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Endometriosis of the kidney
314
Communications
in brief
Amer.
January 15, 1970 J. Obstet. Gym-c.
to tentorial tears resulting from the forceful sudden compression and upward thrust of the passenger against the lap-type seat belt. More fetal damage without uterine rupture in nonpenetrating traumatic injuries of the gravid uterus will probably come to our attention. REFERENCES
1. Pike, 2. Dyer
J. S.: M. Times 86: 869, 1958. and Barclay, D. L.: AM. J. GYNEC. 83: 907, 1962.
Endometriosis STEVEN
of the I.
LEOPOLD
&
kidney
HAJDU, G.
OBST.
M.D.
KOSS,
M.D.
Department of Pathology, Memorial Hospital for Cancer and Allied Diseases, and James Ewing Hospital, New York, New York
Fig. 1. Low-power photomicrograph dometrial tissue in renal parenchyma. lin and eosin. x25.)
showing en(Hematoxy-
of the kidney is extremely Since Marshall9 reported the first histologically proved case in 1943, there have been only 5 further case reports of this condition.2v 316110311 This is a report of yet another case and a review of the literature. ENDOMETRIOSIS
rare.
A 49-year-old white female the hospital because of epigastric
vomiting.
Two
years prior
was admitted pain, nausea,
to and
to present admission,
she had right radical mastectomy for carcinoma. At the time of admission, there was evidence of generalized carcinomatosis. She underwent therapeutic adrenalectomy 2 weeks after admission. There was metastatic mammary carcinoma in both adrenal glands. Postoperatively, she received steroids and she showed some clinical improvement. One month after operation, she developed low back pain and gross hematuria. Her general condition began to deteriorate. There was decrease in urinary output and increase in ascitis. Bilateral pleural effusion was noted. She was considered for radiation treatment when she became lethargic and suddenly died. A complete postmortem examination was done shortly after death. At autopsy, there was metastatic mammary carcinoma on the peritoneal and pleural surfaces. The weight of the kidneys was within normal limits. On cut sections, both kidneys were congested. A well-demarcated, triangular shaped reddish brown area measuring 1.5 X 1 cm. was noted in the parenchyma of left kidney. It was thought to be a hemorrhagic cyst or infarction. The microscopic examination of this area showed endometrial-iike glands surrounded by typical endometrial stroma and smooth muscle fibers (Figs. 1 and 2). There. was an atrophic and somewhat cystic
Fig. 2. Endometrial glands toxylin and eosin. x250.)
and
stroma.
(Hema-
endometrium. There was no endometriosis or adenomyosis of pelvic organs. The cause of death was attributed to massive necrotizing bronchopneumonia in a patient with extensive metastatic breast carcinoma. Ectopic endometrial tissue is occasionally found in extragenital locations, such as the lung,8 sciatic nerve,’ ureters,4 and lymph nodes.5
Volume
106
Number
2
Communications
in brief
315
Renal endometriosis is indeed a rare finding. Not a single case of this disorder was observed in large review of endometriosis of the urinary tract.ls Some similarities among the reported cases are apparent. All seven patients were premenopausal and had gross or microscopic hematuria. In only one of the cases was renal endometriosis suspected clinically because of cyclic pattern of pain and hematuria.3 Intravenous or retrograde pyelogram were done in 5 cases and in all 5 instances they were found to be abnormal. Four patients complained of flank pain on the side of endometriosis and the lesion was large in 3 cases. The histologic diagnosis of endometriosis was made after nephrectomy in 5 cases and as incidental finding at autopsy in 2 cases. The review of the 6 previous case reports and the study of the present case point out that renal endometriosis is primarily observed in premenopausal women and that it may mimic renal carcinoma. It is of importance to note that malignant changes can occur in foci of endometriosis.” REFERENCES
1.
Baker, G. S., Parsons, W. R., and Welch, J. S.: J. Neurosurg. 25: 652, 1966. Blum, E., and Fruhling, L.: J. Chir. 69: 19, 1953. Fruhling, L., and Blum, E.: J. Urol. (Paris) 57: 151. 1951. Grayburn, R. W.: J. Obstet. Gynaec. Brit. Emp. 67: 74, 1960. Javert, C. T.: Cancer 2: 399, 1949. Kamaev, M. F., and Vygovskii, Y. P.: Urologia 28: 56, 1963. Koss, L. G.: Cancer 16: 1369, 1963. Lattes, R., Shepard, F., Tovell, H., and Wylie, R.: Surg. Gynec. Obstet. 103: 552, 1956. Marshall, V. F.: J. Urol. 50: 652, 1943. Maslow, L. A., and Earner, A.: J. Urol. 64: 564, 1950. Megyeri, L.: Magy. Sebesz. 15: 187, 1962. Stanley, K. E., Utz, D. C., and Dockerty, M. B.: Surg. Gynec. Obstet. 120: 491, 1965.
