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Pathak P, Abandeh L, Aboughalia H, Pooyan A, Mansoori B. Overview of F18-FDG uptake patterns in retroperitoneal pathologies: imaging findings, pitfalls, and artifacts. Abdom Radiol (NY) 2024; 49:1677-1698. [PMID: 38652126 DOI: 10.1007/s00261-023-04139-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 11/14/2023] [Accepted: 11/22/2023] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Retroperitoneum can be the origin of a wide variety of pathologic conditions and potential space for disease spread to other compartments of the abdomen and pelvis. Computed tomography (CT) and magnetic resonance imaging (MRI) are often the initial imaging modalities to evaluate the retroperitoneal pathologies, however given the intrinsic limitations, F18-FDG PET/CT provides additional valuable metabolic information which can change the patient management and clinical outcomes. We highlight the features of retroperitoneal pathologies on F18-FDG PET/CT and the commonly encountered imaging artifacts and pitfalls. The aim of this review is to characterize primary and secondary retroperitoneal pathologies based on their metabolic features, and correlate PET findings with anatomic imaging. CONCLUSION Retroperitoneal pathologies can be complex, ranging from oncologic to a spectrum of non-oncologic disorders. While crosse-sectional imaging (CT and MRI) are often the initial imaging modalities to localize and characterize pathologies, metabolic information provided by F18-FDG PET/CT can change the management and clinical outcome in many cases.
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Affiliation(s)
- Priya Pathak
- Abdominal Imaging and Nuclear Medicine Divisions, Department of Radiology, University of Minnesota, 420 Delaware St SE, Minneapolis, MN, 55455, USA.
| | - Laith Abandeh
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Hassan Aboughalia
- Department of Radiology, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Atefe Pooyan
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Bahar Mansoori
- Abdominal Imaging Division, Department of Radiology, University of Washington, Seattle, WA, USA
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Ren L, Fei X, Zhao Y, Xie F, Xue S, Li N, Nie F, Luo Y. Diagnostic value of contrast-enhanced ultrasound in the activity of idiopathic retroperitoneal fibrosis: a retrospective study. Clin Rheumatol 2024; 43:1207-1215. [PMID: 38329616 DOI: 10.1007/s10067-023-06855-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 11/01/2023] [Accepted: 11/24/2023] [Indexed: 02/09/2024]
Abstract
OBJECTIVES To explore the diagnostic value of contrast-enhanced ultrasound (CEUS) in the disease activity of idiopathic retroperitoneal fibrosis (IRPF). METHODS This retrospective study included 148 CEUS examinations from 63 patients with IRPF treated in our hospital from April 2016 to September 2021. They were divided into two groups: IRPF active group (69 examinations) and inactive group (79 examinations). Uni- and multivariable analyses were used to identify independent risk factors for IRPF activity. Receiver operating characteristic (ROC) curves were drawn to establish different diagnostic models to evaluate the diagnostic value of IRPF activity. The z test was used to compare the differences of the area under the curves (AUCs). The value of CEUS in evaluating the variation of disease activity over time was also investigated between repeat patient studies. RESULTS Univariate and multivariate logistic regression analyses revealed the thickness [odds ratio (OR) = 14.125, 95% confidence interval (CI) = 3.017-66.123] was the most significant independent risk factor for IRPF activity (P < 0.01). The best diagnostic model was model 3, which was established by CEUS score combined with thickness. The AUC was 0.944 (95%CI = 0.912-0.977), and the sensitivity and specificity were 89.86% and 86.08%, respectively. The diagnostic performance was not significantly improved after combining clinical symptom (back pain) and laboratory indicators [erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)]. Compared with before treatment, the CEUS score and thickness were significantly decreased after treatment (x2 = 14.580, P < 0.001 and z = 4.708, P < 0.001, respectively). CONCLUSION CEUS has good diagnostic value for IRPF disease activity. Key points • Thickness and contrast-enhanced ultrasound score were significantly higher in the active group than those in inactive group (P < 0.001). • With thickness of 4 mm and contrast-enhanced ultrasound 2 score as optimal cut-off values, the sensitivity and specificity were 89.86%, 81.01% and 52.17%, 100.00%, respectively. • During follow-up, when the disease progressed, the change of CEUS score was earlier than the change of thickness.
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Affiliation(s)
- Ling Ren
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Haidian District, No. 28 Fuxing Road, Beijing, 100853, China
- The Second Medical College of Lanzhou University, Chengguan District, No.222 Tianshui South Road, Lanzhou, 730030, Gansu, China
| | - Xiang Fei
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Haidian District, No. 28 Fuxing Road, Beijing, 100853, China
| | - Yurong Zhao
- Department of Rheumatology, First Medical Center, Chinese PLA General Hospital, Haidian District, No. 28 Fuxing Road, Beijing, 100853, China
| | - Fang Xie
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Haidian District, No. 28 Fuxing Road, Beijing, 100853, China
| | - Shaowei Xue
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Haidian District, No. 28 Fuxing Road, Beijing, 100853, China
| | - Nan Li
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Haidian District, No. 28 Fuxing Road, Beijing, 100853, China
| | - Fang Nie
- The Second Medical College of Lanzhou University, Chengguan District, No.222 Tianshui South Road, Lanzhou, 730030, Gansu, China.
| | - Yukun Luo
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Haidian District, No. 28 Fuxing Road, Beijing, 100853, China.
- The Second Medical College of Lanzhou University, Chengguan District, No.222 Tianshui South Road, Lanzhou, 730030, Gansu, China.
