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Corsi AJ, Bradley TP, Geetha SD. Treatment of Villous Adenoma With Underlying Adenocarcinoma of the Prostatic Urethra Using Combined Chemoradiation: A Case Report. Cureus 2024; 16:e64841. [PMID: 39156275 PMCID: PMC11330304 DOI: 10.7759/cureus.64841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2024] [Indexed: 08/20/2024] Open
Abstract
The presence of villous adenoma in the urinary tract is an exceedingly rare finding. On a histological and cytological level, this tissue is essentially identical to that typically found in the colon. These lesions do have malignancy potential and, when present with coexistent adenocarcinoma, have a risk of recurrence and metastasis even after surgical resection. Although villous adenomas of the urinary tract have been almost exclusively treated with surgical intervention in the literature, we present a case of villous adenoma with underlying adenocarcinoma of the prostatic urethra that was successfully treated with combined chemoradiation therapy. While surgical excision has been shown to be curative in diseases with isolated villous adenoma, more aggressive treatment with radiation and/or chemotherapy can be considered in patients with concurrent adenocarcinoma. However, more research into this subject is required to properly determine the best choice of therapy for this niche patient population.
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Affiliation(s)
- Anthony J Corsi
- Internal Medicine, Zucker School of Medicine, North Shore University Hospital/Long Island Jewish Medical Center, Northwell Health, Greenvale, USA
| | - Thomas P Bradley
- Hematology and Oncology, Zucker School of Medicine, North Shore University Hospital/Long Island Jewish Medical Center, Northwell Health, Greenvale, USA
| | - Saroja Devi Geetha
- Pathology, Zucker School of Medicine, North Shore University Hospital/Long Island Jewish Medical Center, Northwell Health, Greenvale, USA
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2
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Kawamoto T, Ishida M, Yorozu T, Arizono E, Wakabayashi Y, Nagao T, Ohno Y, Saito K. Mucinous adenocarcinoma derived from villous adenoma of the kidney with muconephrosis. Clin Case Rep 2024; 12:e8397. [PMID: 38173885 PMCID: PMC10762481 DOI: 10.1002/ccr3.8397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/29/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024] Open
Abstract
Upper respiratory tract villous adenoma (VA) with muconephrosis is rare and should be included in the differential diagnosis when pelvic dilatation with a solid component is detected. VA may transform into malignant mucinous adenocarcinoma, which should be suspected if contrast enhancement on computed tomography (CT)/magnetic resonance imaging (MRI) and restricted diffusion on MRI are observed.
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Affiliation(s)
- Tsubasa Kawamoto
- Department of RadiologyTokyo Medical University HospitalTokyoJapan
| | - Masanori Ishida
- Department of RadiologyTokyo Medical University HospitalTokyoJapan
| | - Takashi Yorozu
- Department of PathologyTokyo Medical University HospitalTokyoJapan
| | - Elly Arizono
- Department of RadiologyTokyo Medical University HospitalTokyoJapan
| | | | - Toshitaka Nagao
- Department of PathologyTokyo Medical University HospitalTokyoJapan
| | - Yoshio Ohno
- Department of UrologyTokyo Medical University HospitalTokyoJapan
| | - Kazuhiro Saito
- Department of RadiologyTokyo Medical University HospitalTokyoJapan
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3
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Li LL, Song PX, Xing DF, Liu K. Early diagnosis of renal pelvis villous adenoma: A case report. World J Clin Cases 2023; 11:6159-6164. [PMID: 37731564 PMCID: PMC10507558 DOI: 10.12998/wjcc.v11.i26.6159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/12/2023] [Accepted: 07/25/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Villous adenoma is a rare tumor in the urinary system that usually occurs in the bladder. It is extremely uncommon in the renal pelvis. Most of the previously reported cases have been diagnosed with severe hydronephrosis associated with renal parenchyma atrophy prior to surgery. Because of its rarity, available information on the pathogenesis, diagnosis, treatment and prognosis of the disease is limited. We reported a case of kidney stones with hydronephrosis. During percutaneous nephroscopic lithotripsy, a renal pelvis tumor was found. Biopsy confirmed that the tumor was a villous adenoma of the renal pelvis. CASE SUMMARY A 68-year-old female was admitted to the hospital due to right kidney stones with right hydronephrosis. After admission, a urinary system plain computed tomography scan was performed, which revealed right kidney stones with right hydronephrosis and right upper ureteral dilatation. Multiple new cauliflower-like papillary masses were then discovered in the renal pelvis and calyces during right percutaneous nephroscopic lithotripsy. Biopsy results indicated villous adenoma with high-grade glandular intraepithelial neoplasia. The patient underwent laparoscopic radical resection of the right kidney and ureter. Based on histopathological and immunohistochemical examination, the patient was diagnosed with villous adenoma without adenocarcinoma. CONCLUSION Villous adenoma is rare in the urinary system. We reported a case of renal pelvis villous adenoma, which may provide useful information for the early diagnosis and treatment of this tumor.
