Persisting active and proliferative intrinsic ureteral endometriosis underGNRH agonists therapy: a case with immunohistological study

We report the case of a 30-year-old patient who underwent a segmental urete ral resection with ureteroureterostomy because of the presence of a left ur eterohydronephrosis caused by an intrinsic ureteral endometriotic lesion. P reoperatively, the patient received a 3 months course of GNRH agonists. The serum estradiol level was at 12 pg/ml at the moment of surgery. Histology and immunohistochemistry performed on the resected specimen showed the pres ence of numerous large haemorragic endometriotic foci containing very high levels of cc-estrogen and progesterone nuclear receptors, a high Ki-67 labe ling index and a strong positivity for EGF-receptor. This is the first repo rt of immunohistochemical study performed on ureteral endometriosis preoper atively treated with GNRH agonists. Because hormonal treatments are often p rescribed in the treatment of ureteral endometriosis, clinicians should be aware of the possibility of persisting very active and proliferative ureter al endometriotic lesions even under treatment with GNRH agonists and very l ow levels of circulating estradiol. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.