RETROPERITONEAL FIBROSIS

A case of retroperitoneal fibrosis secondary to chronic periaortitis

Retroperitoneal fibrosis is a rare inflammatory disorder causing increased fibrotic deposition in the retroperitoneum, often leading to ureteral obstruction. We present a case report of a 33-year-old male with 2-month history of back pain. Initial imaging showed thickening around the infrarenal aorta. Six months later the patient presented with renal failure; a CT abdomen revealed extensive soft tissue mass around the aorta resulting in ureteral obstruction. Histology results of biopsy of the soft tissue mass revealed retroperitoneal fibrosis. It is important for clinicians to treat periaortitis early as this can prevent progression to retroperitoneal fibrosis which can cause severe secondary complications such as renal failure from ureteral obstruction.

Retroperitoneal fibrosis after chemo-radiotherapy for cervical cancer: A case report

Retroperitoneal fibrosis (RPF) is a rare disease characterized by proliferation of fibro-inflammatory tissue in the retroperitoneum. Multiple studies have reported on the idiopathic cases of the disease, but reports of RPF secondary to irradiation are very limited. Herein, we report the case of a 47-year-old woman who complained of lower abdominal pain 14 months after chemo-radiotherapy for cervical cancer. Computed tomography showed a soft-tissue mass spreading in the presacral space. Biopsy of the lesion revealed fibro-inflammatory tissue without malignancy. Retrospective imaging findings showed that the lesion was consistent with the irradiation field. We diagnosed the patient with RPF caused by radiotherapy. We started oral administration of prednisolone at a dose of 30 mg/day. After 3 months, scans showed a remarkable reduction in lesion size. Prednisolone was tapered to a maintenance dose of 5 mg/day, which is ongoing. The patient is doing well with no recurrence to date.

An Unusual Presentation of Prostate Carcinoma

Prostate carcinoma is the second most common cancer among men worldwide. Although prostate carcinoma is common, its presentation resembling retroperitoneal fibrosis is uncommon. We report a patient with prostate carcinoma mimicking retroperitoneal fibrosis. An elderly male presenting in a volume overload state with features of obstructive uropathy was diagnosed as a case of prostate carcinoma. Magnetic resonance imaging was suggestive of retroperitoneal fibrosis. The presentation of prostate carcinoma as retroperitoneal fibrosis is rare.

Serotonin 5-HT2A receptor induces TGF-beta1 expression in mesangial cells via ERK: proliferative and fibrotic signals

We examined the links between fibrotic and proliferative pathways for the 5-HT2A receptor in rat mesangial cells. Serotonin (5-hydroxytryptamine, 5-HT) induced transforming growth factor-beta1 (TGF-beta1) mRNA in a concentration-dependent (peak at 30 nM 5-HT) and time-dependent fashion. For 10 nM 5-HT, the effect was noticeable at 1 h and maximal by 6 h. Inhibition of 1) protein kinase C (PKC), 2) mitogen- and extracellular signal-regulated kinase kinase (MEK1) with 2'-amino-3'-methoxyflavone (PD-90859), and 3) extracellular signal-regulated kinase (ERK) with apigenin attenuated this effect. The effect was blocked by antioxidants, N-acetyl-L-cysteine (NAC) and alpha-lipoic acid, and mimicked by direct application of H2O2. TGF-beta1 mRNA induction was also blocked by diphenyleneiodonium and 4-(2-aminoethyl)-benzenesulfonyl fluoride, which inhibit NAD(P)H oxidase, a source of oxidants. 5-HT increased the amount of TGF-beta1 protein, validating the mRNA studies and demonstrating that 5-HT potently activates ERK and induces TGF-beta1 mRNA and protein in mesangial cells. Mapping studies strongly supported relative positions of the components of the signaling cascade as follow: 5-HT2A receptor --> PKC --> NAD(P)H oxidase/reactive oxygen species --> MEK --> ERK --> TGF-beta1 mRNA. These studies demonstrate that mitogenic signaling components (PKC, MEK, and oxidants) are directly linked to the regulation of TGF-beta1, a key mediator of fibrosis. Thus a single stimulus can direct both proliferative and fibrotic signals in renal mesangial cells.

La fibrosi retroperitoneale idiopatica. Manifestazioni cliniche: Idiopathic retroperitoneal fibrosis. Clinical features

Retroperitoneal fibrosis (RPF) is probably a partial manifestation of a systemic disease of the connective tissue. The clinical features of RPF are linked to the development of a retroperitoneal fibrous plaque which compresses and obstructs the ureters, the aorta, the inferior cava and the adjacent structures. Ormond's disease is characterised by two clinical stages: the early stage with signs and symptoms very similar to those of any subacute or chronic inflammation and the advanced stage with clinical features attributable to progressive ureteral obstruction, compression of the great vessels and involvement of the digestive apparatus.

L'eziopatogenesi della fibrosi retroperitoneale: Etiopathogenesis of retroperitoneal fibrosis

The etiopathogenesis of retroperitoneal fibrosis is still obscure and probably multifactorial. Among the secondary forms due to demonstrable causes, the one caused by aorto-iliac atherosclerosis has recently been recognised. Its pathogenesis is linked to the low density oxidised lipoproteins of the atheromatous plaque, which are responsible for a local immunologic reaction. The most common form is still idiopathic or primitive, hypothetically related to genetic, environmental, vascular and/or immunologic factors. Idiopathic retroperitoneal fibrosis is sometimes associated with other sclerosing syndromes and/or systemic diseases. In such cases a common pathogenesis, probably immunologic may be postulated. After having illustrated the different categories of retroperitoneal fibrosis, the authors report their experience with 25 patients of whom 14 had idiopathic fibrosis and 11 secondary fibrosis. In the former group 11 patients (78.5%) smoked more than 10 cigarettes a day, while there was a history of prolonged professional exposure to asbestos in one case. The following associated pathologies were observed: hypertension in 7 cases (50%), ischemic cardiopathy in 2 (14.3%), diabetes mellitus in 2 (14.3%), multiple myeloma in 1 (7.1%) and juvenile rheumatoid arthritis in 1 (7.1%). The disease was also associated with other sclerosing pathologies in 3 cases: sclerosing cholangitis in 2 and Dupuytren's contracture in 1. The location of the fibrosis was typically periaortic in 13 cases (92.8%), as shown by CT. Lastly, 10 patients underwent immunosuppressive therapy with a favourable response, suggesting the probable immunologic pathogenesis of the disease.

La fibrosi retroperitoneale idiopatica. Presidi mini-invasivi: Idiopathic retroperitoneal fibrosis. Minimally invasive devices

Some endoscopic percutaneous techniques are described that are useful both in the diagnosis and therapy of retroperitoneal fibrosis. These techniques allow urinary drainage, easily resolving an acute episode, and may be a temporary solution in patients who should respond to medical therapy. They may be considered a final therapy in patients who cannot be operated.

Due casi di fibrosi retroperitoneale con risposta favorevole alla terapia corticosteroidea

Retroperitoneal fibrosis is rare and is usually treated with exploratory laparotomy. Satisfactory response to corticosteroid therapy has been shown, however, in cases with early retroperitoneal disease, while those with late disease show no improvement. Two cases are reported of patients with retroperitoneal fibrosis treated successfully with long-term corticosteroid therapy.