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Affiliation(s)
- Liang-Liang Li
- Department of Urology, Fuyang Hospital of Anhui Medical University, Fuyang 236000, Anhui Province, China
| | - Pei-Xing Song
- Department of Urology, Fuyang Hospital of Anhui Medical University, Fuyang 236000, Anhui Province, China
| | - De-Fu Xing
- Department of Urology, Fuyang Hospital of Anhui Medical University, Fuyang 236000, Anhui Province, China
| | - Kun Liu
- Department of Urology, Fuyang Hospital of Anhui Medical University, Fuyang 236000, Anhui Province, China
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4
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Rochio-Tafoya A, García-Muñiz JA, Flores-Gutiérrez JP, Gutiérrez-González A, Barboza-Quintana O, Garza-Guajardo R. Intestinal-type adenocarcinoma arising from a villous adenoma in the renal pelvis in the context of a kidney abscess: Case report. Urol Case Rep 2023; 46:102325. [PMID: 36687748 PMCID: PMC9851858 DOI: 10.1016/j.eucr.2023.102325] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/03/2023] [Accepted: 01/10/2023] [Indexed: 01/13/2023] Open
Abstract
Villous adenoma is a benign neoplasm with an exceptional presentation in the renal pelvis, hence very few cases have been reported. Herein we present the case of a patient who presented with left flank pain clinically suggestive of complicated pyelonephritis, culminating in simple nephrectomy with a villous adenoma in the renal pelvis as histopathological finding associated to the presence of a microscopic focus of intestinal-type adenocarcinoma.
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Affiliation(s)
- Ary Rochio-Tafoya
- Anatomic Pathology and Cytopathology Service, University Hospital Dr. José Eleuterio González, Autonomous University of Nuevo León, Dr. José Eleuterio Gonzalez S/N, Mitras Centro, 64460, Monterrey, N. L, Mexico
| | - José Antonio García-Muñiz
- Anatomic Pathology and Cytopathology Service, University Hospital Dr. José Eleuterio González, Autonomous University of Nuevo León, Dr. José Eleuterio Gonzalez S/N, Mitras Centro, 64460, Monterrey, N. L, Mexico
| | - Juan Pablo Flores-Gutiérrez
- Anatomic Pathology and Cytopathology Service, University Hospital Dr. José Eleuterio González, Autonomous University of Nuevo León, Dr. José Eleuterio Gonzalez S/N, Mitras Centro, 64460, Monterrey, N. L, Mexico
| | - Adrián Gutiérrez-González
- Urology Service, University Hospital Dr. José Eleuterio González, Autonomous University of Nuevo León, Dr. José Eleuterio Gonzalez S/N, Mitras Centro, 64460, Monterrey, N. L, Mexico
| | - Oralia Barboza-Quintana
- Anatomic Pathology and Cytopathology Service, University Hospital Dr. José Eleuterio González, Autonomous University of Nuevo León, Dr. José Eleuterio Gonzalez S/N, Mitras Centro, 64460, Monterrey, N. L, Mexico
| | - Raquel Garza-Guajardo
- Anatomic Pathology and Cytopathology Service, University Hospital Dr. José Eleuterio González, Autonomous University of Nuevo León, Dr. José Eleuterio Gonzalez S/N, Mitras Centro, 64460, Monterrey, N. L, Mexico,Corresponding author. Current address: 26 Avenue 259, Cumbres, Monterrey N. L, México.
