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CASE REPORT
Year : 2011  |  Volume : 27  |  Issue : 1  |  Page : 140-141
 

Mesonephric adenoma in remnant ureteric stump: A rare entity


Department of Urology, Jeevan Jot Hospital, Amritsar, Punjab, India

Date of Web Publication29-Mar-2011

Correspondence Address:
Kamal Jeet Singh
Jeevan Jot Hospital, 13 Kamla Devi Avenue, FGC Road, Near Byepass Police Post, Amritsar - 143 001, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-1591.78414

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   Abstract 

Nephrogenic Adenomas have been reported though out the Urinary Tract from Renal Pelvis to the Urethra. We present one rare case of its occurrence in the remanant ureteral stump.


Keywords: Mesonephric adenoma, nephrogenic adenoma, ureteric stump


How to cite this article:
Singh KJ. Mesonephric adenoma in remnant ureteric stump: A rare entity. Indian J Urol 2011;27:140-1

How to cite this URL:
Singh KJ. Mesonephric adenoma in remnant ureteric stump: A rare entity. Indian J Urol [serial online] 2011 [cited 2019 Sep 21];27:140-1. Available from: http://www.indianjurol.com/text.asp?2011/27/1/140/78414



   Introduction Top


Nephrogenic adenoma (NA) is a rare benign condition of the urinary system. It is also known as mesonephric adenoma. Friedman and Kuhlenbeck reported eight similar cases of adenomatoid tumors and coined the term "Nephrogenic Adenoma" to describe the resemblance of these lesions w the developing kidney and their possible neoplastic potential. NAs have been reported throughout the urinary tract, from the renal pelvis to the urethra, the most common site being the bladder (71%). However, many cases have been reported in the ureters as well. [1]


   Case Report Top


An 18-year-old male patient presented with chief complains of painless hematuria of 4 days duration. There were no other significant complaints. The patient had undergone right-sided radical nephrectomy 4 years back (histopathology of resected kidney revealed renal papillary cell carcinoma). General and systemic examinations revealed no abnormality, except for the presence of a right-sided flank scar. Ultrasonography revealed the presence of a 2 cm × 2 cm mass in relation to the right ureteric orifice. Microscopic examination of the urinary sample did not reveal the presence of any malignant cells. Hematological and biochemistry examinations were within normal limits. Cystoscopy revealed a polypoidal mass protruding out of the right ureteric orifice, and this mass was resected [Figure 1]. Histopathology of the resected tissue was suggestive of NA. Excision of the ureteric stump with bladder cuff was performed [Figure 2] and histopathology of the excised mass revealed mesonephric tubules, usually lined by a single layer of bland cuboidal or hobnail cells. Cells had clear or eosinophilic cytoplasm, small nuclei and no prominent nucleoli with thickened basement membrane. Stromal edema and inflammatory infiltrate were also seen, which were suggestive of NA [Figure 3].
Figure 1: Resected right ureter with mass seen at its lower end

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Figure 2: Cystoscopic picture of the polypoidal mass protruding from the right ureteric orifice

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Figure 3: Histologically, mesonephric tubules lined by a single layer of bland cuboidal surrounding eosinophilic secretions. Cells had eosinophilic cytoplasm, small nuclei and no prominent nucleoli with thickened basement membrane. Stromal edema and inflammatory infiltrate were present

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   Discussion Top


NA, or mesonephric adenoma, is a rare benign lesion of the urothelial tract. The etiology of NA is not well defined. Various factors implicated in the occurrence of this pathology are:

  • Chronic inflammation - secondary to trauma, infection, catheterization, postoperative. [2]
  • Metplastic changes in the transitional epithelium due to invagination of the mesodermal cells in the embryologic bladder. [3]
  • Transplantation of the renal tubular epithelial cells in the urinary tract. [4]
On light microscopy, NA shows a variety of patterns, including tubulocystic, papillary and, much less frequently, solid, which often coexist. Recognition of its characteristic patterns and awareness of its unusual architectural and cytologic features is key to making the diagnosis of NA and distinguishing this lesion from malignant neoplasms occurring at the same sites, in particular, clear cell carcinoma, nested or microcystic variants of urothelial carcinoma and prostatic adenocarcinoma. Although straightforward in most cases, the correct diagnosis may be difficult to make on limited tissue samples. A number of immunohistochemical markers have been studied in an attempt to characterize NA; however, to date, there is no specific immunohistochemical profile to distinguish this lesion from its malignant mimickers, although PAX2, a new marker, may prove to be helpful in this regard. [5] Epstein et al. presented the first report of a fibromyxoid subtype of NA. Nephrogenic metaplasia, focal and diffuse have also been recorded, and this is seen more often in children than in adults, where adenoma predominates. [4]

Treatment for NA is endoscopic resection. However, due to the risk of local recurrence, follow-up examinations must be emphasized upon.

 
   References Top

1.Friedman NB, Kuhlenbeck H. Adenomatoid tumors of the bladder reproducing renal structures (nephrogenic adenomas). J Urol 1950;64:657-70.  Back to cited text no. 1
    
2.Leonard SA, Silverman AJ, Langston JW, Fuselier HA. Postoperative nephrogenic adenoma of bladder. Urology 1976;7:327-8.  Back to cited text no. 2
    
3.O'Shea PA, Callaghan JF, Lawlor JB, Reddy VC. Nephrogenic adenoma: An unusual metaplastic change of urothelium. J Urol 1981;125:249-52.  Back to cited text no. 3
    
4.Hansel DE, Nadasdy T, Epstein JI. Fibromyxoid nephrogenic adenoma: A newly recognized variant mimicking mucinous adenocarcinoma. Am J Surg Pathol 2007;31:1231-7.  Back to cited text no. 4
    
5.Rahemtullah A, Oliva E. Nephrogenic adenoma: An update on an innocuous but troublesome entity. Adv Anat Pathol 2006;13:247-55.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]

This article has been cited by
1 Multifocal nephrogenic adenoma - A mimicker of malignancy
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2 Multifocal Nephrogenic Adenoma A Mimicker of Malignancy
Pragati Aditya Sathe,Ratnaprabha Kundlikrao Ghodke,Bhuvaneshwari Mahendra Kandalkar
The Indian Journal of Pediatrics. 2012; 79(12): 1661
[Pubmed] | [DOI]



 

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