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Dondi F, Albano D, Giubbini R, Bertagna F. PET in idiopathic retroperitoneal fibrosis. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00059-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Ouchani M, Bachir H, Hamaz S, Alaoui H, Serraj K. Retroperitoneal Fibrosis: Beware of Lymphoma. Cureus 2021; 13:e17587. [PMID: 34646640 PMCID: PMC8483394 DOI: 10.7759/cureus.17587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2021] [Indexed: 11/30/2022] Open
Abstract
Retroperitoneal fibrosis is a rare disease manifesting as chronic soft tissue fibrosis in the retroperitoneum, with potential anatomic and/or functional compromise of adjacent organs. It can be primary (idiopathic) or secondary to other conditions such as cancers, radiotherapy, surgery, traumatisms, infections, autoimmune disorders, or drugs. We report herein a 54-year-old patient with symptomatic retroperitoneal fibrosis leading to bilateral hydronephrosis and renal failure, in whom, after a complex diagnostic workup and protracted clinical course, a follicular lymphoma in the retroperitoneal was identified. The patient was treated with rituximab and cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy protocol, with a resolution of hydronephrosis and lower back pain. We include a thorough literature review on etiopathogenesis, diagnosis, therapy, and prognosis of retroperitoneal fibrosis. A meticulous search for malignancy is necessary for this rare condition that, if positive, may have significant therapeutic and prognostic implications.
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Affiliation(s)
- Mohamed Ouchani
- Internal Medicine, Immunohematology and Cellular Therapy Laboratory, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Houda Bachir
- Internal Medicine, Immunohematology and Cellular Therapy Laboratory, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Siham Hamaz
- Infectious Disease, Immunohematology and Cellular Therapy Laboratory, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Habiba Alaoui
- Infectious Disease, Immunohematology and Cellular Therapy Laboratory, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Khalid Serraj
- Internal Medicine, Immunohematology and Cellular Therapy Laboratory, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
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Ali SK, Du K, Orare K. Idiopathic Retroperitoneal Fibrosis: An East African Diagnostic Challenge. Cureus 2021; 13:e15683. [PMID: 34277272 PMCID: PMC8281799 DOI: 10.7759/cureus.15683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 11/24/2022] Open
Abstract
Retroperitoneal fibrosis (RPF) is a rare disease with variable etiology characterized by chronic inflammation and fibrosis of tissue surrounding the abdominal aorta and iliac arteries. The majority of cases of RPF remain idiopathic and mostly reported in men. Glucocorticoids remain key in the treatment of RPF. Little has been reported on RPF in sub-Saharan Africa.
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Affiliation(s)
- Sayed K Ali
- Medicine, Aga Khan University Hospital, Nairobi, KEN
| | - Katie Du
- Internal Medicine, Aga Khan University Hospital, Nairobi, KEN
| | - Kelvin Orare
- Medicine, Aga Khan University Hospital, Nairobi, KEN
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Li R, Fei S, Lv Y, Kong X, Mao W. A case of idiopathic retroperitoneal fibrosis presenting as gallbladder carcinoma. BMC Surg 2021; 21:162. [PMID: 33765983 PMCID: PMC7993538 DOI: 10.1186/s12893-021-01162-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/16/2021] [Indexed: 12/18/2022] Open
Abstract
Background Retroperitoneal fibrosis (RPF) is a rare disease with a poor prognosis characterized by systemic inflammation and fibroinflammatory tissue. Idiopathic RPF (IRPF) accounts for approximately two-thirds of RPF cases. Case presentation A 56-year-old female patient with abdominal distension was admitted to Changxing Hospital. Laboratory tests revealed mild anemia and elevated CA125, while IgG4 and autoantibodies were within the normal ranges. Computed tomography (CT) revealed a gallbladder-occupying lesion, pancreatic cyst and retroperitoneal mass, which may have contributed to bilateral ureteral compression and hydronephrosis. The initial diagnosis was gallbladder carcinoma with lymph node metastasis. Then, abdominal adhesiolysis, cholecystectomy and partial hepatectomy were performed. Histologically, there were fibrosis and inflammation in the retroperitoneal tissue without any malignant cells in the retroperitoneal or gallbladder tissue. Finally, we confirmed the diagnosis of idiopathic retroperitoneal fibrosis, chronic cholecystitis and pancreatic cyst. The patient recovered well following the CT scan, in which dilatation of the bile duct was reduced, and effusion of the bilateral upper ureter was no longer significant. Conclusion This atypical case illustrates that RPF can be combined with other biliary tract diseases. The coexistence of other diseases conceals the symptoms of RPF, which increases the difficulty of image identification. A high degree of suspicion is necessary for routine clinical work. As more cases are reported, further advances in the diagnosis and treatment of RPF can be expected.
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Affiliation(s)
- Rui Li
- Department of Surgery, Changxing People's Hospital, No. 66, Taihu Road, Changxing, Huzhou, 313100, Zhejiang, China
| | - Shengqi Fei
- Department of Surgery, Changxing People's Hospital, No. 66, Taihu Road, Changxing, Huzhou, 313100, Zhejiang, China
| | - Yongfeng Lv
- Department of Surgery, Changxing People's Hospital, No. 66, Taihu Road, Changxing, Huzhou, 313100, Zhejiang, China
| | - Xiangyu Kong
- Department of Surgery, Changxing People's Hospital, No. 66, Taihu Road, Changxing, Huzhou, 313100, Zhejiang, China
| | - Weikun Mao
- Department of Surgery, Changxing People's Hospital, No. 66, Taihu Road, Changxing, Huzhou, 313100, Zhejiang, China.
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Pacella JC, Niwattisaiwong S, Newman D. IgG4-Related Retroperitoneal Fibrosis: A Rare Association With Riedel's Thyroiditis. Cureus 2021; 13:e13997. [PMID: 33884241 PMCID: PMC8054938 DOI: 10.7759/cureus.13997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Idiopathic retroperitoneal fibrosis is a rare fibro-inflammatory disease that can be associated with other IgG4-related diseases (IgG4-RDs). It is exceedingly uncommon to encounter this condition in a patient with Riedel's thyroiditis (RT), another disease in the IgG4-RD family. We present the case of a 53-year-old man with a history of RT who presented for severe localized lower abdominal and suprapubic pain due to obstructive uropathy from extensive retroperitoneal fibrosis. The biopsy of the mass demonstrated fibro-inflammatory tissue, and its immunohistochemistry was notable for IgG4-positive plasma cells. This case highlights the challenge associated with the diagnosis and management of this rare manifestation of IgG4-RD. In a patient with a history of any form of IgG4-RDs, providers should be vigilant for any signs or symptoms that suggest the development of fibrosis in other organs.