2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.
444 East 68th Street New York, New York
10021
Chemical composition formed on the Lippes prolonged use AMY
D.
of the deposit loop after
ENGINEER,
M.D.,
F.R.C.S.,
F.R.C.O.G. P.
R.
AMIYA
DASGUPTA, B.
KAR,
PH.D. PH.D.,
F.N.I.
Department of Obstetrics and Gynecology, Queen Mary Hospital, K. G. Medical College, and Division of Endocrinology, Central Drug Research Institute, Lucknow, India
Fig. 1. A Lippes loop (27.5 mm.) removed from a patient (V. B.) for bleeding complaints after 33 months of intrauterine residence (enlarged view) .
DE PO s ITS of calcium carbonate on plastic intrauterine contraceptive devices (IUD) have been observed by some investigat0rs.l The present communication reports on the detailed chemical composition of such solid incrustations sometimes formed on the Lippes loop after prolonged intrauterine residence. The loops with the deposit were from women who had been wearing them from 15 to 40 months, but had to be removed in most cases for intractable vaginal bleeding. In a few women loops removed for reasons other than bleeding also showed similar deposits. The incrustations were not uniform but firm and rough (Fig. 1). Immediately after removal the loops werr washed with ion-free distilled water to make them free from any adhering matter, and then thoroughly air dried. The deposits were carefully scraped off the device and weighed accurately. The quantity of deposit per loop was 8 to 10 mg. The estimations were carried out on the pooled sample obtained by thoroughly mixing together the deposits collected from individual devices. A weighed portion of the sample when treated with dilute hydrochloric acid showed effervescence in cold due to liberation of gases. However, only carbon dioxide was identified and measured quantitatively by Warburg manometric technique; sulphur dioxide and bicarbonate could not be detected.” The metals were determined in an Unicam SP900 Flarne Spectrophotometer from a clear solution of the
Communications
in brief
Amer.
January 15, 1970 J. Obstet. Gym-c.
to tentorial tears resulting from the forceful sudden compression and upward thrust of the passenger against the lap-type seat belt. More fetal damage without uterine rupture in nonpenetrating traumatic injuries of the gravid uterus will probably come to our attention. REFERENCES
1. Pike, 2. Dyer
J. S.: M. Times 86: 869, 1958. and Barclay, D. L.: AM. J. GYNEC. 83: 907, 1962.
Endometriosis STEVEN
of the I.
LEOPOLD
&
kidney
HAJDU, G.
OBST.
M.D.
KOSS,
M.D.
Department of Pathology, Memorial Hospital for Cancer and Allied Diseases, and James Ewing Hospital, New York, New York
Fig. 1. Low-power photomicrograph dometrial tissue in renal parenchyma. lin and eosin. x25.)
showing en(Hematoxy-
of the kidney is extremely Since Marshall9 reported the first histologically proved case in 1943, there have been only 5 further case reports of this condition.2v 316110311 This is a report of yet another case and a review of the literature. ENDOMETRIOSIS
rare.
A 49-year-old white female the hospital because of epigastric
vomiting.
Two
years prior
was admitted pain, nausea,
to and
to present admission,
she had right radical mastectomy for carcinoma. At the time of admission, there was evidence of generalized carcinomatosis. She underwent therapeutic adrenalectomy 2 weeks after admission. There was metastatic mammary carcinoma in both adrenal glands. Postoperatively, she received steroids and she showed some clinical improvement. One month after operation, she developed low back pain and gross hematuria. Her general condition began to deteriorate. There was decrease in urinary output and increase in ascitis. Bilateral pleural effusion was noted. She was considered for radiation treatment when she became lethargic and suddenly died. A complete postmortem examination was done shortly after death. At autopsy, there was metastatic mammary carcinoma on the peritoneal and pleural surfaces. The weight of the kidneys was within normal limits. On cut sections, both kidneys were congested. A well-demarcated, triangular shaped reddish brown area measuring 1.5 X 1 cm. was noted in the parenchyma of left kidney. It was thought to be a hemorrhagic cyst or infarction. The microscopic examination of this area showed endometrial-iike glands surrounded by typical endometrial stroma and smooth muscle fibers (Figs. 1 and 2). There. was an atrophic and somewhat cystic
Fig. 2. Endometrial glands toxylin and eosin. x250.)
and
stroma.
