輸尿管的腎性腺瘤：病例討論
郭謹瑋、嚴孟意、王百孚
彰化基督教醫院 外科部 泌尿科
Nephrogenic adenoma of ureter – case report
Kuo-Chin Wei, Meng-Yi Yan, Bai-Fu Wang
Divisions of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
Introduction:
Nephrogenic adenoma is a rare benign lesion of urothelium. It is usually occurred in urinary bladder. And in ureter, the recorded cases are extremely rare. We report a case of nephrogenic adenoma arising from the right lower ureter with clinical features suspicious of carcinoma
Case report:
A 47 years old male, who complained about gross hematuria with lower abdominal tenderness. KUB revealed Right M/3 ureter and renal echo revealed hydronephrosis. So URSL was arranged. During operation, right lower third ureter papillary tumor with hyper-vascular expression was noted. Urothelial carcinoma was impressed and biopsy was done. However the pathological result revealed proliferation of small, round to oval tubular structures lined by a regenerated urothelium. The nuclei of these tubules did not show any mitotic activity. And nephrogenic adenoma is impressed. And he is free from disease for 6 months.
Discussion:
Until now, nephrogenic adenoma is considered as a metaplastic response of urothelium due to chronic irritation. The morphology of the tumor is usually like urothelial carcinoma, with papillary expression and hyper-vascular structure. However, under microscopic, there was no nuclei mitotic activity and immunohistochemically, the lesion was lake of CEA, p53, cytokeratin 20. Nephrogenic adenoma is currently thought to have no malignant potential. However, due to the risk of local recurrence, long term follow up is suggested.
Conclusion:
We present an extremely rare case that have nephrogenic adenoma of ureter. And due to high risk of local recurrence with mass effect related symptom, long term follow up may be needed.