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Affiliation(s)
- Jonathan C Pacella
- Pediatrics, University of North Dakota School of Medicine and Health Sciences, Fargo, USA
| | | | - David Newman
- Endocrinology, Diabetes and Metabolism, Sanford Health, Fargo, USA
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Wang K, Wang Z, Zeng Q, Zhu L, Gao J, Wang Z, Zhang S, Yang F, Shen D, Wang Y, Liu Y. Clinical characteristics of IgG4-related retroperitoneal fibrosis versus idiopathic retroperitoneal fibrosis. PLoS One 2021; 16:e0245601. [PMID: 33600452 PMCID: PMC7891782 DOI: 10.1371/journal.pone.0245601] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 01/04/2021] [Indexed: 12/23/2022] Open
Abstract
Retroperitoneal fibrosis (RPF) is an uncommon condition characterized by inflammation and fibrosis in the retroperitoneal space. More than two-thirds of RPF are idiopathic, with the remaining stemed from a variety of secondary causes. It was suggested that IgG4-related RPF is a secondary form of RPF. We undertook this study to compare detailed demographic, clinical and laboratory characteristics of IgG4-related RPF and IRPF in a large Chinese cohort. We retrospectively reviewed the medical records of 132 RPF patients diagnosed at Peking University People’s Hospital between March 2010 and March 2018. Among the 132 patients, the mean age at disease onset was 54.8 years. IgG4-related RPF group showed greater male predominance compared to IRPF group. IgG4-related RPF patients showed a longer interval between symptom onset and diagnosis, and allergic diseases were more common in this group. Sixty-four patients (48.4%) had lower back pain, which was more common in IRPF group than that in IgG4-related RPF patients. In terms of organ involvement, although 42 of 47 patients (89.3%) with IgG4-related RPF had other organ involvement, there were no patients in the IRPF group with other organ involvement. In addition, the serum IgG4 level, elevated eosinophils counts and IgE level were significantly higher in IgG4-related RPF patients. We described the demographic, clinical and laboratory differences between IgG4-related RPF and IRPF patients, indicating their potential differences in pathogenesis, which was of great importance to diagnose and manage the two phenotypes.
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Affiliation(s)
- Kunkun Wang
- Department of Rheumatology and Immunology, Peking University People’s Hospital, Beijing, China
- Department of Rheumatology and Immunology, Tengzhou Central People’s Hospital, Tengzhou, China
| | - Zhenfan Wang
- Department of Rheumatology and Immunology, Peking University People’s Hospital, Beijing, China
| | - Qiaozhu Zeng
- Department of Rheumatology and Immunology, Peking University People’s Hospital, Beijing, China
| | - Lijuan Zhu
- Department of Rheumatology and Immunology, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Jingyuan Gao
- Department of Geriatrics, Affiliated Hospital of North China University of Technology, Tangshan, China
| | - Ziqiao Wang
- Department of Rheumatology and Immunology, Peking University People’s Hospital, Beijing, China
| | - Shanshan Zhang
- Department of Ultrasound, Peking University People’s Hospital, Beijing, China
| | - Fei Yang
- Department of Pathology, Peking University People’s Hospital, Beijing, China
| | - Danhua Shen
- Department of Pathology, Peking University People’s Hospital, Beijing, China
| | - Yi Wang
- Department of Radiology, Peking University People’s Hospital, Beijing, China
| | - Yanying Liu
- Department of Rheumatology and Immunology, Peking University People’s Hospital, Beijing, China
- * E-mail:
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9
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Into Clinical Practice: Diagnosis and Therapy of Retroperitoneal Fibrosis. Curr Rheumatol Rep 2021; 23:18. [PMID: 33569638 DOI: 10.1007/s11926-020-00966-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE OF THE REVIEW We aim to review the most relevant diagnostic features and treatment options of retroperitoneal fibrosis, in order to provide a useful guide for clinical practice. RECENT FINDINGS The recent literature highlights the role of imaging studies such as computed tomography, magnetic resonance imaging and positron emission tomography as useful tools for the diagnosis of retroperitoneal fibrosis, with retroperitoneal biopsy being reserved to atypical cases. The treatment approach is mainly conservative and is based on the use of medical therapies plus urological interventions. Medical therapies essentially comprise glucocorticoids and immunosuppressants-either traditional or biological agents such as rituximab. Surgical ureterolysis is only left for refractory cases. Recent findings in retroperitoneal fibrosis highlight the possibility of a non-invasive diagnostic approach and a conservative treatment strategy.
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Roussel E, Callemeyn J, Van Moerkercke W. Standardized approach to idiopathic retroperitoneal fibrosis: a comprehensive review of the literature. Acta Clin Belg 2020; 75:239-244. [PMID: 31035909 DOI: 10.1080/17843286.2019.1609152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Idiopathic retroperitoneal fibrosis (iRPF) is a rare fibro-inflammatory disease, characterized by inflammation of the abdominal aorta and its surrounding structures. The exact pathophysiology remains unclear. Diagnosis is often troublesome due to the non-specific and highly variable clinical presentation. Standardized treatment protocols are lacking. OBJECTIVE This article presents a review on iRPF, addressing clinical and diagnostic modalities as well as its pathophysiology and the possible inclusion within the IgG4-related disease (IgG4-RD) spectrum. Finally, a diagnostic-therapeutic algorithm for a standardized approach to iRPF is proposed. METHODS The PubMed Internet database was searched. Articles were selected based on the relevance of abstract, article type and impact of the journal. RESULTS iRPF and IgG4-RD share a common autoimmune aetiology. Diagnostics are multimodal and based on imaging. Ruling out malignancy should be of primary concern. Complications are mostly of renal or vascular origin due to compression of retroperitoneal structures. Corticosteroids remain the first-line treatment regimen and are mostly successful, but evidence supporting alternative immunosuppressive and anti-inflammatory treatments is growing. Long-term therapy, as well as follow-up, is paramount in this chronic and often relapsing disease.
