病例報告: 以雷射燒灼治療輸尿管腎源性腺瘤

劉品均、林益聖、許兆畬、歐宴泉、童敏哲

童綜合醫療社團法人童綜合醫院

Case report: Successful laser ablation treatment of ureter nephrogenic adenoma

Pin-Chun Liu, Yi-Shang Lin, Chao-Yu Hsu, Yen-Chuan Ou, Min-Che Tung

Department of Urology, Tungs' Taichung Metroharbor Hospital, Taichung, Taiwan

Introduction:

Ureter nephrogenic adenoma is unusual urothelial tract benign tumor. We presented a rare case of asymptomatic nephrogenic adenoma of right ureter treated by laser ablation.

Presenting of case:

A 55-year-old male patient with past history of type B of aortic dissection, presented with dysuria and urine frequency for one day. Urine examination revealed microscopic hematuria but no pyuria. Sonography of urinary system was done and disclosed smooth urinary bladder wall and right hydronephrosis. Abdomen non-contrast CT was performed and revealed radiopaque lesion over right ureterovesical junction and right hydronephrosis. Right ureterovesical stone with right obstructive uropathy was impressed. The patient received right ureteroroscopic lithostripsy for symptoms relieve.

However, a long strip of mass, smooth and elongated surface, with a stalk originating from the right upper ureter about 3 centimeters length was found incidentally. Endoscopic mass biopsy was done and the pathology report confirmed the diagnosis of ureter nephrogenic adenoma. Under microscopy, the sections show picture of ureteral polyp with transitional lining epithelium and loose, edematous and myxomatous fibrous stroma tissue, and hyperplasia of the transitional epithelium. Holmium-YAG laser was applied for nephrogenic adenoma ablation. The patient stood whole procedure well without post-operative complication. No persistent hydronephrosis was found during follow-up outpatient follow-up for six months.

Discussion:

Nephrogenic adenoma is a rare but benign lesion of urinary tract, which is most commonly located at urinary bladder. Most people are symptomatic, such as hematuria, lower urinary tract symptoms or flank pain and some are asymptomatic. Most patients were managed with endoscopic resection of their tumors. We presented that laser ablation could be a promising alternative treatment option for symptomatic ureteral nephrogenic adenoma.