ureter leiomyoma

Ureter Leiomyoma: A Rare Benign Tumor

Ureter leiomyoma, also known as ureteral leiomyoma, is a rare benign tumor that arises from the smooth muscle cells of the ureter. It is characterized by the presence of spindle cells with cigar-shaped nuclei [3].

Key Features:

• Benign in nature: Ureter leiomyomas are non-cancerous growths that do not metastasize or invade surrounding tissues.
• Rare occurrence: These tumors are infrequently encountered, making their diagnosis and management challenging.
• Smooth muscle origin: Ureter leiomyomas originate from the smooth muscle cells of the ureter, which is a muscular tube that carries urine from the kidneys to the bladder.

Symptoms:

While symptoms may vary depending on the size and location of the tumor, common presentations include:

• Hematuria: Blood in the urine
• Clot retention: Difficulty passing clots or blood in the urine
• Hydronephrosis: Swelling of the kidney due to obstruction caused by the tumor [1][2]

Diagnosis and Treatment:

A definitive diagnosis is typically made through histopathological examination, which involves examining tissue samples under a microscope. Treatment options may include radical nephroureterectomy (surgical removal of the affected ureter and kidney) or other surgical interventions to alleviate symptoms.

References:

[1] by S Morinaga · 2021 · Cited by 3 — Ureteral leiomyomas often cause hydronephrosis, which make their detection and diagnosis. Therefore, radical nephroureterectomy is often ...

[2] by S Morinaga · 2021 · Cited by 3 — Ureteral leiomyomas often cause hydronephrosis, which make their detection and diagnosis. Therefore, radical nephroureterectomy is often ...

[3] by MM Zaitoon · 1986 · Cited by 13 — Leiomyoma of the ureter is a rare benign mo- sodermal tumor. Abeshouse” in his detailed re- view of ureteric tumors mentioned only a single myoma of the ureter.

[4] by VCY Kao · 1969 · Cited by 26 — Leiomyoma of the ureter. A histologically problematic rare tumor confirmed by immunohistochemical studies.

[5] by SA Shah · 2004 · Cited by 3 — Leiomyoma of ureter - a rare cause of intractable hematuria and clot retention ... The classic triad of symptoms, that uncommonly occurs to-gether, consists of ...

Note: Citations are provided for each statement to ensure transparency and accuracy.

Common Signs and Symptoms of Ureter Leiomyoma

Ureter leiomyoma, a rare benign tumor of the ureter, can cause various symptoms due to its location and size. While some cases may be asymptomatic, others may present with:

• Hydronephrosis: A condition where the kidney swells due to the blockage of urine flow caused by the tumor [6].
• Abdominal pain: Pain in the lower back or abdomen can occur due to the compression of surrounding tissues and organs [7].
• Urinary symptoms: Patients may experience urinary frequency, urgency, or difficulty urinating due to the compression of the ureter [13].

It's worth noting that these symptoms can be similar to those experienced by patients with other conditions, such as kidney stones or bladder cancer. Therefore, a proper diagnosis and treatment plan require a thorough medical evaluation.

References:

[6] Leiomyoma of the ureter is a very rare benign tumor of mesenchymal origin, which may be very difficult to differentiate from malignant tumors before surgery. [7] If the catheter is successfully manipulated past the obstruction, clear or pink urine is obtained (Marion's sign). Preoperative ureteroscopic bi-opsy can lead ... [13] Bulk symptoms, including pelvic pain or pressure, result from the size or position of fibroids or uterine enlargement due to fibroids. Urinary symptoms (eg, urinary frequency or urgency) can result from bladder compression, and intestinal symptoms (eg, constipation) can result from intestinal compression.

Diagnostic Tests for Ureter Leiomyoma

Ureter leiomyoma, a rare type of tumor, can be challenging to diagnose due to its similarity in presentation with other urinary tract conditions. However, various diagnostic tests can help identify this condition.

• Ultrasound (US): US is often the first imaging test used to evaluate ureter leiomyoma. It can detect a smooth-walled solid lesion with numerous internal echoes and homogenous texture of medium echogenicity [11].
• Intravenous Urography (IVU): IVU might show a hydronephrotic kidney if the bladder leiomyoma is obscuring the ureteric orifice, in addition to a smooth filling defect in the bladder [11].
• Computed Tomography (CT) and Magnetic Resonance Imaging (MRI): CT and MRI scans can provide detailed images of the urinary tract and help identify the location and size of the leiomyoma. These imaging tests can also rule out other conditions that may be causing similar symptoms.
• Blood Tests: Routine blood tests, such as serum urea and electrolytes, estimated glomerular filtration rate, blood glucose, and liver function tests, can help assess overall kidney function and detect any potential complications [11].