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Affiliation(s)
- Eduard Roussel
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Jasper Callemeyn
- Department of Internal Medicine, Nephrology and Renal Transplantation Research Group, Leuven, Belgium
| | - Wouter Van Moerkercke
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
- Department of Gastroenterology, AZ Groeninge, Department of Gastroenterology, Kortrijk, Belgium
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Peng L, Zhang P, Li J, Liu Z, Lu H, Zhu L, Wang X, Teng F, Li X, Guo H, Fei Y, Zhang W, Zhao Y, Zeng X, Zhang F. IgG4-related aortitis/periaortitis and periarteritis: a distinct spectrum of IgG4-related disease. Arthritis Res Ther 2020; 22:103. [PMID: 32366271 PMCID: PMC7197178 DOI: 10.1186/s13075-020-02197-w] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 04/23/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Large vessels could be involved in immunoglobulin (Ig)-G4-related disease (IgG4-RD). This study aimed to clarify the clinical features and evaluate the treatment efficacy for IgG4-RD with aortitis/periaortitis and periarteritis (PAO/PA). METHODS This study prospectively enrolled 587 patients with IgG4-RD with a follow-up time of more than 6 months. The distribution of IgG4-related PAO/PA was classified into four types: type 1, thoracic aorta; type 2a, abdominal aorta; type 2b, abdominal aorta and iliac artery; type 2c, iliac artery; type 3, thoracic and abdominal aorta; and type 4, other arteries. Patient's demographic data, clinical characteristics, laboratory parameters, and treatment efficacy were analyzed. RESULTS Of 587 IgG4-RD patients, 89 (15.2%) had PAO/PA. The average age was 58.3 ± 11.1 years, with male predominance (85.4%). Vessels affected were as follows: abdominal aorta (83.1%), iliac artery (70.8%), thoracic aorta (13.5%), and other vessels (13.5%). The most prevalent distribution type of IgG4-related PAO/PA was type 2b, with 74 (83.1%) patients, followed by type 2a, type 2c, type 3, and type 1. Fifty-five (61.8%) PAO/PA patients had hydronephrosis, with renal insufficiency occurring in 43 (48.3%), and 31 (34.8%) PAO/PA patients had D-J stent drainage due to severe ureteral obstruction. After treatment with a glucocorticoid and immunosuppressants, 82% patients achieved remission with shrinking of the perivascular mass by more than 30%. CONCLUSIONS IgG4-RD with PAO/PA was distinct from non-PAO/PA in demographic features, organ involvement distribution, inflammatory markers, and serum IgG4 and IgE. The most common affected vessel was the abdominal aorta, and most patients responded well with treatment.
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Affiliation(s)
- Linyi Peng
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education & National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China
| | - Panpan Zhang
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education & National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China
| | - Jieqiong Li
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education & National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China
| | - Zheng Liu
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education & National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China
| | - Hui Lu
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education & National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China
| | - Liang Zhu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Xiaorong Wang
- Department of Rheumatology, The First People's Hospital of Yangquan, Yangquan, China
| | - Fei Teng
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education & National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China
| | - Xuemei Li
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Huifang Guo
- Department of Rheumatology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yunyun Fei
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education & National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China
| | - Wen Zhang
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education & National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China.
| | - Yan Zhao
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education & National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China
| | - Xiaofeng Zeng
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education & National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China
| | - Fengchun Zhang
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education & National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China
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CT-Guided Percutaneous Needle Biopsy in Patients with Suspected Retroperitoneal Fibrosis: A Retrospective Cohort Study. Cardiovasc Intervent Radiol 2019; 42:1434-1440. [PMID: 31292673 DOI: 10.1007/s00270-019-02266-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 06/08/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The outcome of CT-guided biopsy in patients with suspected retroperitoneal fibrosis (RF), regarded as technically challenging, remains unclear. This study aimed to evaluate the results of CT-guided biopsy in patients with lesions considered in the differential diagnosis of RF and compare them with results from patients with other retroperitoneal lesions. MATERIALS AND METHODS Patients who underwent CT-guided biopsy of retroperitoneal lesions between January 2010 and September 2018 were retrospectively reviewed. The study cohort with retroperitoneal lesions surrounding the infra-abdominal aorta, iliac vessels, and/or ureters was divided into two groups: Group F included patients with lesions for which RF was considered in the differential diagnosis, and Group C comprised patients with a retroperitoneal mass or lymphadenopathy. Lesion size and depth, and biopsy details including technical success, position, procedure time, diagnostic yield, and complications between the two groups were compared. RESULTS Group F included 27 patients (mean age 68.5 years ± 11.6, 17 male) and Group C 30 patients (mean age 65.0 years ± 11.8, 16 male). The short axis was significantly smaller in Group F than in Group C (19 mm vs 26 mm, P = 0.041), and procedure time was significantly longer in Group F than in Group C (31.5 min ± 13.2 vs 20.3 min ± 8.4, P = 0.001). Technical success rate (93% vs 100%), accuracy (93% vs 93%), and complications (3.7% vs 10%) between Groups F and C were not significantly different. CONCLUSIONS CT-guided biopsy of patients with suspected RF is considered safe and effective.
