A rare case of huge villous adenoma of the renal pelvis deforming the abdominal wall

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.

Urinary tract villous adenoma in Indonesia

This is the first recorded case of urinary tract villous adenoma in Indonesia. A 70-years-old man suffered from a painful left flank mass and jelly like mixed urine. He had undergone percutaneous nephrostomy yielding a jelly like substance, and a previous stone surgery. Left nephrectomy and lymph nodes dissection were performed. Intraoperative finding showed significant mucus fluxed from this enlarged kidney. Histopathological examination revealed columnar epithelium and goblet cells amongst the villiform glands. There is no standard established protocol for follow up and management. We should follow-up for a possibility of recurrence or progression.

Villous adenoma of the renal pelvis and ureter

Villous adenoma originating in the urinary tract is a rare condition. Mucus-filled kidney (muconephrosis), one of the manifestations of this condition, occurs due to intestinal type of metaplastic changes occurring in the urothelium. This condition is commonly associated with urolithiasis and/or chronic infection. Concomitant adenocarcinomatous changes in the urothelium may be present along with this and unless a careful search is made to identify this, this serious condition may be overlooked leading to an inappropriate follow-up and dire consequences. We are reporting the third case of muconephrosis due to villous adenomatous changes of the renal pelvis and ureter.