THE JOURNAL OF UROLOC:Y
Vol. 114. October
Copyri~ht © 1975 h,· The Williams & Wilkins Co.
Prin ted in U.S.A.
BENIGN MESODERMAL POLYP IN CHILDHOOD ALEX GUP
ABSTRACT
A ureteral fibrous polyp presenting as ureteropel vic junction obstruction in a 10-year-old boy is reported. These neoplas ms are uncommon. especially in children. If a salvageable kidney is present. resection of the tumor and adjacent ureter is proper therapy. However, in the present case the fibrous polyp had produced marked ureteropelvic junction obstruction. resulting in only a thin shell of renal parenchymal tissue, and therefore. nephroureterectomy was performed. Ureteral polyps a re uncommon and have been estimated to occur in approximately 1 of every 3,700 urological hospital admissions. 1 · ' They a re usuall y epithelial in origin, malign a nt a nd occur in patients between 40 a nd 90 years old. 3 These facts indicate that benign mesoderm a l ureteral polyps in children are rare and review of t he lit erature has revealed only 7 cases. 3 -•
na lys is. hemogra m . bl ood urea nitrogen and serum creat inine were normal. An excretory urogram showed m a rkedly del ayed excretion of the co ntrast mate rial by th e lert kidn e~· and s ignificant left rena l hvdron ephros is. The left ureter was not vis uali zed and left ureteropelvic jun ct ion obstruction see med to be present (fig. I. A). The right kidney a nd ureter. and the bladder a ppea red norm a l. A left retrograde pye logram revealed a filling defect in the ureter just below th e ureteropelvic junction which later proved to be caused by a fibrou s polyp (fig. L Hl.
CASE REPORT
A 10-year-old white boy had a history of intermitten t left flank and upper abdominal colicky
pain. with occasiona l associated na usea a nd vomiting sin ce in fa ncy . The pain did not radiate and fever had never occ urred durin g this distress. Urologica l history was otherwise unrem a rkab le . Phys ica l examination re vea led a well de\·eloped . well nourished bov an d was unremarkabl e exce pt for slight left costovertehral a ngle tendern ess. l lriAccepted for publication Mav 16. 19,,-,. 619
Through a sta nd a rd flank in c ision the left kidney a nd upper ureter were explored. Marked hvdronephrosis with litt le parenchymal tissue was found. Prior to opening the uret er. it ap pea red normal and th ere was no extrin s ic uret era l or uret eropelvi c .iunct ion ohst ru ct ion pres ent . Wh en the peh· iouretera l .iun ct ion an d upper uret er were opened. a poh·poicl tumor was found (fig. :2). This tumor was a pproxim atel y ;j cm . in length and
620
C:l"P
FIG. 2
about 4 cm. below the ureteropelvic junction. Because there appeared to be little functioning renal tissue, nephroureterectomy was performed. The specimen was a pink, soft lohulated mass Fi cm. in length and G mm. in diameter. Microscopically the neoplasm showed a vascular fibrous stroma covered by benign transitional epithelium (fig. :3). The patient is doing well 1 year postoperatively. COMMENTS
There are various treatments for benign ureteral tumors. Nephroureterectomy is advised by many for epithelial tumors since the lesion may be m ulticentric in origin or potentially malignant. 3 However, this concern is not universally shared and some authorities advise only conservative resection of the neoplasm.2 Local ureteral resection with the tumor has been more commonly practiced for benign mesodermal tumors. 8 Nephroureterectomy was done in the present case because a mesodermal polyp had produced marked ureteropelvic junction obstruction and damaged the kidney to such a degree that it was non-salvageable. The Medical Center, 1750 N. Palafox St., Pen sacola, Florida 32501
REFERENCES
1. Aheshouse. R. S.: Primary benign and malignant tumors of the ureter: review of the literature and report of one benign and 12 malignant tumors. Arner. ,J. Surg., 91: 2:l7, 1956. 2. Miranda, D. and DeAssis, A. S.: Transit ion al cell papillorna of ureter in young hoy. l'rologv, 5: 559, 19,.~. :l. Parker, D . .J.: A fibrous polyp of the ureter in childhood. Brit .•J. Urol., 40: 418, 1968. 4. Evans, A. T. and Stevens, R. K.: Fibroepithelial polyps of ureter and renal pelvis: a case report .•J. llrol.. 86: :ll:l. 1961. 5. Compere, D. E., Begley, G. F., Isaacks, H. E., Frazier, T. H. and Dryden. C. B.: Ureteral polvps ..J. l'rol., 79: 209, 1%8. 6. Crum, P. M .. Sayegh, E. S .. Sacher, E. C. and Wescott, .J. W.: Benign ureteral polyps. ,J. Urol.. 102: 678. 1969. 7. Soderdahl, D. W. and Schuster, S. R.: Benign ureteral polyp in the newborn .•J.A.M.A., 207: 1714, 19(i9. 8. Colgan, ,J. R., III, Skaist, L. and Morrow, .J. W.: Benign ureteral tumors in childhood: a case report and a plea for conservative management. ,J. Urol., 109: :l08. I (J'i:l.
