- Email: [email protected]
Villous adenoma of female urethra
VILLOUS ADENOMA OF FEMALE URETHRA G. C. RAJU,
M.D.
A. ROOPNARINESINGH, J. WOO,
M.R.C.O.G.
M.R.C.O.G.
From the Departments of Pathology and Obstetrics and Gynecology, Port of Spain General Hospital, Trinidad, West Indies
ABSTRACT-Villous and compare with
adenoma of the female urethra is extremely only other case reported in the literature.
Villous adenomas of the female urethra are rare neoplasms whose malignant potential is unclear. A caseof morphologically benign, noninvasive, mucin-producing villous adenoma of the female urethra is presented. Case Report A fifty-eight-year-old black woman was seen at the Port of Spain General Hospital, Trinidad, in 1979, with a fleshy polypoidal mass in the
rare. We present one such case
distal urethra. She had noticed it a few months before, and it was slowly increasing in size. She was otherwise asymptomatic. An excisional biopsy was performed, with a clinical diagnosis of urethral polyp. The excised lesion was a soft grayish mass, 1 cm in diameter and was processeden bloc. Histologically, it consisted of papillary fronds of mucin-producing columnar cells which showed neither atypicality nor invasion into the stroma.
FIGURE 1. (A) Villous adenoma consisting of papillary fronds of orderly columnar cells with mucus production. (B) High-powered view showing benignappearing lining cells. (Hematoxylin and eosin, original magnifications, x 100 and x 200, respectively.)
446
UROLOGY
/
APRIL
1987
i
VOLUME
XXIX,
NUMBER
4
The nuclei were hyperchromatic, basally situated, and uniform in size and shape (Fig. 1). No evidence of invasion was noted at the base, and the edges of the resection were free of the tumor. Complete gastrointestinal evaluation failed to reveal any similar lesions. No further treatment was offered, and the patient is free of local recurrence or malignancy seventy-two months after diagnosis. Comment Villous adenomas are uncommon epithelial lesions with a high malignant potential and are encountered usually in the gastrointestinal tract.1-2 Villous adenomas occurring in the urinary tract are raree3 The presence of these tumors in the bladder or the urethra were explained embryologically4; the cloaca is divided by the urorectal septum into the rectum dorsally and the urogenital sinus ventrally, and glandular remnants in the bladder or urethra may give rise to these villous tumors. Histologically, this case is similar to the villous adenoma of the female urethra reported by Powell, Cartwright, and Janoh However, their patient, a fifty-nine-year-old black woman, presented originally with benign villous
UROLOGY
/
APRIL
1987
I
VOLUME
XXIX,
NUMBER
4
adenoma that progressedwithin a year to invasive adenocarcinoma. These authors recommend that patients with this type of lesion be followed closely and treated aggressively for any signs of malignancy. Our patient, seventytwo months after diagnosis, is free of local recurrence or malignancy. The prognosis and behavior of these rare villous adenomas of the urethra are unpredictable. Patients with villous adenomas of the urethra need an adequate local excision, a thorough histologic examination for signs of atypicality and invasion, and should be followed carefully for recurrent diseaseor malignancy. Department of Pathology National University Hospital Lower Kent Ridge Road Singapore 0511, Republic of Singapore (DR. RAJU) References 1. Jahadi MR, and Baldwin A Jr: WOW adenomas of the colon-and rectum, Am J Surg 130: ?29 (1975). 2. Delevett AF. and Cue110 R: True villous adenoma of the iejunum, Gastroenierology 69: 217 (1975). 3. Assor D: A villous tumour of the bladder, J Urol 119: 287 (1978). 4. Daroca PJ, MacKenzie F, Reed RJ, and Keane JM: Primary adenovillous carcinoma of the bladder, ibid 115: 41 (1976). 5. Powell I, Cartwright H, and Jano F: Villous adenoma and adenocarcinoma of female urethra, Urology 18: 612 (1981).
447
M.D.
A. ROOPNARINESINGH, J. WOO,
M.R.C.O.G.
M.R.C.O.G.
From the Departments of Pathology and Obstetrics and Gynecology, Port of Spain General Hospital, Trinidad, West Indies
ABSTRACT-Villous and compare with
adenoma of the female urethra is extremely only other case reported in the literature.
Villous adenomas of the female urethra are rare neoplasms whose malignant potential is unclear. A caseof morphologically benign, noninvasive, mucin-producing villous adenoma of the female urethra is presented. Case Report A fifty-eight-year-old black woman was seen at the Port of Spain General Hospital, Trinidad, in 1979, with a fleshy polypoidal mass in the
rare. We present one such case
distal urethra. She had noticed it a few months before, and it was slowly increasing in size. She was otherwise asymptomatic. An excisional biopsy was performed, with a clinical diagnosis of urethral polyp. The excised lesion was a soft grayish mass, 1 cm in diameter and was processeden bloc. Histologically, it consisted of papillary fronds of mucin-producing columnar cells which showed neither atypicality nor invasion into the stroma.
FIGURE 1. (A) Villous adenoma consisting of papillary fronds of orderly columnar cells with mucus production. (B) High-powered view showing benignappearing lining cells. (Hematoxylin and eosin, original magnifications, x 100 and x 200, respectively.)
446
UROLOGY
/
APRIL
1987
i
VOLUME
XXIX,
NUMBER
4
The nuclei were hyperchromatic, basally situated, and uniform in size and shape (Fig. 1). No evidence of invasion was noted at the base, and the edges of the resection were free of the tumor. Complete gastrointestinal evaluation failed to reveal any similar lesions. No further treatment was offered, and the patient is free of local recurrence or malignancy seventy-two months after diagnosis. Comment Villous adenomas are uncommon epithelial lesions with a high malignant potential and are encountered usually in the gastrointestinal tract.1-2 Villous adenomas occurring in the urinary tract are raree3 The presence of these tumors in the bladder or the urethra were explained embryologically4; the cloaca is divided by the urorectal septum into the rectum dorsally and the urogenital sinus ventrally, and glandular remnants in the bladder or urethra may give rise to these villous tumors. Histologically, this case is similar to the villous adenoma of the female urethra reported by Powell, Cartwright, and Janoh However, their patient, a fifty-nine-year-old black woman, presented originally with benign villous
UROLOGY
/
APRIL
1987
I
VOLUME
XXIX,
NUMBER
4
adenoma that progressedwithin a year to invasive adenocarcinoma. These authors recommend that patients with this type of lesion be followed closely and treated aggressively for any signs of malignancy. Our patient, seventytwo months after diagnosis, is free of local recurrence or malignancy. The prognosis and behavior of these rare villous adenomas of the urethra are unpredictable. Patients with villous adenomas of the urethra need an adequate local excision, a thorough histologic examination for signs of atypicality and invasion, and should be followed carefully for recurrent diseaseor malignancy. Department of Pathology National University Hospital Lower Kent Ridge Road Singapore 0511, Republic of Singapore (DR. RAJU) References 1. Jahadi MR, and Baldwin A Jr: WOW adenomas of the colon-and rectum, Am J Surg 130: ?29 (1975). 2. Delevett AF. and Cue110 R: True villous adenoma of the iejunum, Gastroenierology 69: 217 (1975). 3. Assor D: A villous tumour of the bladder, J Urol 119: 287 (1978). 4. Daroca PJ, MacKenzie F, Reed RJ, and Keane JM: Primary adenovillous carcinoma of the bladder, ibid 115: 41 (1976). 5. Powell I, Cartwright H, and Jano F: Villous adenoma and adenocarcinoma of female urethra, Urology 18: 612 (1981).
447