腎源性腺瘤: 膀胱及輸尿管同時侵犯之案例

洪紹綸¹、王華斌¹

¹義大醫療財團法人義大醫院 泌尿科

Nephrogenic Adenoma:

A Case of Simultaneous Involvement of the Bladder and Ureter

Leo Shao-lun Hung¹, Hua-pin Wang¹

Department of Urology¹, E-Da Hospital, Kaohsiung, Taiwan

Abstract

Nephrogenic adenoma is a rare urothelial lesion histologically characterized by the differentiation of urothelial cells towards renal tubular cells. Despite its benign nature, this tumor presents diverse clinical manifestations and morphologic features, thereby posing diagnostic challenges. Herein, we report a case with a unique clinical presentation that necessitated a more aggressive surgical intervention.

A 64-year-old female, with a medical history of bilateral ureterorenoscopic lithotripsy and recurrent urinary tract infections, presented with dysuria and hesitancy persisting for one month. The renal echography and computed tomography showed right hydroureteronephrosis with a transitional zone at the ureterovesical junction. Although no intramural lesions were detected, circumferential thickening of the bladder wall was noted. Subsequent cystoscopy revealed multiple papillary tumors and a protruding tumor at the right ureteral orifice. A transurethral resection of bladder tumors (TURBT) with a biopsy of the right lower ureter was performed. Pathological examination revealed nephrogenic adenoma in the bladder and inflammation in the ureter.

Persistent hydronephrosis was observed after removal of the right ureteral catheter two months later. Follow-up cystoscopy showed recurrent polypoid tumors obstructing the right ureteral orifice. Consequently, right distal ureterectomy with bladder cuff excision and ureteroneocystostomy was performed. Final pathology confirmed nephrogenic adenoma at the right lower ureter. At three-month follow-up, no hydronephrosis was observed and the patient remained asymptomatic.

Nephrogenic adenoma has traditionally been regarded as a benign lesion requiring only TURBT or minimal resection, with recurrence being rare in adults. Nevertheless, this case illustrates concurrent bladder and ureter nephrogenic adenoma necessitating a more invasive surgical intervention.