Idiopathic Retroperitoneal Fibrosis Mimicking a Pelvic Tumor: a Case of Pericystitis Plastica

Retroperitoneal fibrosis was first described in 1905 by Albarran, a French urologist, who performed ureterolysis for ureteral compression produced by the disease. However, this disease became an established clinical entity by Ormond's account in the English literature in 1948. Pericystitis plastica has been used the define an extremely rare type of Idiopathic retroperitoneal fibrosis (IRF) constricting the bladder. In this study, we discussed the recovery of 29-year-old woman with pericystitis plastica who was misdiagnosed as pelvic malignancy or a chronic/subacut pelvic inflammation at the first evaluation.

Multilocular echinococcosis in humerus: a case report

Hydatid cysts caused by E. multilocularis are less common than those caused by E. granulosus [Pintilie et al., 1996]. Infection in the bones is rare, accounts to 09-2% of all hydatid cysts [Wirbel et al., 1997]. A thirty five year old female was presented with a four month history of pain and swelling in her humerus. Plain radiography and ultrasonography revealed partial destruction of bone. Laboratory investigations revealed Hb. 15.2 gm, ESR 11 1 [st] hr and WBC 10.000. Indirect haemagglutination test using hydatid antigen was positive [1/16000] and ELISA [IgG] was positive [1/4096]. Lung, liver and brain scans were normal. Endosteal sarcoma was considered and a biopsy was performed. Histopathological examination of bone tissue, showed many cysts. On surgical operation a huge number of cysts were found and removed. The patient was given albendazole in the recommended dose [Mazyad et al., 1998], and followed up. Six months later, all symptoms and signs regressed. Again three months more, the serological levels markedly decreased and X ray was normal. Multilocular echinoccocosis is limited in distribution because of greater host specificity. Documented only in northern hemisphere mainly, North America, Europe and Asia [Murray et al. 1995]. Previously this type of cysts was thought to be a neoplasm of liver and named, alveolar colloid or multilocular tumour of liver. Macroscopically, it is difficult, or sometimes impossible to be distinguished from a malignant tumour. The precise diagnosis is histologically by its characteristic morphology [Uysal and Paksoy, 1986]. It is a disease of adults, who aquired infection in childhood. It produces a slowly progressive destructive lesion without evoking sclerosis, weakness and pathological fracture [Murray et al., 1995]. The lesion is usually secondary to hepatic or pulmonary infection, but may occur as a primary one. Cases have been reported in the vertebral column, spinal cord, femura, tibia and pelvis [Madiwale et al., 1992; Mazyad et al., 1998]. Misdiagnosis are common, as it may be confused with or mimic tuberculosis, acute arthritis, fibrocystic disease, sarcoma and simple cyst lesion. The orthopaedic surgeon may be confronted with hydatid cysts from a bone during biopsy. The disease is often asymptomatic for a long duration and is usually detected only after a sudden fracture by compression. A definite preoperative diagnosis without histopathologic examination is often difficult. Plain X ray is not helpful, but MRI is valuable. People at risk are trappers, hunters, and workers with fox fur