Giant congenital urethral polyp

Giant congenital urethral polyp

Journal of Pediatric Surgery (2008) 43, 1211–1212 www.elsevier.com/locate/jpedsurg Giant congenital urethral polyp Alfredo Bertolotti, Sebastian Gre...

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Journal of Pediatric Surgery (2008) 43, 1211–1212

www.elsevier.com/locate/jpedsurg

Giant congenital urethral polyp Alfredo Bertolotti, Sebastian Gregorio Tobia González⁎, Raul Etcheverry, Ricardo Drut Hospital de Niños “Sor María Ludovica” de La Plata Received 31 August 2007; revised 21 January 2008; accepted 7 February 2008

Key word: Urethral polyp

Abstract A case of giant congenital urethral polyp on a female newborn is reported. The lesion appeared as a large fleshy, exuberant tumor at the introitus between the labia minora. The mass was constituted by orderly arranged layers of transitional and squamous epithelium outside and loose connective tissue and smooth muscle in its core. The patient was treated by simple excision of the lesion. © 2008 Elsevier Inc. All rights reserved.

Urethral polyps in children are most commonly present in boys affecting the proximal region and are considered to be congenital [1]. Rare examples of urethral polyp in young girls are also on record [2,3]. We are describing the case of a female newborn presenting a large urethral polyp a condition that seems to be reported only once [4].

1. Case report A 26-year-old woman gave birth to a abdominally delivered, 3100 kg female neonate. Apgar score was 9 at 5 minutes. Physical examination revealed an exuberant reddish mass showing undulating movements at manual stimulation, measuring 6 × 3 × 3 cm, protruding at the vulva (Fig. 1). A voiding cystogram and ultrasound showed normal bladder and kidneys. Renal function as reflected by blood urea nitrogen and serum creatinine levels was normal. Urine culture was negative for bacteria. A biopsy done at the second day of life did not reveal malignancy. At the third week of life under general anesthesia, the patient was placed in the lithotomic position for urologic examination. The cystoscopy demonstrated the tumor arising ⁎ Corresponding author. Especialista en Urología, Hospital de Niños “Sor María Ludovico.” La Plata, Argentina. 0022-3468/$ – see front matter © 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.jpedsurg.2008.02.004

from the posterior wall of the urethra. The prolapsed mass was excised by an incision around its base. The edges were approximated with 5.0 polyglactin suture. A urethral catheter was left in place along 2 days, after which the patient retained urinary continence. Follow-up at 18 months showed no evidence of recurrent disease on physical and cystoscopical examination. Histologically, the mass was composed of a core of smooth muscle bundles containing some nerves, overlaid by edematous, loose connective tissue with engorged capillaries and surface epithelial layer composed of squamous cells on

Fig. 1

Exuberant reddish mass protruding at the vulva.

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2. Comment The lesion appeared as a large fleshy, exuberant tumor at the introitus between the labia minora. The mass was constituted by orderly arranged layers of transitional and squamous epithelium outside and loose connective tissue and smooth muscle in its core. The patient was treated by simple excision of the lesion and was curative. This appears to represent the second example of urethral polyp presenting in a female newborn. Present patient is quite similar to the one reported by Mahajan et al [4] although this time the size of the polyp largely surpassed their case. Masses presenting at the introitus in newborns incite to differential diagnosis with malformations (prolapsed ectopic ureterocele, paraurethral cyst) and the true tumors (embryonic rhabdomyosarcoma). A urethral polyp, most probably also a peculiar hamartomatous lesion, is then to be included in the list. Although just speculative, the lesion may have resulted from an abnormal inclusion of part of ventral area of the urethral fold into the urethra itself, later presenting as a giant polyp.

References Fig. 2 Chronic inflammatory infiltrates extended from the corium to the epithelial layer, which was focally eroded.

one side and transitional cells on the other. Chronic inflammatory infiltrates extended from the corium to the epithelial layer, which was focally eroded (Fig. 2).

[1] Murphy WM, Grigon DJ, Perlman EJ. Tumours of the kidney, bladder and related urinary structures. AFIP Atlas Tumor Pathol Series 4 2004:369. [2] Klee LW, Rink RC, Gleason PE, et al. Urethral polyp presenting as interlabial mass in young girls. Urology 1993;41:132-3. [3] Lamahewage AK, Kesley A, Gough DC. Urethral polyp in young girl. Br J Urol 1998;82:456. [4] Mahajan JK, Chalapathi G, Rao KLN. Urethral polyp in a female newborn. J Urol 2002;168:2188.