Periureteral Lipomatosis: Case Report

THE ,TOURNAL OF

Vol. 103, :ifar. Printed in U.S.A.

UROLOGY

Copyright © 1970 by The Williams & Wilkins Co.

PERIURETERAL LIPO:\IATOSIS: CASE REPORT LEON BENDER*

AND

MARTIN KASS

From the Division of Urology and Department of Obstetrics and Gynecology, Michael Reese Hospital and Medical Center, Chicago, Illinois

Since 1959, 13 cases of pelvic lipomatosis have been reported in male The entity is characterized radiogrnphically by high fixa·1ion of the bladder and vertical straightening of the rectosigrnoicl colon. Patie11 ts with and without urinary tract symptoms lm\·e been described and, occasionally, a lower abdominal mass is palpable. The process has been defined as a non-malignant overgrowth of normal fatty tissue limited to the perirectal and perivesical spaces in the peh·is. \Ye recently encounterccl a woman with such presumably non-malignant, neoplastic a growth surrounding both ureters. This case may represent a variant of peh·ic lipomatosis. To our knowledge this is the first reported cftse 111 a woman. CASE REPORT

E. B., No. 109-033, a 51-year-olcl Negress, :3, parn 2, abortns 1, 4 years post-menopausal, had dull lower abdominal pain. Sincc, a thyroidectomy in 1955 the patient has been euthyroid on replacement thcrnpy. Physical examination was unremarkable except for the pelvis in whicb bilateral firm, rubbery, nontencler masses were fixed to the lateral lJelvic walls. The upper extent of these masses could not be determined but were estimated to be approximately 6 cm. in diameter. The possibility of a retroperitoneal origin for these masses was considered. Extensive laboratory and x-rny studies, including excretory mogram, barium

enema, up1:er gastrointestinal ,;cries and serum cholesterol, were witbin normal limits. Ten days after admission to the hospital exploratory laparotomy was performed. The toneal cavity and its contents appeared normaL The fallopian tubes contained minimal rnsidue of old inflammatory disease without enlargement. On each side of the rectosigmoid in the hollow of the sacrum. there were 2 cylindrical masses, approximately 4 cm, in diameter, filling both rctroperitoncal spaces. Each mass extenclecl in a cephalad direction into the lumbar gutters for approximately 10 cm. The left retroperitonea1 space was entered and a well-encapsulated fatty mass was encounterncl. A portion of the lower encl of the mass was excised for biopsy. A normal ureter which was embedded within the mass was inadvertently trnnsected during this procedme (fig. 1), A No. 5 ureteral catheter was passed up the cut meter (fig 2), A left ureteroneocystrn:itomy was performed. Since frozen section was benign, no further operntive procedme \\·as performed. The pathology report revealed normal fatty tissue smrounding a normal ureter (fig. 3). The postoperative comse was uneventful and

Accepted for publication May 28, 1969. * Current address: 2025 South Chariton, Los Angeles, California 90034. 1 Engels, E. P.: Sigmoid colon and urinary bladder in high fixation: roentgen changes simulating pelvic tumor. Radiology, 72: 419, 1959. 2 Leuzinger, D. E., Bahr, tL D., Miller, C. D. and Shipman, G. A.: Case report of high fixation of bladder and sigmoid colon. J. Urol., 85: 163, 1961. 3 Fogg, L. B. and Smyth, W, J.: Pelvic lipomatosis: a condition stimulating pelvic neoplasm. Radiology, 90: 558, 1968. 4 Mahlin, JVI. S. and Dovitz, B. W., Perivesical lipomatosis J. Urol., 100: 720, 1968.

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FIG. 2. Note normal caliber and degree of encapsulation of ureter

FIG. 3

the patient has remained asymptomatic. The left ureteroneocystostomy is functioning satisfactorily and repeated pelvic examinations have shown no change in size or character of the masses. We plan to follow the patient's course closely with periodic excretory urograms and physical examinations. DISCUSSION

The previous 13 cases of extraperitoneal nonrenal fatty depositions have occurred only in men. These have not been associated with systemic metabolic disorders or generalized lipomatosis. They have all exhibited radio-

graphic abnormalities in the lower urogenital and gastrointestinal tract but no involvement of the ureters has been previously described. The present case differs in that both ureters were embedded within the fatty neoplasm without apparent obstruction in an otherwise normal woman. The distinction between lipoma and normal adipose tissue is often difficult. Clinically and histologically the fatty tissue in this case was well encapsulated. On this basis we have considered this collection of adipose tissue to represent a lipoma and, therefore, to be a true neoplasm.

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PERIURETERAL LIPOJ\IATOSIS

The differential cliagnmis of bilateral pel,·ic nrn:;,;e" in women run:; the gamut from ovarian neoplasm to retroperitoncal lymphomas. In addition we have reported an unusual and jntel'esting case of benign lipomas :-ml'rnunding normal ureten;. Our patient pl'esentecl with bilateral pelvic masses ::,imulating gynecological neopl:::;111. Pre\'iondy described cases ,yere also 110t8d Lo ha,·e lo,wr ahdomiDal ma:;:;e:;. Because thi:, may be found on rnui.iue exarni1mtion it should Le oI interest to general ~urgeons and gynecologists, a" well a:; urologi,b. ::,UMi\LARY

Au unusual l'DSf'. of benign bilateral 1:eriureteral lipomato:;is in a ,nnnau has be<:'n pre-

sented. This case may represent a variant of 11elvic lipomatosis described in men. To our knowledge this is the firot case reported of thi:-; eutity ~pecifically located in this area. Al>Dt:NDUM

Since the preparation of thi8 paper, the patient, hydronephrosis on the has suffered operated side. She underwent ureteral tion which ohowed the previo1rnly exposed ureter emased in a dense fibrous reaction with a calcified, constricted area 4 cm. above the ureteroneocysto:-stomy. An intubated ureterotomy and sigmoid patch 11·ere performed.