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Benign Fibrous Polyp of Ureter: A Case Report
Vol. 108, Auiust
THE JOURNAL OF UROLOGY
Copyright© 1972 by The Williams & Wilkins Co.
Printed in U.S.A.
BENIGN FIBROUS POLYP OF URETER: A CASE REPORT JAMES M. NEAL
AND
L. DAVIS ARBUCKLE
From the Department of Urology, Akron General Medical Center, Akron, Ohio
Primary tumorn of the ureter are infrequently encountered. They are usually malignant and of epithelial origin. Benign tumors are less common and the majority of these are epithelial in origin. This fact makes benign tumors of mesodermal origin quite rare. Up to 1943, 6 cases of benign tumors of
CASB RJ,JPORT
A 69-year-old white man was admitted to this medical center on December 30, 1970 with a complaint of "trouble in my kidney tube". During a diagnostic study for arthritic type back pain an excretory urogram (IVP) :ohowed a defect in the
Fm. 1 right lower ureter (fig. 1, A). The patient's history was unremarkable for urologic problems except for nocturia times 2 and occasional hesitancy of stream. Hematuria, pyuria and flank pain were denied. Family and social history were unremarkable. Physical examination revealed a well developed, well nourished man. The prostate was 2 plus enlarged and benign. The examination was otherwise unremarkable. Admis:oion urinalysis and hemogram were normal. Blood urea nitrogen, creatinine, fasting blood sugar, phosphorus, calcium, alkaline and acid phosphatase, serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase, total protein and bilirubin were normal. The 12-hour creatinine clearance was 130 ml. per minute. Cystoscopy 1 day after admission revealed non-obstructing lateral lobe
mesodermal origin had been reported in the literature.1 Since 1943 there have been reports of 16 cases in which the histologic findings indicated mesodermal origin. 2- 11 It is noteworthy that 2 of these cases were reported in children. 2 , 3 Accepted for publication November 24, 1971. Read at annual meeting of North Central Section, American Urological Association, Detroit, Michigan, September 22-25, 1971. 1 Lucke, B. and Schlumberger, H. S.: Tumors of the kidney, renal pelvis and ureter. In: Atlas of Tumor Pathology. Washington, D. C.: Armed Forces Institute of Pathology, sect. VIII, fasc. 30, p. 200, 1957. 2 Parker, D. J.: A fibrous polyp of the ureter in childhood. Brit. J. Urol., 40: 418, 1968. 3 Evans, A. T. and Stevens, R. K.: Fibroepithelial polyps of ureter and renal pelvis: a case report. J. Urol., 86: 313, 1961. 4 Crum, P. M., Sayegh, E. S., Sacher, E. C. and Wescott, J. W.: Benign ureteral polyps. J. Urol., 102: 678, 1969. 5 Brock, D. R.: Benign polyp of ureter. J. Urol., 83: 572, 1960. 6 DeKlotz, R. J. and Young, B. W.: Conservative surgery in the management of benign ureteral polyps. A case report. Brit. J. Urol., 36: 375, 1964. 7 Roen, P. R. and Kandalaft, S.: Primary benign mesodermal ureteral tumor. J. Urol., 96: 890, 1966.
8 Senger, F. L. and Furey, C. A., Jr.: Primaryureteral tumors with a review of the literature since 1943. J. Urol., 69: 243, 1953. 9 Pierce, W. V. and Miner, W. R.: Benign tumors of ureter. Southern Med. J., 45: 485, 1952. 10 Oppenheimer, G. D. and Narins, L.: Benign tumor of ureter. J. Mt. Sinai Hosp., 21: 213, 1954. 11 Hudson, H. C. and Howland, R. L., Jr.: Primary benign ureteral tumor of mesodermal origin. J. Urol., 105: 794, 1971.
230
BENIGN FIBROUS POLYP OF URETER
231
l<'IG. 2
hypertrophy of the prostate with minimal trabeculation of the bladder. An occlusive retrograde pyelogram showed obstruction in the lower third of the right ureter (fig. 1, B). Six days later the patient underwent exploration of the right ureter through a Gibson incision. A fusiform smooth mass was easily palpable in the ureter. A longitudinal ureterotomy was made over the mass revealing a polypoid lesion approximately 4 cm. in length with a grossly malignant appearance. A biopsy was performed and surprisingly the frozen section interpretation wa:, benign fibrous polyp. The polyp was excised with a portion of the ureter and the ureter was anastomosed over a No. 5 ureteral catheter which was threaded into the bladder. Convalescence was uneventful and the splinting catheter was removed cystoscopically at 3 weeks. The specimen measured 44 mm. in length and 5 mm. in diameter. It was soft in consistency with a mottled gray-white, pinkish-tan color with a yellow necrotic tip. Microscopically the tumor showed a vascular-fibrous stroma with areas of myxoid-like edema covered by benign transitional epithelium (fig. 2, A). There were cyst-like protrusions of this epithelium into the stroma resembling meteritis cystica (fig. 2, B). Eight months postoperatively the patient is doing well and IVP is normal (fig. 3). Fm. 3
THE JOURNAL OF UROLOGY
Copyright© 1972 by The Williams & Wilkins Co.