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5
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Özsoy Ş, Deniz K, Temiz MZ, Semerciöz A. Traditional Serrated Adenoma of the Urinary Bladder: The First Report. Int J Surg Pathol 2022:10668969221113495. [PMID: 35898180 DOI: 10.1177/10668969221113495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 71-year-old woman was hospitalized with hematuria and underwent cystourethroscopy. Cystourethroscopy revealed a polypoid bladder tumor. Histopathologic examination showed complex villiform growth pattern, slit-like serrations, and ectopic crypts lined by epithelium with eosinophilic cytoplasm, pseudostratified elongated nuclei, consistent with traditional serrated adenoma. Nephrogenic and intestinal metaplasia with severe inflammation were present in adjacent bladder mucosa. Molecular study of the polyp revealed mutation (p.G12V) in codon 12 of exon 2 of the KRAS gene. Traditional serrated adenoma is a rare type of colonic serrated polyp, making up less than 1% of the colonic polyps with a predilection to distal colon. In the literature, there is no traditional serrated adenoma reported outside the gastrointestinal tract. Here in we report the first extra-gastrointestinal traditional serrated adenoma within the bladder and bladder diverticulum, arising from intestinal metaplasia. The present study reports an additional information on molecular background of this unusual bladder polyp.
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Affiliation(s)
- Şule Özsoy
- Department of Pathology, University of Health Sciences, Bağcılar Training and Research Hospital, İstanbul, Turkey
| | - Kemal Deniz
- Department of Pathology, Erciyes University, Kayseri, Turkey
| | - Mustafa Zafer Temiz
- Department of Urology, University of Health Sciences, Bağcılar Training and Research Hospital, İstanbul, Turkey
| | - Atilla Semerciöz
- Department of Urology, University of Health Sciences, Bağcılar Training and Research Hospital, İstanbul, Turkey
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Bharti S, Vishwajeet V, Pandey H, Elhence PA. Villous adenoma of the renal pelvis: a common entity at an uncommon location. AUTOPSY AND CASE REPORTS 2021; 11:e2021283. [PMID: 34307234 PMCID: PMC8214884 DOI: 10.4322/acr.2021.283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/05/2021] [Indexed: 11/25/2022] Open
Abstract
Villous adenoma is uncommonly seen in the urogenital tract and is even more rarely seen in the upper urinary tract and renal pelvis. Like colorectal adenomas, these neoplasms can transform into adenocarcinoma. The preoperative diagnosis is challenging due to their frequent association with hydronephrosis. Herein, we present the case of a villous adenoma of the renal pelvis in a 62-year-old man presenting with recurrent urinary tract infection. The computed tomography scan showed marked hydronephrosis but no suspicious mass in the right kidney. A laparoscopic right nephrectomy was performed. Gross examination revealed a dilated renal pelvis with an irregular exophytic lesion in the renal pelvis’s upper surface. The histopathological examination showed slender, elongated villi with thin fibrovascular cores, consistent with villous adenoma morphology. Isolated villous adenomas have a favorable prognosis. However, the pathologist should undertake a search for an invasive component.
