Search

An 82 year-old female presents with severe, sharp right-sided chest, shoulder and flank pain, worse with deep inspiration. Cardiac workup is negative for myocardial ischemia or aortic dissection. Computed tomography demonstrates a right posterior diaphragmatic (Bochdalek) hernia, involving the right extra-renal pelvis and proximal ureter, with an associated delayed nephrogram and mild hydronephrosis. There is no obstructing nephrolithiasis. The patient is taken to the operating room and right-sided double-J ureteral stent is placed (Fig. 1), with immediate resolution of pain. Diaphragmatic hernia repair in coordination with urology and general surgery is scheduled.

Extrauterine pelvic hemangiopericytomas are rare tumors with malignant potential. Herein, we report a case of a 55-year-old male who presented with hydronephrosis and obstructive urinary symptoms. Cystoscopy, imaging and biopsy were unable to provide a definitive preoperative diagnosis. He underwent pelvic mass resection, and final pathology revealed malignant hemangiopericytoma. The patient is being closely monitored with serial imaging, and remains disease-free at 23 months of post-operative follow-up without adjuvant therapy. Our experience and evidence from the existing literature suggests that given the rarity of these tumors, adherence to standard oncologic principles is necessary to ensure adequate resection and appropriate follow-up.