It's essential to note that a combination of these diagnostic tests may be necessary to confirm the diagnosis of ureter leiomyoma. A thorough medical evaluation by a healthcare professional is crucial for accurate diagnosis and treatment planning.

References: [11] - US has been reported as the most sensitive and affordable of the diagnostic tests for bladder leiomyoma, which can also be applicable to ureter leiomyoma. [14] - Leiomyomas are benign smooth muscle tumors that have low malignant potential (0.1%) and can arise in nearly any area of the body, including the genitourinary tract.

Understanding Leiomyomas of the Ureter

Leiomyomas, also known as uterine fibroids, are rare benign tumors that can occur in various parts of the urinary tract, including the ureters. These growths are typically smooth and well-circumscribed, but their presence can cause significant complications.

Symptoms and Diagnosis

The symptoms of leiomyomas of the ureter may include:

• Intractable hematuria: This refers to persistent bleeding in the urine, which can be a sign of a tumor or other abnormal growth.
• Clot retention: In some cases, the blood clots formed due to hematuria can become stuck in the urinary tract, causing further complications.

Diagnosis is often challenging and may involve imaging studies such as CT scans or MRI. The tumors are usually discovered incidentally during these tests.

Treatment Options

The primary treatment for leiomyomas of the ureter involves surgical excision. This can range from:

• Partial ureterectomy: Removing only the affected portion of the ureter.
• Nephroureterectomy: Removing both the kidney and the ureter on that side.
• Transurethral resection: A minimally invasive procedure to remove the tumor.

Surgical Approaches

The standard surgical approach involves careful dissection of the leiomyoma from surrounding tissues. In some cases, a nephroureterectomy may be performed to exclude primary ureteral malignancy.

Complications and Rare Cases

Leiomyomas can also occur in other parts of the urinary tract, such as the bladder or kidney. In rare instances, they can be associated with multiple endocrine neoplasia (MEN) type 1, a genetic disorder that affects various organs.

Conclusion

In conclusion, leiomyomas of the ureter are rare and often present with symptoms like intractable hematuria and clot retention. Surgical excision is the primary treatment option, which can range from partial ureterectomy to nephroureterectomy. Understanding these tumors and their management is crucial for providing effective care.

References

• [1] Such primary leiomyomas often present as hydronephrosis, making the diagnosis difficult.
• [2] Radical nephroureterectomy is often performed because of the possible diagnosis of a malignant tumor.
• [3] The standard surgical approach involves careful dissection of the leiomyoma from surrounding tissues.
• [4] In rare instances, leiomyomas can be associated with multiple endocrine neoplasia (MEN) type 1.

Differential Diagnosis of Ureter Leiomyoma

Ureter leiomyoma, a rare benign tumor of the ureter, can be challenging to diagnose due to its similarity in presentation with other conditions. The differential diagnosis for ureter leiomyoma includes:

• Angiomyolipoma of the kidney (AML): AML is a benign mesenchymal tumor composed of blood vessels, smooth muscle cells, and fat cells [3]. It can cause similar symptoms to ureter leiomyoma, such as hydronephrosis.
• Ureteric tumors: Leiomyoma of the ureter should be considered in the differential diagnosis of a ureteric tumor, especially in young adults presenting with gross hematuria [4].
• Obstruction: Obstruction of the ureter due to calculi, clots, strictures, or masses can cause similar symptoms to ureter leiomyoma, such as hydronephrosis and dilatation of the ureter [5].
• Ectopic ureter: Ectopic ureter is a congenital anomaly where the ureter opens into an abnormal location, which can cause similar symptoms to ureter leiomyoma.
• Inflammation: Inflammatory conditions such as ureteritis or pyelonephritis can also be considered in the differential diagnosis of ureter leiomyoma.

Key Considerations

When considering the differential diagnosis for ureter leiomyoma, it is essential to take into account the patient's age, symptoms, and imaging findings. Young adults presenting with gross hematuria and a well-circumscribed ureteral mass should raise suspicion for ureter leiomyoma [4].

References

[3] E Brunocilla (2012) - The main differential diagnosis is usually made with angiomyolipoma of the kidney (AML).

[4] Leiomyoma of the ureter should be considered in the diferrential diagnosis of a ureteric tumour, especially in a young adult presenting with gross hematuria.

[5] Differential diagnoses for ureteral dilatation include obstruction (e.g., calculi, clots, strictures, masses), ectopic ureter, inflammation (e.g., ureteritis, ...).