以膀胱腫瘤為表現的輸尿管巨大纖維上皮性息肉的腹腔鏡手術治療:病例報告
黃國倫1、王華斌1、吳俊賢1、林嘉祥1、2
1義大醫療財團法人義大醫院 泌尿科；
2義守大學 醫學系
Giant fibroepithelial polyps of the ureter presenting as a bladder tumor treated laparoscopically: a case report
Allen, Guo-Lun Huang1, Hua-Ping Wang1, Chun-Hsien Wu1, Victor C. Lin1,2
Department of Urology1, E-Da Hospital, Kaohsiung, Taiwan ;
School of Medicine, College of Medicine2, I-Shou University, Kaohsiung, Taiwan
Introduction: Primary ureteral neoplasms account for only 1% of all upper genitourinary tract neoplasms. Fibroepithelial polyps (FEPs) of the ureter, a mesodermal benign tumor, are extremely rare. They are different from malignant urothelial cell and squamous cell tumors which are derived from the epithelium. The management of FEPs of the ureter typically depends on factors such as the degree of obstruction, the presence of any existing urinary tract infection, and suspicion of potential malignancy. Complete excision of polyps is the optimal method to avoid recurrence, by either open or endoscopic approaches. We herein present a rare case of a 50-year-old female patient with giant FEPs in the left lower ureter, protruding from the ureteral orifice and mimicking a bladder tumor. Giant FEPs of the ureter is successfully resected with laparoscopic segmental ureterectomy and end-to-end anastomosis under the assistance of ureteroscopy.
Case report: A 50-year-old woman with a medical history of uterine myoma and right breast fibroma presented with painless gross hematuria persisting for 3 months. There was no reported history of fever, flank pain, nausea, vomiting, dysuria, or associated lower urinary tract symptoms. Additionally, the patient denied smoking habits, and occupational exposure to chemical agents or Chinese herbs use. Urine analysis revealed the presence of more than 100 red blood cells per high-power field without white blood cells or bacteria colonization. Laboratory data indicated mild anemia with a hemoglobin level of 11.4 gm/dl. Otherwise, the levels of blood urea nitrogen and serum creatinine were within the normal range. The kidney and bladder echo revealed an isoechoic bladder lesion without hydronephrosis, renal or ureteral stone. Cystoscopy showed polypoid tumors protruding from the left ureter orifice (Figure 1). Abdomen computed tomography confirmed the presence of a soft tissue lesion in the left lower third ureter extending to the left ureterovesical junction and protrusion into the urinary bladder (Figure 2). A diagnosis of left lower third ureteral urothelial carcinoma with urinary bladder invasion was highly suspicious. Pelvic computed tomography and chest x-ray did not show any distant metastasis or lymphadenopathy. Surgical intervention of laparoscopic left nephroureterectomy with bladder cuff excision was indicated. Under general anesthesia, the patient was placed supine in the Johnnie Walker position to optimize the feasibility of laparoscopic surgery combined with ureteroscopy [11]. Ureteroscopic examination revealed a smooth surface, elongated and polypoid tumor in the left lower ureter, with clear identification of tumor base (Figure 3A). Considering a benign etiology for giant FEPs of the ureter, laparoscopic left segmental ureterectomy with end-to-end anastomosis was performed. The cut end of the ureter was sent for frozen section analysis, which reported negative finding for malignancy. Laparoscopic exploration demonstrated that the ureteral polyps were pulled from the left lower ureter (Figure 3B). The polyps were excised from the left lower ureter, measuring approximately 7 cm in length (Figure 4). Subsequently, end-to-end anastomosis of the left lower ureter was performed with double-J stenting. The postoperative period was uneventful without any complications. Histopathological examination confirmed the diagnosis of FEPs. The double-J stent was removed one month after the operation, and no complications or recurrence were observed during the one-year follow-
up period.
Conclusions: We have reported one case of a female patient who exhibited giant FEPs of the ureter, which projected into the urinary bladder and imitated a bladder tumor. The FEPs can be effectively and safely managed via the laparoscopic approach.