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Raffiotta F, da Silva Escoli R, Quaglini S, Rognoni C, Sacchi L, Binda V, Messa P, Moroni G. Idiopathic Retroperitoneal Fibrosis: Long-term Risk and Predictors of Relapse. Am J Kidney Dis 2019; 74:742-750. [PMID: 31204195 DOI: 10.1053/j.ajkd.2019.04.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 04/15/2019] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE Idiopathic retroperitoneal fibrosis (IRF) is a rare disorder of unknown cause. Medical therapy can induce remission, but disease relapses are common. This study sought to characterize long-term outcomes of IRF and the factors associated with disease recurrences. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS Retrospective analysis of 50 patients with IRF prospectively followed up for 8.9 (IQR, 4.7-12.7) years at a tertiary-care referral center. EXPOSURES Demographic, clinical, treatment, and laboratory parameters, including measures of autoimmunity. OUTCOME Disease relapse. ANALYTICAL APPROACH Proportional hazards analysis for the subdistribution of competing risks. RESULTS 49 patients received medical treatment and 35 underwent interventional procedures. All patients experienced a clinical response (defined as regression of disease-related symptoms and hydronephrosis, and decrease in the maximal transverse diameter of the retroperitoneal mass on computed tomography of >50%), 44 of whom responded within 1 year. The remaining 6 responded over a median of 2.95 years after starting therapy. 40 patients were alive at last observation, 1 receiving maintenance dialysis and 15 with estimated glomerular filtration rate < 60mL/min/1.73m2. Patient survival at 5, 10, and 15 years was 95%, 84%, and 68%, respectively. 19 (38%) patients had at least 1 relapse (occurring a median of 5.19 years after starting therapy), defined as an increase in serum creatinine level of at least 30% or recurrence/development of hydronephrosis and ≥20% increase in the maximal transverse diameter of the retroperitoneal mass on computed tomography. Cumulative incidences of relapse at 5, 10, and 15 years were 21%, 41%, and 48%, respectively. Baseline antinuclear antibody positivity and male sex were associated with relapse (subdistribution hazard ratios [sHRs] of 5.35 [95% CI, 2.15-13.27] and 4.94 [95% CI, 1.32-18.57], respectively), while higher corticosteroid therapy dosage at 1 year (sHR for relapse per 1-mg/d greater dosage, 0.91 [95% CI, 0.84-0.98]) and treatment with prednisone alone or with tamoxifen (sHR for relapse of 0.25 [95% CI, 0.07-0.85] vs other therapies) were associated with lower rate of relapse. LIMITATIONS Small sample size and variable approaches to therapy. CONCLUSIONS IRF relapses were common and were experienced more frequently by male patients. Corticosteroids alone or with tamoxifen were associated with a lower rate of relapse. The strong association of antinuclear antibody positivity with relapse supports the hypothesis of an autoimmune pathogenesis of IRF.
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Affiliation(s)
- Francesca Raffiotta
- Nephrology Unit, Fondazione Ca'Grande Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Silvana Quaglini
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Carla Rognoni
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Milano, Italy
| | - Lucia Sacchi
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Valentina Binda
- Nephrology Unit, Fondazione Ca'Grande Ospedale Maggiore Policlinico, Milano, Italy
| | - Piergiorgio Messa
- Nephrology Unit, Fondazione Ca'Grande Ospedale Maggiore Policlinico, Milano, Italy
| | - Gabriella Moroni
- Nephrology Unit, Fondazione Ca'Grande Ospedale Maggiore Policlinico, Milano, Italy.
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Cohan RH, Shampain KL, Francis IR, Davenport MS, Stuart Wolf J, Marder W, Swartz RD. Imaging appearance of fibrosing diseases of the retroperitoneum: can a definitive diagnosis be made? Abdom Radiol (NY) 2018; 43:1204-1214. [PMID: 28849414 DOI: 10.1007/s00261-017-1282-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To assess the frequency with which previously reported characteristic findings of retroperitoneal fibrosis (RPF) (a circumferential or almost circumferential peri-aortic mass centered at L4, which does not displace the abdominal aorta or proximal common iliac arteries) are present in patients with RPF, in patients with other fibrosing diseases, and in cancer patients referred to a subspecialty clinic with a suspected diagnosis of RPF, in order to determine whether diagnostic percutaneous biopsy can be avoided in some patients. METHODS This HIPAA-compliant Institutional Review Board-approved retrospective study assessed clinical and CT and MR imaging abnormalities on imaging studies in 92 patients referred to a subspecialty clinic with suspected RPF over a 14-year period. Two reviewers, in consensus, determined the frequency of different CT and MRI findings in three groups of patients (Group 1: those with an eventual diagnosis of RPF, Group 2: those with a fibrosing disease associated with vascular or urologic abnormalities, and Group 3: those with cancer). Assessed imaging features included the presence of retroperitoneal masses, whether masses were single or multiple, whether such masses were circumferential or nearly circumferential, whether they displaced the aorta away from the spine (with the degree of such displacement measured), and whether there were abnormalities outside of the peri-aortic region of the retroperitoneum. The frequency with which findings previously reported as characteristic of RPF were present was determined for each of the three groups. Imaging results were correlated with the final diagnoses. RESULTS Of 68 subjects eventually diagnosed with retroperitoneal fibrosis (RPF) (Group 1), 47 had peri-aortic retroperitoneal masses, 18 of which displaced the aorta anteriorly away from the spine. Of 12 subjects with fibrosing abnormalities related to vascular or urologic disease (Group 2), six had retroperitoneal masses, none of which displaced the aorta away from the spine. Of 12 subjects with malignancies (Group 3), six had peri-aortic retroperitoneal masses only two of whom had aortic displacement. Only 34 of 68 Group 1 subjects had peri-aortic masses characteristic of RPF, compared with six Group 2 subjects and one Group 3 subject. Subjects with characteristic retroperitoneal masses were significantly more likely to have benign disease than cancer (p = 0.009). CONCLUSION Many patients with RPF do not have characteristic imaging findings. Contrary to prior publications, absence of aortic displacement is not seen in all patients with RPF and is seen in some cancer patients. Nonetheless, when infiltrative peri-aortic retroperitoneal soft tissue that does not displace the aorta is encountered on CT or MRI, RPF can be diagnosed with a high degree of confidence, obviating the need for biopsy.
