Article

Fibroepithelial polyp of the lower urinary tract in adults.

Department of Pathology, Johns Hopkins Hospital, Baltimore, MD 21231, USA.
American Journal of Surgical Pathology (Impact Factor: 4.59). 05/2005; 29(4):460-6. DOI: 10.1097/01.pas.0000155153.64360.1a
Source: PubMed

ABSTRACT Fibroepithelial polyps of the urinary tract are rare with most cases reported in children.
We report the clinicopathologic features of 12 fibroepithelial polyps of the lower urinary tract in adults.
There were 9 males, 2 females, and 1 patient where the gender was unknown (median age, 44 years; range, 17-70 years).
Chief clinical symptoms were hematuria, urinary urgency, and hesitancy. Five patients were asymptomatic, where the lesions were discovered incidentally. Most lesions were located near the verumontanum or the bladder neck. Ten patients were treated by transurethral resection. Of the 10 patients with follow-up information, none showed recurrence (mean, 20 months; median, 17 months). Histologically, all of the fibroepithelial polyps were lined by normal-appearing urothelium, with in one lesion the additional finding of a columnar epithelial lining. There were three overall architectural patterns seen within fibroepithelial polyps. The most common pattern (Pattern 1) seen in 5 cases consisted of a polypoid mass with club-like projections resembling a cloverleaf with florid cystitis cystica et glandularis of the nonintestinal type in the stalk. The second pattern (Pattern 2) seen in 4 cases consisted of a papillary tumor composed of numerous small, rounded fibrovascular cores containing dense fibrous tissue. The last morphologic pattern (Pattern 3) consisted of a polypoid lesion with secondary tall finger-like projections, which was seen in 3 cases. All lesions lacked prominent edema and inflammation seen in polypoid cystitis. Fibroepithelial polyps contained broader stalks with dense fibrous tissue, in contrast to the thin delicate loose fibroconnective tissue seen in the stalk of papillomas. One lesion contained atypical degenerative-appearing stromal cells.
Although fibroepithelial polyps have been considered to be congenital, we think that some of these polyps could develop after birth because all of our patients first showed clinical symptoms in adulthood. Because fibroepithelial polyps in adults are rare, some of these cases can be misdiagnosed as urothelial neoplasms or reactive conditions. Recognition of the precise histologic features of fibroepithelial polyp can facilitate its correct diagnosis.

