Reviewer’s report
Title: 
Idiopathic retroperitoneal fibrosis with endometrial cancer: A case report
and literature review
Version: 
0 
Date: 
17 May 2022
Reviewer's report:
Background: Retroperitoneal fibrosis is a rare disease characterized by chronic
nonspecific inflammation, which leads to clinical compression manifestations of
retroperitoneal organs especially ureter. 
Approximately 70 percent of retroperitoneal fibrosis cases are idiopathic which
has no clear etiology. This study reported a rare case of a 48-year-old woman
presented with idiopathic retroperitoneal fibrosis (IRPF) and endometrial cancer. 
Case presentation: A 48-year-old woman presented with irregular vaginal
bleeding without abdominal pain, bloating or discomfort. The patient was
diagnosed IRPF after splenectomy 13 years ago. Then she took prednisone in 2
years and took tamoxifen for about 10 years. She stopped taking medicine from
October 2019 to May 2020 and then started taking tamoxifen again until
November 2020. Two weeks after she stopped taking tamoxifen, she presented
with irregular vaginal bleeding. Gynecological ultrasound revealed a thick
endometrium with echo enhancement and blood flow signals. Then diagnostic
curettage was performed with pathological examination showed endometroid
carcinoma. Preoperative imaging examinations, including CT, MRI, and
PET/CT, all showed pelvic enlarged lymph nodes and they were highly
suspected to have lymph node metastasis. The patient underwent laparoscopic
surgical staging and enlarged lymph nodes in the pelvic and aortic regions were
removed. Finally, the pathology confirmed that endometrioid adenocarcinoma
and fibrosis, but there was no tumor infiltration in these enlarged lymph nodes. 
This case report stressed the difficulty to distinguish between lymph node
metastasis and inflammatory hyperplasia by common imaging methods. Due to
increased surgical difficulty among retroperitoneal patients, lymphadenectomy
should be carefully evaluated to avoid additional surgical complications and
over-treatment.
It is an interesting case report, presented in well-designed format, with clear
images and can be accepted for publication without any suggested changes. 
Regards 
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