Leiomyosarcoma of the ureter: a rare case.

Mrs R., aged 57, had had abdominal pain predominantly in the right lumbar fossa for several weeks. Ultrasound exploration was therefore undertaken and revealed isolated right ureterohydronephrosis. A double J ureteral endoprosthesis was inserted to alleviate the pain. Secondly, a CT urogram was carried out and revealed a well limited and rounded retroperitoneal mass with peripheral enhancement which was in very close contact with the right ureter (Figs. 1 and 2). No other significant abnormality came to light, particularly none of the bladder. Two hypotheses were put forward: either retroperitoneal adenomegaly extrinsically compressing the ureter or an urothelial tumour developing extrinsically. A diagnostic biopsy was performed. From the anatomopathological analysis and more particularly, study of the immunohistochemical markers, it was possible to confirm the diagnosis of leiomyosarcoma of the ureter (Figs. 3 and 4). An additional PET scan confirmed a retroperitoneal right para-ureteral focus of hyperfixation, with no other focus of hyperfixation in the lymph nodes (Fig. 5). Complete surgical exeresis of the lesion was undertaken with confection of a termino-terminal ureteroureteral anastomosis. Postoperative monitoring was simple. Since the patient’s general condition permitted it, adjuvant chemotherapy was started. Early scan checks and at 9 months did not reveal any signs of complication, nor of recurrence.