ENDOMETRIOSIS AND COEXISTENT URETHRAL LEIOMYOMA IN A POSTMENOPAUSAL WOMAN
ANDREW STRANG, SCOTT W. LISSON, STEVEN P. PETROU
Wake Forest School of Medicine, Winston Salem, North Carolina, and Department of Urology, Mayo Clinic, Jacksonville, Florida, USA
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.
words: ureter; urethra; leiomyoma; endometriosis
Endometriosis occurs rarely in postmenopausal women and is usually associated with exogenous estrogen use or excessive endogenous production by the adrenals or pituitary gland (1). Leiomyomas are benign tumors of smooth muscle origin and are infrequently found in the urinary tract, with only 40 cases of urethral leiomyoma reported in the literature (2,3). The growth of both endometriomas and leiomyomas may be hormonally related. We report the case of a postmenopausal woman with a synchronous obstructing intrinsic endometrioma of the left ureter and a coexistent periurethral leiomyoma.
65-year-old woman was evaluated for painless gross hematuria. She denied
irritative voiding symptoms or a history of urolithiasis or urinary tract
infections. The patient’s medications included conjugated estrogens
and ramipril. Pelvic examination indicated a thickened urethra. Her laboratory
test results were unremarkable. The patient had normal cystoscopic findings,
and intravenous pyelography (IVP) revealed poorly opacified, dilated calices
throughout the left intrarenal collecting system without visualization
of the left distal ureter. Computed tomography (CT) noted a high-density
mass within the left distal ureter. Ureteroscopic biopsy of the ureteral
mass (Figure-1) indicated endometriosis. Magnetic resonance imaging of
the urethra noted a 2.9X2.9X3 cm posterior periurethral mass (Figure-2)
with signal characteristics suggestive of a leiomyoma.
in postmenopausal women is a rarity usually associated with exogenous
estrogen use or excessive endogenous production by the adrenals or pituitary
gland (1). Endometriosis involving the genitourinary tract has been reported
with an incidence of 1.2% and a mean age between 30 and 35 years (1).
The ratio of occurrence in the bladder to ureter to urethra is 40:5:1
(1). On IVP, intrinsic endometriomas tend to produce filling defects and
may mimic transitional cell carcinoma and radiolucent stones. Intrinsic
lesions represent advanced disease and require resection of the involved