Retroperitoneal fibrosis in radiotherapy-treated ankylosing spondylitis

Spontaneous resolution of apparent radiation associated retroperitoneal fibrosis

A 70-year-old man was diagnosed with retroperitoneal fibrosis (RPF) complicated by ureteral obstruction 4 months after finishing radiotherapy for prostate cancer. He was treated conservatively with ureteral stent placement. After 3 months, computed tomography scan of the abdomen revealed resolution of RPF without any medical or surgical interventions. Although an uncommon event, the possibility of spontaneous resolution of RPF, as demonstrated by this and previously reported cases, has led some to encourage conservative management.

Retroperitoneal fibrosis and ankylosing spondylitis: which links?

OBJECTIVES

To report a case of retroperitoneal fibrosis (RPF) in a patient with ankylosing spondylitis (AS) and to review the medical literature for similar cases to detect possible links between the 2 diseases.

METHODS

The presentation, clinical course, diagnostic work-up, and treatment of our patient are described, and the English and French medical literature from 1960 to 2000 is reviewed using a MEDLINE search for cases with coexisting RPF and spondyloarthritis.

RESULTS

Our patient with AS had RPF, which mimicked rectal cancer with retroperitoneal and vertebral metastases. Special attention is paid to the unusual clinical presentation, the multistep diagnostic process, and the therapeutic strategy which was both radiologically and histologically successful. Literature review revealed 18 cases of concomitant RPF and spondyloarthritis, mainly AS. Patients were more frequently male (M/F, 3/1) and developed spondyloarthritis several years before RPF.

CONCLUSIONS

RPF may result from a local immune response to products of aortic atheromatous plaques, with subsequent periaortic deposition of fibrous tissue. However, the clinical features and the frequent association with other fibrosing disorders suggest that RPF is a systemic inflammatory condition. The role of AS-associated aortitis in the development of RPF warrants consideration.

Idiopathic retroperitoneal fibrosis and ankylosing spondylitis. A new case report

The case of a 52-year-old man with retroperitoneal fibrosis and ankylosing spondylitis is described. Inflammatory low back pain and acute renal insufficiency prompted a computed tomography scan of the abdomen with contrast agent injection. A fibrous sheath surrounding the aorta and attracting the ureters toward the midline was seen, strongly suggesting retroperitoneal fibrosis. The diagnosis of ankylosing spondylitis was based on the presence of inflammatory low back pain responsive to nonsteroidal anti-inflammatory drugs, syndesmophytes at the lumbar and cervical spine, bilateral sacroiliitis, and presence of the HLA-B27 antigen. Prednisone therapy in a daily dosage of 1 mg/kg induced a marked improvement. Only nine cases of concomitant retroperitoneal fibrosis and ankylosing spondylitis have been reported. These two conditions share similarities in some of the etiologic factors and anatomic localizations, suggesting that both may stem from a predisposition to fibrotic diseases.

Spondyloarthropathy and retroperitoneal fibrosis: a case report

Retroperitoneal fibrosis is an uncommon inflammatory condition in which the retroperitoneal tissue is transformed into a tight sheet of fibrous tissue. It can occur in association with various diseases, including rheumatic conditions. We report a new case in a 66-year-old man with spondyloarthropathy. Nine similar cases have been reported. Axial manifestations predominated, and half the patients carried the HLA-B27 antigen. The relation between retroperitoneal fibrosis and spondyloarthropathy remains controversial.

Retroperitoneal fibrosis following radiotherapy for stage I testicular seminoma

Retroperitoneal fibrosis, proved by surgical exploration and pathology, was discovered in a patient 13 years after 3,000 rad external beam cobalt retroperitoneal radiation therapy for stage I testicular seminoma. Ureteral obstruction resulted in the loss of 1 kidney, necessitating ipsilateral nephrectomy and contralateral ureterolysis. To my knowledge this is the first reported case of retroperitoneal fibrosis occurring after radiotherapy for testicular cancer.