Vol. 114. October
Copyri~ht © 1975 h,· The Williams & Wilkins Co.
Prin ted in U.S.A.
BENIGN MESODERMAL POLYP IN CHILDHOOD ALEX GUP
ABSTRACT
A ureteral fibrous polyp presenting as ureteropel vic junction obstruction in a 10-year-old boy is reported. These neoplas ms are uncommon. especially in children. If a salvageable kidney is present. resection of the tumor and adjacent ureter is proper therapy. However, in the present case the fibrous polyp had produced marked ureteropelvic junction obstruction. resulting in only a thin shell of renal parenchymal tissue, and therefore. nephroureterectomy was performed. Ureteral polyps a re uncommon and have been estimated to occur in approximately 1 of every 3,700 urological hospital admissions. 1 · ' They a re usuall y epithelial in origin, malign a nt a nd occur in patients between 40 a nd 90 years old. 3 These facts indicate that benign mesoderm a l ureteral polyps in children are rare and review of t he lit erature has revealed only 7 cases. 3 -•
na lys is. hemogra m . bl ood urea nitrogen and serum creat inine were normal. An excretory urogram showed m a rkedly del ayed excretion of the co ntrast mate rial by th e lert kidn e~· and s ignificant left rena l hvdron ephros is. The left ureter was not vis uali zed and left ureteropelvic jun ct ion obstruction see med to be present (fig. I. A). The right kidney a nd ureter. and the bladder a ppea red norm a l. A left retrograde pye logram revealed a filling defect in the ureter just below th e ureteropelvic junction which later proved to be caused by a fibrou s polyp (fig. L Hl.
CASE REPORT
A 10-year-old white boy had a history of intermitten t left flank and upper abdominal colicky
pain. with occasiona l associated na usea a nd vomiting sin ce in fa ncy . The pain did not radiate and fever had never occ urred durin g this distress. Urologica l history was otherwise unrem a rkab le . Phys ica l examination re vea led a well de\·eloped . well nourished bov an d was unremarkabl e exce pt for slight left costovertehral a ngle tendern ess. l lriAccepted for publication Mav 16. 19,,-,. 619
Through a sta nd a rd flank in c ision the left kidney a nd upper ureter were explored. Marked hvdronephrosis with litt le parenchymal tissue was found. Prior to opening the uret er. it ap pea red normal and th ere was no extrin s ic uret era l or uret eropelvi c .iunct ion ohst ru ct ion pres ent . Wh en the peh· iouretera l .iun ct ion an d upper uret er were opened. a poh·poicl tumor was found (fig. :2). This tumor was a pproxim atel y ;j cm . in length and
620
C:l"P
FIG. 2
about 4 cm. below the ureteropelvic junction. Because there appeared to be little functioning renal tissue, nephroureterectomy was performed. The specimen was a pink, soft lohulated mass Fi cm. in length and G mm. in diameter. Microscopically the neoplasm showed a vascular fibrous stroma covered by benign transitional epithelium (fig. :3). The patient is doing well 1 year postoperatively. COMMENTS
There are various treatments for benign ureteral tumors. Nephroureterectomy is advised by many for epithelial tumors since the lesion may be m ulticentric in origin or potentially malignant. 3 However, this concern is not universally shared and some authorities advise only conservative resection of the neoplasm.2 Local ureteral resection with the tumor has been more commonly practiced for benign mesodermal tumors. 8 Nephroureterectomy was done in the present case because a mesodermal polyp had produced marked ureteropelvic junction obstruction and damaged the kidney to such a degree that it was non-salvageable. The Medical Center, 1750 N. Palafox St., Pen sacola, Florida 32501
REFERENCES
1. Aheshouse. R. S.: Primary benign and malignant tumors of the ureter: review of the literature and report of one benign and 12 malignant tumors. Arner. ,J. Surg., 91: 2:l7, 1956. 2. Miranda, D. and DeAssis, A. S.: Transit ion al cell papillorna of ureter in young hoy. l'rologv, 5: 559, 19,.~. :l. Parker, D . .J.: A fibrous polyp of the ureter in childhood. Brit .•J. Urol., 40: 418, 1968. 4. Evans, A. T. and Stevens, R. K.: Fibroepithelial polyps of ureter and renal pelvis: a case report .•J. llrol.. 86: :ll:l. 1961. 5. Compere, D. E., Begley, G. F., Isaacks, H. E., Frazier, T. H. and Dryden. C. B.: Ureteral polvps ..J. l'rol., 79: 209, 1%8. 6. Crum, P. M .. Sayegh, E. S .. Sacher, E. C. and Wescott, .J. W.: Benign ureteral polyps. ,J. Urol.. 102: 678. 1969. 7. Soderdahl, D. W. and Schuster, S. R.: Benign ureteral polyp in the newborn .•J.A.M.A., 207: 1714, 19(i9. 8. Colgan, ,J. R., III, Skaist, L. and Morrow, .J. W.: Benign ureteral tumors in childhood: a case report and a plea for conservative management. ,J. Urol., 109: :l08. I (J'i:l.