Printed in U.S.A.
BENIGN FIBROUS POLYP OF URETER: A CASE REPORT JAMES M. NEAL
AND
L. DAVIS ARBUCKLE
From the Department of Urology, Akron General Medical Center, Akron, Ohio
Primary tumorn of the ureter are infrequently encountered. They are usually malignant and of epithelial origin. Benign tumors are less common and the majority of these are epithelial in origin. This fact makes benign tumors of mesodermal origin quite rare. Up to 1943, 6 cases of benign tumors of
CASB RJ,JPORT
A 69-year-old white man was admitted to this medical center on December 30, 1970 with a complaint of "trouble in my kidney tube". During a diagnostic study for arthritic type back pain an excretory urogram (IVP) :ohowed a defect in the
Fm. 1 right lower ureter (fig. 1, A). The patient's history was unremarkable for urologic problems except for nocturia times 2 and occasional hesitancy of stream. Hematuria, pyuria and flank pain were denied. Family and social history were unremarkable. Physical examination revealed a well developed, well nourished man. The prostate was 2 plus enlarged and benign. The examination was otherwise unremarkable. Admis:oion urinalysis and hemogram were normal. Blood urea nitrogen, creatinine, fasting blood sugar, phosphorus, calcium, alkaline and acid phosphatase, serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase, total protein and bilirubin were normal. The 12-hour creatinine clearance was 130 ml. per minute. Cystoscopy 1 day after admission revealed non-obstructing lateral lobe
mesodermal origin had been reported in the literature.1 Since 1943 there have been reports of 16 cases in which the histologic findings indicated mesodermal origin. 2- 11 It is noteworthy that 2 of these cases were reported in children. 2 , 3 Accepted for publication November 24, 1971. Read at annual meeting of North Central Section, American Urological Association, Detroit, Michigan, September 22-25, 1971. 1 Lucke, B. and Schlumberger, H. S.: Tumors of the kidney, renal pelvis and ureter. In: Atlas of Tumor Pathology. Washington, D. C.: Armed Forces Institute of Pathology, sect. VIII, fasc. 30, p. 200, 1957. 2 Parker, D. J.: A fibrous polyp of the ureter in childhood. Brit. J. Urol., 40: 418, 1968. 3 Evans, A. T. and Stevens, R. K.: Fibroepithelial polyps of ureter and renal pelvis: a case report. J. Urol., 86: 313, 1961. 4 Crum, P. M., Sayegh, E. S., Sacher, E. C. and Wescott, J. W.: Benign ureteral polyps. J. Urol., 102: 678, 1969. 5 Brock, D. R.: Benign polyp of ureter. J. Urol., 83: 572, 1960. 6 DeKlotz, R. J. and Young, B. W.: Conservative surgery in the management of benign ureteral polyps. A case report. Brit. J. Urol., 36: 375, 1964. 7 Roen, P. R. and Kandalaft, S.: Primary benign mesodermal ureteral tumor. J. Urol., 96: 890, 1966.
8 Senger, F. L. and Furey, C. A., Jr.: Primaryureteral tumors with a review of the literature since 1943. J. Urol., 69: 243, 1953. 9 Pierce, W. V. and Miner, W. R.: Benign tumors of ureter. Southern Med. J., 45: 485, 1952. 10 Oppenheimer, G. D. and Narins, L.: Benign tumor of ureter. J. Mt. Sinai Hosp., 21: 213, 1954. 11 Hudson, H. C. and Howland, R. L., Jr.: Primary benign ureteral tumor of mesodermal origin. J. Urol., 105: 794, 1971.
230
BENIGN FIBROUS POLYP OF URETER
231
l<'IG. 2
hypertrophy of the prostate with minimal trabeculation of the bladder. An occlusive retrograde pyelogram showed obstruction in the lower third of the right ureter (fig. 1, B). Six days later the patient underwent exploration of the right ureter through a Gibson incision. A fusiform smooth mass was easily palpable in the ureter. A longitudinal ureterotomy was made over the mass revealing a polypoid lesion approximately 4 cm. in length with a grossly malignant appearance. A biopsy was performed and surprisingly the frozen section interpretation wa:, benign fibrous polyp. The polyp was excised with a portion of the ureter and the ureter was anastomosed over a No. 5 ureteral catheter which was threaded into the bladder. Convalescence was uneventful and the splinting catheter was removed cystoscopically at 3 weeks. The specimen measured 44 mm. in length and 5 mm. in diameter. It was soft in consistency with a mottled gray-white, pinkish-tan color with a yellow necrotic tip. Microscopically the tumor showed a vascular-fibrous stroma with areas of myxoid-like edema covered by benign transitional epithelium (fig. 2, A). There were cyst-like protrusions of this epithelium into the stroma resembling meteritis cystica (fig. 2, B). Eight months postoperatively the patient is doing well and IVP is normal (fig. 3). Fm. 3