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. Terapia medica: Idiopathic retroperitoneal fibrosis. Medical treatment

Medicai treatment of both idiopathic and secondary retroperitoneal fibrosis (RPF) aims at stopping the inflammatory process in the early stage of the disease. Glucocorticoids and non-steroidal antiestrogen drugs are used. Methylprednisolone, the most commonly used glucocorticoid, is successfully employed with different therapeutic protocols. Although based on a few cases, results of treatment with tamoxifen are also satisfactory. The authors report 25 cases of RPF, idiopathic in 14 and secondary in 11. Twelve patients underwent medical therapy, corticosteroids being used in 10 and tamoxifen in 2. All patients recovered from the fibrotic disease. Only 1 patient stopped steroid therapy due to worsening diabetes. Easy administration and the lack of side effects make tamoxifen a valid alternative to corticosteroids.

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.