that il also has a central mid-line division, others, including Raper (1956), have not been able to demonstrate it satisfactorily.…”

“…Microscopically the plaques may consist of proliferating fibrous tissue, often infiltrated focally with lymphocytes, plasma cells or polymorphs, or of hyalinized collagen in which inflammatory cells are scanty (Raper, 1956; AUGUST Hutch et al, 1959;Stueber, 1959;Knowlan et al, 1960). Small abscesses (Miller et al, 1952) and arteriolitis (Ewell and Bruskewitz, 1952) have also been recorded.…”

“…The clinical manifestations are not limited to the urinary system and symptoms due to vascular obstruction are-not uncommon (Ross and Tinckler, 1958;Hutch et al, 1959). All the retroperitoneal structures tend to be compressed and distorted but the veins and some of the small arteries, and sometimes the ureters, may be invaded and partially or completely obliterated by the fibrous tissue.…”

“…The two most important conditions to be considered in the differential diagnosis are retroperitoneal connective tissue tumours and the extremely rare peri-ureteritis plastica (Vest and Barelare, 1953), which most authors agree is distinct from the entity of retroperitoneal fibrosis, although several (Ross and Tinckler, 1958;Hutch et aL., 1959) believe that the two diseases may ultimately prove to be interrelated. Vest and Barelare's 4 patients all gave a history of urinary infection and had greatly thickened right ureters, due to a chronic inflammatory process affecting the peri-ureteral lymphatics.…”

“…x 40. literature for evidence of previous infection in the areas whose lymphatics drain into the paraaortic nodes, which lie well within the fascial space (Harlin and Hamm, 1952;Chisholm et al, 1954;Hutch et al, 1959). Preceding intraabdominal disease such as colitis or diverticulitis, although present in some cases, is not found sufficiently frequently to become established as a likely cause.…”