由中段輸尿管突出至膀胱的尿路上皮乳頭瘤
黃烱焜1、林冠榮1,2,3、黃子豪1,2,3、林子平1,2,3、黃志賢1,2,3
台北榮民總醫院 泌尿部1；國立陽明大學醫學院 泌尿學科2；書田泌尿科學研究中心3
Urothelial papilloma growing from middle third ureter and protruding into urinary bladder in a young female
Chiung-Kun Huang1, Kuan-Jung Lin1,2,3 ,Tzu-Hao Huang1,2,3, Tzu-Ping Lin1,2,3, William J.S. Huang1,2,3
Department of Urology, Taipei Veterans General Hospital1; School of Medicine2 and Shu-Tien Urological Institute3, National Yang-Ming University, Taiwan
Introduction:
Urothelial papilloma is uncommon, comprises ~1% of papillary urothelial neoplasms. Patients are typically younger than 50 years old and can be seen in children. It is always encountered as de novo lesion (without prior urothelial neoplasm). Cystoscopy shows pedunculated appearance. Histology presented slender papillae with minimal branching. Papillae (with fibrovascular core) lined by normal-appearing urothelium, including presence of umbrella cells. Nuclei are elongated or oval shape. The recurrence rate is about 9~31%, but with no risk for progression to higher-grade tumors.
Case presentation:
A 26-year-old woman denied systemic disease presented with dysuria and intermittent low abdominal discomfort for more than 5 months. She had been treated as urinary tract infection, but symptoms persisted. Serial survey was done and results of physical examination, complete blood count, and metabolic panel were normal. Urinalysis showed 6 to 10 red cells per high-power field and 0 to 2 white cells per high-power field. Low abdominal sonogram showed a polypoid lesion with no blood flow about 1.6 x 1.1 cm in size at left posterior urinary bladder wall. CT scan revealed filling defect in left upper to lower third ureter suspected tumor growth. There is no upper tract hydronephrosis. No bladder tumor was seen at CT image. Cystoscopy showed one protruding mass over left ureteral orifice. An ureteroscopic examination found a long papillary polypoid tumor protruding out the left UO, with the base found over middle third ureter. The tumor base circumferentially grew from the ureter wall, making the ureter seems blind-ended. A small opening was found over the tumor base, and the ureteroscope could reach upper third ureter and renal pelvis, which appeared normal on examination. Ureter washing cytology showed negative and biopsy revealed polypoid ureteritis. The patient underwent laparoscopic segmental ureterectomy with end-to-end anastomosis. Pre-operative diagnostic ureteroscopic measurement of tumor length was performed. The final pathological evaluation showed urothelia papilloma. Follow-up CT showed mild residual hydronephrosis above upper third ureter 3 months after operation. Urinalysis was negative and ureteroscopic examination for residual hydronephrosis disclosed mild mucosa fibrosis at previous operation site without stricture or recurrence. Currently, she has been followed up at our OPD every 6 months. No evidence of recurrence was found.
Conclusion:
A rare presentation of urothelial papilloma derived from middle third ureter protruding into ureter orifice. It presented with painless gross hematuria. Compared to urothelial carcinoma, it has no malignant potential and a low recurrence rate.