PDF(Pubmed)
Abstract：
Retroperitoneal fibrosis, a rare and often idiopathic condition, poses significant diagnostic challenges. While most cases are considered idiopathic or immune-mediated, a small but important proportion are associated with malignant neoplasms, with implications for prognosis and management. The present study describes the case of a 69-year-old man who presented to the emergency department of the Virgen de las Nieves University Hospital (Granada, Spain), with a 2-week history of epigastric pain, vomiting and altered bowel habits. Laboratory investigations revealed previously undiagnosed renal insufficiency. An abdominal computed tomography (CT) scan showed extensive diffuse retroperitoneal infiltration extending from the periduodenal region to the pubic bone, resulting in gastric dilatation and hydronephrosis. A CT-guided retroperitoneal biopsy was performed and pathology confirmed the presence of urothelial carcinoma. This diagnosis led to the initiation of a chemotherapy regimen consisting of carboplatin and gemcitabine specifically designed for urothelial carcinoma. A follow-up 18F-FDG PET scan performed 6 months later showed a partial functional response. This case illustrates a rare presentation of urothelial carcinoma masked by extensive retroperitoneal fibrosis, and highlights the importance of accurate diagnosis in reducing tumor burden and improving the clinical status of patients.
摘要：
腹膜后纤维化,一种罕见且通常是特发性的疾病，提出了重大的诊断挑战。虽然大多数病例被认为是特发性或免疫介导的，一个小但重要的比例与恶性肿瘤有关，对预后和管理有影响。本研究描述了一名69岁男子的病例，该男子被送往VirgendelasNieves大学医院急诊科（格拉纳达，西班牙),有2周的上腹痛病史,呕吐和改变排便习惯.实验室检查显示以前未确诊的肾功能不全。腹部计算机断层扫描（CT）扫描显示广泛的弥漫性腹膜后浸润，从十二指肠周围区域延伸到耻骨，导致胃扩张和肾积水。CT引导下腹膜后活检，病理证实存在尿路上皮癌。这种诊断导致启动了专门为尿路上皮癌设计的由卡铂和吉西他滨组成的化疗方案。6个月后进行的随访18F-FDGPET扫描显示部分功能反应。此病例说明尿路上皮癌的罕见表现被广泛的腹膜后纤维化掩盖，并强调了准确诊断对减轻肿瘤负担和改善患者临床状况的重要性。