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Liao S, Wang Y, Li K, Zhu J, Zhang J, Huang F. Idiopathic retroperitoneal fibrosis: a cross-sectional study of 142 Chinese patients. Scand J Rheumatol 2017; 47:198-205. [PMID: 29219671 DOI: 10.1080/03009742.2017.1363280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- S Liao
- Department of Rheumatology, PLA General Hospital, Beijing, PR China
| | - Y Wang
- Department of Rheumatology, PLA General Hospital, Beijing, PR China
| | - K Li
- Department of Rheumatology, PLA General Hospital, Beijing, PR China
| | - J Zhu
- Department of Rheumatology, PLA General Hospital, Beijing, PR China
| | - J Zhang
- Department of Rheumatology, PLA General Hospital, Beijing, PR China
| | - F Huang
- Department of Rheumatology, PLA General Hospital, Beijing, PR China
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Sanchez-Alvarez C, Bowman AW, Menke DM, Wang B. IgG4 Isolated Retroperitoneal Fibrosis and Aneurysmal Periaortitis. Am J Med 2017; 130:e521-e524. [PMID: 28882661 DOI: 10.1016/j.amjmed.2017.08.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 08/16/2017] [Accepted: 08/23/2017] [Indexed: 12/30/2022]
Affiliation(s)
| | | | - David M Menke
- Department of Pathology, Mayo Clinic, Jacksonville, Fla
| | - Benjamin Wang
- Department of Rheumatology, Mayo Clinic, Jacksonville, Fla
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Jadhav KK, Kumar V, Punatar CB, Joshi VS, Sagade SN. Retroperitoneal fibrosis-clinical presentation and outcome analysis from urological perspective. Investig Clin Urol 2017; 58:371-377. [PMID: 28868510 PMCID: PMC5577335 DOI: 10.4111/icu.2017.58.5.371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/21/2017] [Indexed: 12/24/2022] Open
Abstract
Purpose To study clinical presentation, laboratory results, imaging findings and treatment options and outcomes of retroperitoneal fibrosis (RPF). To determine whether it follows the same natural course and response to treatment in the Asian population as in the Western world. Materials and Methods Medical records of patients diagnosed with RPF on imaging and histopathology between February 2010 and April 2016 were reviewed. Results Of the 21 patients analyzed, mean age at presentation was 50.81 years. The male to female ratio was 0.9:1. Pain was most common presenting complaint (95.23% cases), almost 85% cases were idiopathic and rests were postradiation induced. The median creatinine level was 1.8 mg/dL. The mean erythrocyte sedimentation rate (ESR) was 53.2 mm/h. Hydronephrosis was present in all patients and 47.6% had atrophic kidneys. Diffuse retroperitoneal mass was present in 61.1%. Ureterolysis with lateralization, omental wrapping or gonadal pedicle wrap was done in 17 cases. Two patients underwent uretero-ureterostomy. One patient underwent ileal replacement of ureter, and one ileal conduit. Eighteen patients received concurrent medical treatment, 11 were given tamoxifen, 2 steroids (Prednisolone), and five were given both. Of the 20 patients with follow-up, 70% had complete symptomatic relief; ESR improvement was seen in 77.8%. Follow-up ultrasound showed resolved and decreased hydronephrosis in 20% and 55% respectively. One patient had treatment failure and 17.65% had disease recurrence. Conclusions RPF is a rare disease with varied presentation and outcomes. The male to female ratio may be equal in Asians and smoking could be lesser contributing factor. More Asian cohort studies are required to support same.
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Affiliation(s)
- Kunal Kishor Jadhav
- Department of Urology, P.D. Hinduja National Hospital & Medical Research Centre, Maharashtra, India
| | - Vikash Kumar
- Department of Urology, P.D. Hinduja National Hospital & Medical Research Centre, Maharashtra, India
| | - Chirag B Punatar
- Department of Urology, P.D. Hinduja National Hospital & Medical Research Centre, Maharashtra, India
| | - Vinod S Joshi
- Department of Urology, P.D. Hinduja National Hospital & Medical Research Centre, Maharashtra, India
| | - Sharad N Sagade
- Department of Urology, P.D. Hinduja National Hospital & Medical Research Centre, Maharashtra, India
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Wang Y, Guan Z, Gao D, Luo G, Li K, Zhao Y, Wang X, Zhang J, Jin J, Zhao Z, Yang C, Zhang J, Zhu J, Huang F. The value of 18F-FDG PET/CT in the distinction between retroperitoneal fibrosis and its malignant mimics. Semin Arthritis Rheum 2017; 47:593-600. [PMID: 28958769 DOI: 10.1016/j.semarthrit.2017.07.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 07/11/2017] [Accepted: 07/28/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To discuss the utility of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computerized tomography (PET/CT) in the diagnosis of idiopathic retroperitoneal fibrosis (iRPF). METHODS IRPF patients diagnosed between September 2011 and June 2016 were included. Retroperitoneal malignancy patients were included as control. The morphological features and FDG uptake of retroperitoneal lesions were measured along with lymph node (LN) mapping. RESULTS Seventy-one iRPF patients were included. Fifteen lymphoma patients and 6 retroperitoneal metastatic malignancy patients were included as control. Significant differences in morphological features were observed between iRPF and lymphoma but not retroperitoneal metastatic carcinoma. Compared with malignancy, iRPF displayed a lower frequency of high-FDG-uptake retroperitoneal lesions (P = 0.017) and a lower mean maximum standardized uptake value (SUVmax) (P < 0.001). LNs located at axillary, retroperitoneal, supraclavicular, inguinal or peritoneal sites were more frequently observed in retroperitoneal malignancy, therefore, were defined as specific LNs. The area under the curve (AUC) for SUVmax was 0.893 with a sensitivity of 85.7% and a specificity of 80.3%, when the cut-off value of the SUVmax was 6.23. The AUC for the logistic regression model combining the lesions above renal arteries, the SUVmax and the number of specific LNs was 0.987 with a sensitivity of 90.5% and a specificity of 98.6%. The risk stratification model analysis indicated that most of the retroperitoneal malignancy patients were at moderate or high level, while most of the iRPF patients were at low risk. CONCLUSIONS Retroperitoneal malignancy can mimic iRPF morphologically. 18F-FDG PET/CT can help to distinguish iRPF from retroperitoneal lymphoma and metastatic malignancy.