(Hema-
endometrium. There was no endometriosis or adenomyosis of pelvic organs. The cause of death was attributed to massive necrotizing bronchopneumonia in a patient with extensive metastatic breast carcinoma. Ectopic endometrial tissue is occasionally found in extragenital locations, such as the lung,8 sciatic nerve,’ ureters,4 and lymph nodes.5
Volume
106
Number
2
Communications
in brief
315
Renal endometriosis is indeed a rare finding. Not a single case of this disorder was observed in large review of endometriosis of the urinary tract.ls Some similarities among the reported cases are apparent. All seven patients were premenopausal and had gross or microscopic hematuria. In only one of the cases was renal endometriosis suspected clinically because of cyclic pattern of pain and hematuria.3 Intravenous or retrograde pyelogram were done in 5 cases and in all 5 instances they were found to be abnormal. Four patients complained of flank pain on the side of endometriosis and the lesion was large in 3 cases. The histologic diagnosis of endometriosis was made after nephrectomy in 5 cases and as incidental finding at autopsy in 2 cases. The review of the 6 previous case reports and the study of the present case point out that renal endometriosis is primarily observed in premenopausal women and that it may mimic renal carcinoma. It is of importance to note that malignant changes can occur in foci of endometriosis.” REFERENCES
1.
Baker, G. S., Parsons, W. R., and Welch, J. S.: J. Neurosurg. 25: 652, 1966. Blum, E., and Fruhling, L.: J. Chir. 69: 19, 1953. Fruhling, L., and Blum, E.: J. Urol. (Paris) 57: 151. 1951. Grayburn, R. W.: J. Obstet. Gynaec. Brit. Emp. 67: 74, 1960. Javert, C. T.: Cancer 2: 399, 1949. Kamaev, M. F., and Vygovskii, Y. P.: Urologia 28: 56, 1963. Koss, L. G.: Cancer 16: 1369, 1963. Lattes, R., Shepard, F., Tovell, H., and Wylie, R.: Surg. Gynec. Obstet. 103: 552, 1956. Marshall, V. F.: J. Urol. 50: 652, 1943. Maslow, L. A., and Earner, A.: J. Urol. 64: 564, 1950. Megyeri, L.: Magy. Sebesz. 15: 187, 1962. Stanley, K. E., Utz, D. C., and Dockerty, M. B.: Surg. Gynec. Obstet. 120: 491, 1965.
2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.
444 East 68th Street New York, New York
10021
Chemical composition formed on the Lippes prolonged use AMY
D.
of the deposit loop after
ENGINEER,
M.D.,
F.R.C.S.,
F.R.C.O.G. P.
R.
AMIYA
DASGUPTA, B.
KAR,
PH.D. PH.D.,
F.N.I.
Department of Obstetrics and Gynecology, Queen Mary Hospital, K. G. Medical College, and Division of Endocrinology, Central Drug Research Institute, Lucknow, India
Fig. 1. A Lippes loop (27.5 mm.) removed from a patient (V. B.) for bleeding complaints after 33 months of intrauterine residence (enlarged view) .
DE PO s ITS of calcium carbonate on plastic intrauterine contraceptive devices (IUD) have been observed by some investigat0rs.l The present communication reports on the detailed chemical composition of such solid incrustations sometimes formed on the Lippes loop after prolonged intrauterine residence. The loops with the deposit were from women who had been wearing them from 15 to 40 months, but had to be removed in most cases for intractable vaginal bleeding. In a few women loops removed for reasons other than bleeding also showed similar deposits. The incrustations were not uniform but firm and rough (Fig. 1). Immediately after removal the loops werr washed with ion-free distilled water to make them free from any adhering matter, and then thoroughly air dried. The deposits were carefully scraped off the device and weighed accurately. The quantity of deposit per loop was 8 to 10 mg. The estimations were carried out on the pooled sample obtained by thoroughly mixing together the deposits collected from individual devices. A weighed portion of the sample when treated with dilute hydrochloric acid showed effervescence in cold due to liberation of gases. However, only carbon dioxide was identified and measured quantitatively by Warburg manometric technique; sulphur dioxide and bicarbonate could not be detected.” The metals were determined in an Unicam SP900 Flarne Spectrophotometer from a clear solution of the