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A Case of Pedunculated Urethral Polyp
A CASE OF PEDUNCULATED URETHRAL POLYP H. M. N. WYNNE From the Department of Gynecology and Obstetrics, University of Minnesota Received for publication July 26, 1926
Polyps are not common in the female urethra. They are usually small and sometimes can be seen at the external meatus. It is rare that one hangs down over the vestibule by a pedicle. The majority of those found in women are the result of chronic gonorrhea. "' Mrs. D . C. H ., aged thirty-seven mother of six children, examined in my office January 5, 1926, on account of slight blood stains on her underclothing between periods. Seven years ago the patient was treated for a severe cystitis with complete relief and has had no recurrence of the urinary symptoms except slight frequency before periods for the last few months. August 1, 1924, the appendix, left tube and left ovary were removed. A chronic salpingitis and an old abscess of the right ovary were found at the operation. At this time there was no evidence of a urethral tumor on inspection of the external genitalia. The examination of January, 1926, showed a fiery red, insen~itive polyp, measuring 10 by 8 by 3 mm. , dangling at the end of a pedicle 1 cm. in length and giving the appearance of a small placenta with its umbilical cord. The pedicle was attached to the posterior urethral wall 0.5 cm. above the external meatus. A small vein was seen in the pedicle. The polyp was removed with a small cautery knife close to the urethral mucosa. Dr. J . S. McCartney, Jr., examined the specimen and has furnished the following pathological description : Microscopic examination of the urethral tumor shows (as figure 1 illustrates) a very definite papillomatous structure. The surface of the mass and the convolutions are covered with squamous type of epithelium which shows no cornification. This epithelial covering varies greatly in thickness in different areas. The core of the mass is made up of a very 315
316
H. M. N. WYNNE
Fm. 1.
Fm. 2.
PHOTOMICROGRAPH OF POLYP.
PHOTOMICROGRAPH OF SECTION
OF POLYP.
HIGH POWER
See figure I, area 2
Fm. 3.
Low
POWER
PHOTOMICROGRAPH OF SECTION OF POLYP.
HIGH POWER
See figure 1, area 3
PEDUNCULATED URETHRAL POLYP
317
loose connective tissue which is extensively infiltrated with plasma cells, polymorphnuclear leucocytes and eosinophiles. In some areas these leucocytes are rather scattered; on others they are so numerous as to form almost a solid mass. One of the areas showing the more extensive leucocytic infiltration is illustrated in figure 2 which is a high power photomicrograph of area 2, figure 1. Figure 3 which is a high power of area 3, figure 1, shows one of the less intensely infiltrated areas. In this area there is a homogeneous precipitate (edema). The leucocytic infiltration is not confined to the connective tissue core but is also found in the epithelium itself. Between the papillary projections of the mass are collections of leucocytes, red blood cells and homogeneous material. In one area in the section there is what is apparently a lymph follicle with a quite definite germinal center.
I wish to thank Dr. McCartney, Assistant Professor of Pathology of the University of Minnesota Medical School, for his assistance.
Polyps are not common in the female urethra. They are usually small and sometimes can be seen at the external meatus. It is rare that one hangs down over the vestibule by a pedicle. The majority of those found in women are the result of chronic gonorrhea. "' Mrs. D . C. H ., aged thirty-seven mother of six children, examined in my office January 5, 1926, on account of slight blood stains on her underclothing between periods. Seven years ago the patient was treated for a severe cystitis with complete relief and has had no recurrence of the urinary symptoms except slight frequency before periods for the last few months. August 1, 1924, the appendix, left tube and left ovary were removed. A chronic salpingitis and an old abscess of the right ovary were found at the operation. At this time there was no evidence of a urethral tumor on inspection of the external genitalia. The examination of January, 1926, showed a fiery red, insen~itive polyp, measuring 10 by 8 by 3 mm. , dangling at the end of a pedicle 1 cm. in length and giving the appearance of a small placenta with its umbilical cord. The pedicle was attached to the posterior urethral wall 0.5 cm. above the external meatus. A small vein was seen in the pedicle. The polyp was removed with a small cautery knife close to the urethral mucosa. Dr. J . S. McCartney, Jr., examined the specimen and has furnished the following pathological description : Microscopic examination of the urethral tumor shows (as figure 1 illustrates) a very definite papillomatous structure. The surface of the mass and the convolutions are covered with squamous type of epithelium which shows no cornification. This epithelial covering varies greatly in thickness in different areas. The core of the mass is made up of a very 315
316
H. M. N. WYNNE
Fm. 1.
Fm. 2.
PHOTOMICROGRAPH OF POLYP.
PHOTOMICROGRAPH OF SECTION
OF POLYP.
HIGH POWER
See figure I, area 2
Fm. 3.
Low
POWER
PHOTOMICROGRAPH OF SECTION OF POLYP.
HIGH POWER
See figure 1, area 3
PEDUNCULATED URETHRAL POLYP
317
loose connective tissue which is extensively infiltrated with plasma cells, polymorphnuclear leucocytes and eosinophiles. In some areas these leucocytes are rather scattered; on others they are so numerous as to form almost a solid mass. One of the areas showing the more extensive leucocytic infiltration is illustrated in figure 2 which is a high power photomicrograph of area 2, figure 1. Figure 3 which is a high power of area 3, figure 1, shows one of the less intensely infiltrated areas. In this area there is a homogeneous precipitate (edema). The leucocytic infiltration is not confined to the connective tissue core but is also found in the epithelium itself. Between the papillary projections of the mass are collections of leucocytes, red blood cells and homogeneous material. In one area in the section there is what is apparently a lymph follicle with a quite definite germinal center.
I wish to thank Dr. McCartney, Assistant Professor of Pathology of the University of Minnesota Medical School, for his assistance.