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Affiliation(s)
- Yiwen Wang
- Department of Rheumatology, Chinese PLA General Hospital, Beijing, China
| | - Zhiwei Guan
- Department of Nuclear Medicine, Chinese PLA General Hospital, Beijing, China
| | - Dai Gao
- Department of Rheumatology, Chinese PLA General Hospital, Beijing, China
| | - Gui Luo
- Department of Rheumatology, Chinese PLA General Hospital, Beijing, China
| | - Kunpeng Li
- Department of Rheumatology, Chinese PLA General Hospital, Beijing, China
| | - Yurong Zhao
- Department of Rheumatology, Chinese PLA General Hospital, Beijing, China
| | - Xiuru Wang
- Department of Rheumatology, Chinese PLA General Hospital, Beijing, China
| | - Jie Zhang
- Department of Rheumatology, Chinese PLA General Hospital, Beijing, China
| | - Jingyu Jin
- Department of Rheumatology, Chinese PLA General Hospital, Beijing, China
| | - Zheng Zhao
- Department of Rheumatology, Chinese PLA General Hospital, Beijing, China
| | - Chunhua Yang
- Department of Rheumatology, Chinese PLA General Hospital, Beijing, China
| | - Jianglin Zhang
- Department of Rheumatology, Chinese PLA General Hospital, Beijing, China
| | - Jian Zhu
- Department of Rheumatology, Chinese PLA General Hospital, Beijing, China.
| | - Feng Huang
- Department of Rheumatology, Chinese PLA General Hospital, Beijing, China.
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Idiopathic retroperitoneal fibrosis: clinical features and long-term renal function outcome. Int Urol Nephrol 2017; 49:1327-1334. [DOI: 10.1007/s11255-017-1608-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 04/28/2017] [Indexed: 11/27/2022]
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Průcha M, Czinner P, Prokopová P. IgG4-related Diseases - A Rare Polycystic Form of Ormond's Disease. Prague Med Rep 2016; 117:124-128. [PMID: 27668529 DOI: 10.14712/23362936.2016.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Currently, Ormond's disease is classified among IgG4-associated diseases. Its clinical manifestation varies and is characterized by the presence of fibrous retroperitoneal tissue that often affects the ureters or abdominal aorta and iliac arteries. We present a unique case of the polycystic form of Ormond's disease, imitating tumour in the retroperitoneal space. At the time of diagnosis, the disease was not metabolically active and did not require immunosuppressive therapy. The polycystic mass was removed surgically. There has been no exacerbation of the disease during the last 12 months.
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Affiliation(s)
- Miroslav Průcha
- Department of Clinical Biochemistry, Haematology and Immunology, Na Homolce Hospital, Prague, Czech Republic.
| | - Petr Czinner
- Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic
| | - Petra Prokopová
- Department of Pathology, Na Homolce Hospital, Prague, Czech Republic
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Abstract
Idiopathic retroperitoneal fibrosis (RPF), reviewed herein, is a rare fibro-inflammatory disease that develops around the abdominal aorta and the iliac arteries, and spreads into the adjacent retroperitoneum, where it frequently causes ureteral obstruction and renal failure. The clinical phenotype of RPF is complex, because it can be associated with fibro-inflammatory disorders involving other organs, is considered part of the spectrum of IgG4-related disease, and often arises in patients with other autoimmune conditions. Obstructive uropathy is the most common complication, although other types of renal involvement may occur, including stenosis of the renal arteries and veins, renal atrophy, and different types of associated GN. Environmental and genetic factors contribute to disease susceptibility, whereas the immunopathogenesis of RPF is mediated by different immune cell types that eventually promote fibroblast activation. The diagnosis is made on the basis of computed tomography or magnetic resonance imaging, and positron emission tomography is a useful tool in disease staging and follow-up. Treatment of idiopathic RPF aims at relieving ureteral obstruction and inducing disease regression, and includes the use of glucocorticoids, combined or not with other traditional immunosuppressants. However, biologic therapies such as the B cell-depleting agent rituximab are emerging as potentially efficacious agents in difficult-to-treat cases.
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Alvarez Argote J, Bauer FA, Posteraro AF, Dasanu CA. Retroperitoneal fibrosis due to B-cell non-Hodgkin lymphoma: Responding to rituximab! J Oncol Pharm Pract 2016; 22:179-85. [PMID: 25013186 DOI: 10.1177/1078155214543279] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Retroperitoneal fibrosis is a rare disease manifesting as chronic soft tissue fibrosis in the retroperitoneum, with potential anatomic and/or functional compromise of adjacent organs. It can be primary (idiopathic) or secondary to other conditions such as cancers, autoimmune disorders, or drugs. We report herein a 66-year-old patient with symptomatic retroperitoneal fibrosis leading to bilateral hydronephrosis and renal failure, in whom, after a complex diagnostic work-up and protracted clinical course, a B-cell non-Hodgkin lymphoma in the retroperitoneal space and several vertebral bodies was identified. The patient was treated with radiation therapy and weekly rituximab infusions, with resolution of hydronephrosis and lower back pain. We include a thorough literature review on etiopathogenesis, diagnosis, therapy, and prognosis of retroperitoneal fibrosis. A meticulous search for malignancy is necessary in this rare condition that, if positive, may have significant therapeutic and prognostic implications.
