A 46-year-old hysterectomized patient due to leiomyomas presented to the emergency department with severe pain in the left renal fossa, malaise and repeated episodes of hematuria.
Several urine cytological studies were negative for cells.
Imaging studies determined the surgical intervention of the patient with an atrophic left kidney, as well as a large 'tumor mass' that encompassed the theoretical output of the left internal iliac artery, left ureter, lateral peritoneal sac of Doug
Due to the technical difficulties involved in enucleation of this lesion, a ureteral sample was taken and sent for histopathological diagnosis with suspected ureteral carcinoma.
The macroscopic study of the material showed a white irregular tissue with an elastic-firm consistency and fibrous appearance that the serial sections showed a fine red dotted hard to appreciate.
Histological examination revealed a ureteral segment with presence of multiple glandular intramuscular structures covered by endometrial epithelium whose immunohistochemical staining was strongly positive for cytokeratins, estrogen receptors and estrogen receptors.
Involving the ureteral wall abundant disordered fibrous tissue with signs of hemorrhage was observed.
With all these data the diagnosis of intrinsic ureteral endometriosis was emitted, although the intense extraureteral tissue response and the clear signs of hemorrhage that accompanied it made us think of an extrinsic glandular component accompanying were identified.