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Affiliation(s)
- Sushma Bharti
- All India Institute of Medical Sciences (AIIMS) Jodhpur, Department of Pathology & Lab Medicine, Jodhpur, Rajasthan, India
| | - Vikarn Vishwajeet
- All India Institute of Medical Sciences (AIIMS) Jodhpur, Department of Pathology & Lab Medicine, Jodhpur, Rajasthan, India
| | - Himanshu Pandey
- All India Institute of Medical Sciences (AIIMS) Jodhpur, Department of Urology, Jodhpur, Rajasthan, India
| | - Poonam Abhay Elhence
- All India Institute of Medical Sciences (AIIMS) Jodhpur, Department of Pathology & Lab Medicine, Jodhpur, Rajasthan, India
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7
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Demir H, Cin S, Citgez S, Uygun N. Villous Adenoma Arising in the Urethra of a Female with Bladder Augmentation History: A Case Report and Review of the Literature. Turk Patoloji Derg 2021; 37:161-166. [PMID: 32779155 PMCID: PMC10512680 DOI: 10.5146/tjpath.2020.01502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 07/14/2020] [Indexed: 11/18/2022] Open
Abstract
Villous adenomas (VAs) in the female urethra are rare with only seven cases in the English literature to our knowledge. In patients with bladder augmentation cystoplasty, the neoplasia development risk increases and most of these develop in the neobladder or anastomosis line. Only two cases of VA developing from the native bladder mucosa have been reported. Physical examination of a 76-year-old female who had a history of augmentation cystoplasty revealed a caruncula-like structure protruding from the urethral meatus. The urinary USG showed that the lesion had no relation with the bladder. The lesion was excised. Microscopically, it consisted of villous structures covered with pseudostratified intestinal type epithelium. Low-grade dysplasia was present in the epithelium but high-grade dysplasia or in-situ/invasive carcinoma was not observed. Immunohistochemical study showed positivity for CK7, CK20, EMA, CEA and CDX2. The case was reported as VA of the urethra. We presented the first VA case arising in the urethra of a female patient with intestinal bladder augmentation. Excision is curative for pure VAs. Transformation to carcinoma or recurrence has not been reported. However, in one third of the cases, a malignant tumor may accompany the lesion. Therefore, all excision material should be examined carefully. Routine endoscopic follow-up should be performed in cases with bladder augmentation.
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Affiliation(s)
- Hale Demir
- Department of Pathology, Amasya University, School of Medicine, Amasya, Turkey
| | - Selçuk Cin
- Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Sinharib Citgez
- Department of Urology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Nesrin Uygun
- Department of Pathology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
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8
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Stoykov B, Kolev N, Dunev V, Genov P, Atanasov J, Mateva S. A rare case of huge villous adenoma of the renal pelvis deforming the abdominal wall. Urol Case Rep 2020; 31:101183. [PMID: 32309146 PMCID: PMC7154995 DOI: 10.1016/j.eucr.2020.101183] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 03/28/2020] [Indexed: 12/04/2022] Open
Abstract
The villous adenoma is a benign epithelial tumor affecting most often the gastrointestinal tract, especially the colon and rectum. The incidence of this disease in the genitourinary tract is less than 1% as the most commonly affected organs are bladder, urethra, prostate, vulva and vagina. Only several cases of villous adenoma in the renal pelvis have been reported in the scientific literature. The disease is more common in men between the ages of 40 and 70. We presented a rare case of huge villous adenoma of the renal pelvis in 61 years old man.
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Affiliation(s)
- Boyan Stoykov
- Department of Urology, Medical University Pleven, Bulgaria
| | - Nikolay Kolev
- Department of Urology, Medical University Pleven, Bulgaria
| | | | | | | | - Svetlana Mateva
- Department of Pathoanatomy, Medical University Pleven, Bulgaria
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9
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Nambiyar K, Pandey T, Chatterjee D, Saikia UN, Mavuduru RS. Upper Urinary Tract Adenocarcinoma Arising in Tubular Adenoma-A Rare Entity: Report of 2 Cases and Review of Literature. Int J Surg Pathol 2019; 28:310-315. [PMID: 31594436 DOI: 10.1177/1066896919880263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Tubular adenoma of the urinary tract is a recently recognized entity, and there is a paucity of clinicopathological information. We describe 2 rare cases of adenocarcinoma of upper urinary tract arising in the background of tubular adenoma with high-grade dysplasia. The first case was an extremely uncommon combination of multifocal tubular adenomas involving ureter and renal pelvis and adenocarcinoma of kidney in a patient with renal calculi. The second case was of adenocarcinoma of kidney arising from tubular adenoma of renal pelvis in the right moiety of horseshoe kidney. There was no microsatellite instability. These findings indicate, probably, an adenoma-carcinoma pathway is also followed in the urinary tract similar to the gastrointestinal tract. To the best of our knowledge, no such observations are reported in the English literature previously.
