Multifocal Nephrogenic Adenoma of
the Bladder in a Pediatric Patient
Roy A. Filly, MD, Laurence S. Baskin, MD
eoplasms of the urinary bladder in children are fortunately rare.1–5
Rhabdomyosarcomas are the most common, which appear as a bladder
mass on a sonogram, although in boys, they often arise in the prostate.1
Nonetheless, a variety of other tumors and tumorlike conditions occur and
can be difficult to diagnose without resection and histologic examination.2–5
Neoplasms run the gamut from benign to malignant and include a variety of benign
cellular proliferations and inflammatory masses.
Carcinoma of the bladder is extremely rare in children. The most common carcino-
ma to involve the bladder is transitional cell carcinoma.4In contrast to adults, most
pediatric bladder carcinomas are low grade, are superficial, and have a good prognosis
after transurethral resection.3,4Squamous cell and more aggressive carcinomas, how-
ever, have been reported.5
In this report, we share the sonographic findings in a case of multifocal nephrogenic
adenoma in the bladder of a pediatric patient. We found only 2 other reports of the
sonographic findings in this unusual condition.6,7In a third report, focused on a treat-
ment option, a sonogram was depicted.8
Received March 1, 2010, from the Departments of
Radiology and Biomedical Imaging (R.A.F.) and
Urology (L.S.B.), University of California, San
Francisco, California USA. Revision requested
March 17, 2010. Revised manuscript accepted for
publication March 23, 2010.
Address correspondence to Roy A. Filly, MD,
Department of Radiology, University of California,
505 Parnassus Ave, L374, San Francisco, CA 94143-
A 16-year-old male patient had gross hematuria, and a
sonogram at our institution showed multifocal papillary
excrescences from the urinary bladder wall (Figure 1).
At 4 years of age in Mexico, the patient underwent
bilateral ureteral reimplantation for recurrent urinary
tract infections and reflux. The kidneys showed calyceal
dilatation without concomitant dilatation of the
infundibula or renal pelvis. There were no overlying
cortical scars. The patient subsequently underwent
cystoscopy, which revealed frondlike sessile lesions
throughout the posterior and lateral walls of the bladder.
Random biopsies confirmed multifocal nephrogenic
adenoma as the underlying cause of the sonographic
findings. During the time between the procedure and the
2-year follow-up, the patient had 2 additional sporadic
episodes of gross hematuria.
© 2010 by the American Institute of Ultrasound in Medicine • J Ultrasound Med 2010; 29:1239–1241 • 0278-4297/10/$3.50
Nephrogenic adenoma is a benign proliferation
of glands that can occur at several sites within the
urogenital tract, including the calyx, pelvis, ureter,
bladder, and urethra.9–16Although it is benign, the
histopathologic appearance may sometimes be
mistaken for a malignancy, particularly in biop-
sies around the prostatic urethra. Nephrogenic
adenomas in adults occur throughout the entire
urinary tract. However, this pathologic entity
has been observed exclusively in the bladder in
children. The most frequent predisposing factor
in the pediatric population for the development
of this tumor is surgical injury such as ureteric
reimplantation. Occasionally, the precursor is
long-term irritation of the urothelium caused by
a foreign body. Diagnosis primarily includes
sonography of the urinary tract, cystoscopy, and
By far the most common patient condition is
hematuria followed by urinary frequency.
Nephrogenic adenoma occurs most often after
surgery of the urinary tract, followed by urinary
tract infection and intravesical Bacillus Calmette-
Guérin treatment.8,12,14Although not premalig-
nant, frequent follow-up is mandatory because
of a high recurrence rate.7
Nephrogenic adenomas are benign tumorlike
lesions within the urothelial mucosa of the uri-
nary tract. Of some interest, these lesions are not
uncommon in renal transplant recipients.17–19
In kidney allograft recipients, these lesions are
thought to develop as urothelial metaplastic pro-
liferations in response to mechanical trauma,
chemical irritation, irradiation, and bacterial or
Treatment is controversial, with complete
resection problematic because this, in itself, is
traumatic to the bladder, resulting in a high rate
of recurrence.19,20Therapy should focus on con-
trolling active bleeding. Extensive lesions, such
as seen in this patient, have been known to
remain quiescent for years.
Overall, the sonographic features seen in our
case and described elsewhere are not definitive
and need to be correlated with cystoscopy and
biopsy. However, in that all bladder neoplasms
are rare in children, nephrogenic adenoma
should be a consideration when a focal lesion or
lesions are detected in a child with the appropri-
ate antecedent history, particularly that of blad-
J Ultrasound Med 2010; 29:1239–1241
Multifocal Nephrogenic Adenoma of the Bladder
Figure 1. A, Longitudinal sonogram of the urinary bladder showing multiple focal papillary tumors. B, Transverse axial sonogram of the urinary blad-
der again showing multifocal tumors.
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J Ultrasound Med 2010; 29:1239–1241
Filly and Baskin