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Affiliation(s)
| | - Frank A Bauer
- Department of Pathology, St. Francis Hospital and Medical Center, Hartford, USA
| | - Anthony F Posteraro
- Department of Radiology, St. Francis Hospital and Medical Center, Hartford, USA
| | - Constantin A Dasanu
- Department of Hematology-Oncology, St. Francis Hospital and Medical Center, Hartford, USA
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Abstract
To describe clinical features and outcomes of 26 patients with idiopathic retroperitoneal fibrosis from a single center, we reviewed medical records of consecutive patients with idiopathic retroperitoneal fibrosis evaluated at our facility from January 1, 1998 to December 31, 2013 for clinical features, laboratory and radiographic findings, management, and outcomes. Twenty-six patients met criteria for idiopathic retroperitoneal fibrosis and were included in the study. Median age at diagnosis was 58 years; male-female ratio was 3.3:1.0. Median duration of symptoms was 7 weeks. Abdominal, flank, and/or low back pain were the most common presenting symptoms. Four patients (15 %) had associated autoimmune or fibrosing disorders. Baseline erythrocyte sedimentation rate was elevated in 17 (77 %) of 22 patients tested and C-reactive protein was elevated in 10 (56 %) of 18 patients tested. Hydronephrosis was present in 17 (68 %) patients; 8 (47 %) of 17 had bilateral hydronephrosis. Retroperitoneal mass biopsy was performed in 18 (69 %) patients. Two patients had idiopathic retroperitoneal fibrosis classifiable as IgG4-related disease. Therapy consisted of medications alone in 7 cases, surgical interventions alone in 7 cases, and a combination in 11 cases. One patient achieved remission with no treatment. Most patients treated medically received initial corticosteroids. Methotrexate (1 case), azathioprine (1 case), mycophenolate mofetil (1 case), and tamoxifen (5 cases) were used. No relapses occurred after a median 5-year follow-up. Two (8 %) patients died; five (19 %) developed cancer after diagnosis. In this series, we emphasize the importance of early diagnosis and therapy for overall favorable prognosis of idiopathic retroperitoneal fibrosis.
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ALBERTI C. Drug-induced retroperitoneal fibrosis: short aetiopathogenetic note, from the past times of ergot-derivatives large use to currently applied bio-pharmacology. G Chir 2015; 36:187-91. [PMID: 26712075 PMCID: PMC4732590 DOI: 10.11138/gchir/2015.36.4.187] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Among the secondary forms of retroperitoneal fibrosis (RPF), that drug-induced shows very intriguing aspects given both the broad range of involved pharmaceuticals and the considerable interest arisen from the related pathogenetic mechanisms. The particular incidence, in the last four decades past century, of the RPF due to long-term use of ergot alkaloid derivatives (ergotamine, methysergide, pergolide, bromocriptine, cabergoline) and specific L-dopa derived agents, such as methyldopa, as well as to different analgesics, came progressively down given that their long-term use for either the prevention of migraine attacks or the therapy of chronic pathologies (Parkinson's disease, prolactinoma, pain management, etc) has been, year after year, supplanted or even made unavailable in many countries. More recently, instead, the occurrence of the RPF has been sometimes identified with the use of antitumoral chemotherapeutics, such as carboplatin and methotrexate, and, just lately, as an unusual side-effect of certain biological agents, about which it is timely to go into specific pathogenetic problems in more depth.
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Moura C, Aquino MA, Rocha Filho J, Santiago M. Takayasu's or tuberculous arteritis? BMJ Case Rep 2015; 2015:bcr-2014-208717. [PMID: 26106169 DOI: 10.1136/bcr-2014-208717] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Takayasu's arteritis (TA) is a large vessel vasculitis of unknown aetiology characterised by involvement of the aorta and its major branches. Tuberculous arteritis of the aorta is an uncommon condition usually secondary to the dissemination of Mycobacterium tuberculosis infection from the mediastinum and/or lung to the adjacent aorta; this may mimic TA. We report a case of a 23-year-old woman with cutaneous granulomatous vasculitis and saccular aneurysmal dilation of the aorta and large vessels, and highlight the findings shared by TA and tuberculous arteritis.
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Liang W, Xu S. Imaging-based Evaluation of Retroperitoneal Fibrosis: A Challenge for Radiologists. Radiology 2015; 274:937-8. [DOI: 10.1148/radiol.14141682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Swartz RD. Retroperitoneal Fibrosis and Asbestosis—A Plausible Association? Am J Kidney Dis 2015; 65:378-80. [DOI: 10.1053/j.ajkd.2014.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 09/26/2014] [Indexed: 11/11/2022]
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Idiopathic vs. secondary retroperitoneal fibrosis: a clinicopathological study of 12 cases, with emphasis to possible relationship to IgG4-related disease. Virchows Arch 2013; 463:721-30. [DOI: 10.1007/s00428-013-1480-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 09/11/2013] [Indexed: 12/24/2022]
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Shirani M, Davoudian A, Sharifi A. Retroperitoneal fibrosis associated with propranolol: a case report; is corticosteroid administration necessary after ureterolysis? J Renal Inj Prev 2013; 2:67-9. [PMID: 25340131 PMCID: PMC4206015 DOI: 10.12861/jrip.2013.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 03/25/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Retroperitoneal fibrosis is a rare disease. It can be primary (Ormond's disease) or secondary to inflammation, malignancy or some drugs. Beta-adrenergic blockers including propranolol can cause the retroperitoneal fibrosis disease. CASE A 44-year-old woman who was taking propranolol for 13 years came to our center with complaints of oliguria and uremia symptoms (malaise, nausea and vomiting). After some investigations, it was found that the disease was retroperitoneal fibrosis. In the first step, she was treated with corticosteroids and then because of inadequate response, bilateral ureterolysis was performed. Then, an additional course of corticosteroid therapy was required after surgery. CONCLUSION Retroperitoneal fibrosis is an unknown cause disease that can involve ureters and can cause obstructive symptoms. The imaging procedure of choice for diagnosis is abdominal CT scanning with oral and intravenous contrast agents. Corticosteroids are the first option for treatment, however, if they are not effective and in case of severe obstruction, ureterolysis can be performed. Beta- adrenergic blocker drugs that are widely used in heart diseases can be a cause of retroperitoneal fibrosis.
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Affiliation(s)
- Majid Shirani
- Department of Urology, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Azadeh Davoudian
- Department of Urology, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Abolghasem Sharifi
- Deputy for Research Affairs, Shahrekord University of Medical Sciences, Shahrekord, Iran
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