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Affiliation(s)
- Kaniyappan Nambiyar
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Tushar Pandey
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Debajyoti Chatterjee
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Uma N Saikia
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ravimohan S Mavuduru
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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10
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Villous Adenoma in Renal Pelvis With Manifestation of Percutaneous Fistula and Mucus Secretion. Urology 2017; 102:e3-e4. [PMID: 28069333 DOI: 10.1016/j.urology.2016.12.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 12/25/2016] [Accepted: 12/28/2016] [Indexed: 11/20/2022]
Abstract
A 70-year-old man, complaining of percutaneous fistula with jelly-like yellow mucus in the right kidney for a month, was admitted to our department. From computed tomography, stones and severe hydronephrosis but no suspicious mass was found in right kidney. Nephrectomy of right kidney was performed and pathological examination revealed a villous adenoma in the renal pelvis with moderate to severe atypical hyperplasia of glandular epithelium. Primary villous adenoma in renal pelvis is rare and believed to be related to chronic irritation of stone and inflammation. Mostly nephrectomy was performed before diagnosis was made.
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11
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Xiong X, Jia L, Wang J. Primary adenocarcinoma of the renal pelvis, ureter and the urinary bladder: A case report and review of the literature. Oncol Lett 2016; 11:1811-1814. [PMID: 26998081 DOI: 10.3892/ol.2016.4151] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 12/07/2015] [Indexed: 12/25/2022] Open
Abstract
Primary adenocarcinoma is a rare type of urological neoplasm. The present study reports the case of a 55-year-old man with multifocal adenocarcinoma of the renal pelvis, ureter and urinary bladder that occurred in association with a large cystic calculus and perinephric abscess. The patient had suffered from gross hematuria for 2 years and right flank pain for 2 months. Following a series of investigations, a large cystic calculus with multiple tumors in the renal pelvis and ureter was identified. Multifocal tumors and a large calculus were located in the bladder using a cystoscope. The pathological report of 3 individual biopsies revealed a moderately differentiated tubular adenocarcinoma. Right nephrectomy, ureterectomy, radical cystectomy and left ureterocutaneostomy were performed. The pathological investigation revealed a moderately differentiated adenocarcinoma of the renal pelvis, ureter and urinary bladder. No additional treatment was administered and the patient remains alive at follow-up without disease recurrence or metastasis. Although uncommon, the development of a tumor is possible in patients that possess long-standing urolithiasis, particularly when accompanied by hydronephrosis or infection.
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Affiliation(s)
- Xing Xiong
- Department of Urology, Jiangxi Provincial People's Hospital, Nanchang, Jiangxi 330006, P.R. China
| | - Linghua Jia
- Department of Urology, Jiangxi Provincial People's Hospital, Nanchang, Jiangxi 330006, P.R. China
| | - Jingen Wang
- Department of Urology, Jiangxi Provincial People's Hospital, Nanchang, Jiangxi 330006, P.R. China
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Sagnotta A, Dente M, Socciarelli F, Cacchi C, Stoppacciaro A, Balducci G. Primary adenocarcinoma of the renal pelvis: histologic features of a stepwise process from intestinal hyperplasia to dysplasia in a patient with chronic renal abscess. Int J Surg Pathol 2013; 22:182-5. [PMID: 24008439 DOI: 10.1177/1066896913502225] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pure adenocarcinomas of the urothelium are very rare and their location in the pelvis is uncommon. Although their pathogenesis is not well defined, adenocarcinomas are likely to originate from neoplastic transformation of the glandular cells of the urothelial intestinal metaplasia usually arising in response to chronic irritating stimuli, such as long-duration inflammation, urolithiasis, and hydronephrosis. We report a case of an 81-year-old woman who underwent right nephrectomy for relapsing renal abscess due to a staghorn calculus. Histological examination disclosed an infiltrating adenocarcinoma arising from a tubulovillous adenoma with the surrounding pelvic mucosa showing a sequence of intestinal metaplasia, low- and high-grade villous adenoma, and invasive adenocarcinoma, supporting the hypothesis of cancer progression due to chronic inflammation from the urothelium through the metaplasia step.
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Affiliation(s)
- Andrea Sagnotta
- 1Department of General Surgery, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
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