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    ABSTRACT: zet Fibroepitelyal polipler ürogenital sistemde son derece nadir gözlenen benign tümöral oluşumlardır. Tanı ve tedavisinde konsensüs olmamasına karşın günümüzde tedavisi sıklıkla minimal invaziv tedavi yöntemleri ile yapılmaktadır. Abstract Fibroepithelial polyps are extremely rare benign tumoral lesions in the urogenital tract. So there is no consensus on diagnosis and treatment but nowadays minimally invasive treatments should prefer at treatment. Anahtar kelimeler: Fibroepitelyal polip, Üreteroskopi Minimal invaziv cerrahi Giriş Fibroepitelyal polipler sıklıkla deri ve genitoüriner sistemde rastlanan nadir görülen benign nonepitelyal tümöral oluşumlardır. Literatürde 200 den daha az vaka bildirilmiştir. Gebelerde ve prenatal dönemde tanı alan simultane vakalar da söz konusudur [1,2] . Patogenezi tam olarak bilinmemekle birlikte kronik inflamatuar prosesin anahtar rol aldığı ileri sürülmektedir. Patogenezde yavaş büyüyen konjenital lezyonların da etkili olabileceği iddia edilmektedir. Histopatolojik olarak polipoid, vasküleriteden zengin stromal yapılar ve ödemli alanlar barındıran sıklıkla multinükleer mezenkimal hücrelerle karakterize lezyonlar şeklinde kendisini gösterir [3-11] . Klinik prezentasyonu lokalizasyona göre değişmekle birlikte ciltte kozmetik sorunlar, ağrı; solunum sistemi tutulumlarında hemoptizi, dispne, rekürrent pnömoni, atelektazi; üriner sistem tutulumlarında obstrüksiyon derecesine ve lokalizasyonuna göre alt üriner sistem semptomları, kolik tarzda yan ve kasık ağrısı, tekrarlayan üriner enfeksiyon, hematüri, taş gelişimi, bilateral vakalarda böbrek yetmezliği gibi semptomlara neden olabileceği gibi asemptomatik olarak da karşımıza çıkabilmektedir. Üriner tutulumda tüm diğer organ tutulumlarında olduğu gibi tanı ve tedavisinde konsensüs sağlanamamıştır. Bulunduğu lokalizasyona göre öykü, tam idrar tetkiki, ultrasonografi, intravenöz ürografi, bilgisayarlı tomografi, manyetik rezonans görüntüleme, üretra tutulumlarında voiding sistoüretrografi, sistoüretroskopi, üreteroskopi ve endoskopi eşliğinde biyopsi tanısal yaklaşımlardır. Dolum defekti şeklinde izlenen bu lezyonun ayırıcı tanısında özellikle mesane ve üst üriner sistem tutulumlarında transizyonel hücreli karsinom akılda tutulmalıdır. Görüntüleme yöntemlerinin herhangi birisinde dolum defekti saptanması durumunda endoskopik muayene, eş zamanlı biyopsi ve sonrasında lazer fulgurasyon, transüretral rezeksiyon/ablasyon, açık ve laparoskopik cerrahi tedavi seçenekleri masaya yatırılmalıdır. Yerleşim lokalizasyonlarına göre kategorize edildiğinde tanısal ve terapötik yaklaşımları aşağıdaki gibi detaylandırabiliriz. Böbrek ve üreter :
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    ABSTRACT: Ureteral fibroepithelial polyps are rarely seen benign tumors with mesodermal origin. These polyps can involve kidney, pelvis, ureter, bladder, and urethra. The most common symptoms are hematuria and flank pain. The choice of treatment is either endoscopic or surgical resection of polyp by sparing kidney. Here, we presented a pediatric case with giant, fibroepithelial polyp that mimics bladder tumor, originating from middle segment of the ureter.
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    ABSTRACT: Aim: Polyps of the male posterior urethra are rare and usually benign congenital lesions. We report a case of an 8-year-old boy who presented with recurrent urine retention caused by urethral polyp. Case report: At his first admittance to the hospital, the 8-year-old boy presented with urine retention. The performed urethrocystoscopy and cystourethrography were not diagnostic. His condition spontaneously improved, micturition was normal and the boy was discharged. Two years later he presented with recurrent urine retention, and ultrasonography (US) revealed a polypoid mass at the bladder base while cystourethrogram showed a filling defect. Magnetic resonance imaging (MRI) revealed the localization of urethral polyp projecting from verumontanum into the bladder cavity. After successful transurethral resection, histological analysis showed fibroepithelial polyp indicating congenital origin. Discussion: Urethral polyps are very rare and their etiology is controversial. The presenting symptoms are intermittent urine retention, incomplete bladder emptying, hematuria and urinary infection. Rarely, they are asymptomatic. The diagnosis is usually made by US and voiding cystourethrogram (VCUG). Urethrocystoscopy is always diagnostic. The role of MRI is to define the surgical approach to the polypoid lesion. Conclusions: The diagnosis of urethral polyp can be made by US, VCUG or MRI but urethrocystoscopy still has a major diagnostic and therapeutic value, especially in boys presenting with urine retention. Sažetak. Cilj: Polipi stražnje uretre u muške djece rijetke su i obično benigne kongenitalne lezije. U ovom radu prikazat ćemo slučaj osmogodišnjeg dječaka koji je po drugi put primljen u bolnicu zbog akutne retencije urina (ARU) uzrokovane polipom stražnje uretre. Prikaz slučaja: Kod prvog primitka dječaka u bolnicu, zbog ARU-a, učinjene su uretrocistoskopija i cistouretrografija. No, navedenim pretragama nije se uspio pronaći uzrok dječakovim tegobama. Njegovo mokrenje postupno se normaliziralo i dječak je otpušten kući. Dvije godine kasnije, kada je ponovno primljen zbog ARU-a, ultrazvukom (UZ) je uočena polipoidna tvorba na bazi mjehura i defekt punjenja na mikcijskoj cistouretrografiji (MCUG). Magnetskom rezonancijom (MR) točno se definiralo mjesto na kojem se nalazi polip; s ishodištem u verumontanumu i protruzijom u mokraćni mjehur, gdje slobodno prominira. Nakon transuretralne resekcije učinjena je patohistološka analiza kojom je potvrđen fibroepitelni polip koji je vrlo vjerojatno kongenitalan. Rasprava: Uretralni polipi izuzetno su rijetki, a njihova etiologija je stalna tema rasprave. Prezentirajući simptomi su intermitentna retencija urina, nepotpuno pražnjenje mjehura, hematurija i urinarna infekcija. Mogu biti i asimptomatski, ali rijetko. Dijagnoza se obično postavlja s UZ-om i MCUG-om. MR definira kirurški pristup polipoznoj tvorbi, dok se uretrocistoskopijom postavlja definitivna dijagnoza. Zaključci: Dijagnoza uretralnog polipa može se postaviti sa UZ, MCUG i MR, ali uretrocistoskopija ima važnu ulogu, kako dijagnostičku, tako i terapijsku.

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