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Copy:·ight ,Q ; 977
The 'I/Jilliar:1s .& Vlilkins
THE PEDIATRIC AG.h: GROUP: CASE REPORT JOSEPH EILENBERG, WILLIAM SEERY
AND
ANDREW COLE
From the Department of Surgery, Division of Urology, Long Island Jewish-Hillside Medical Center, New Hyde Park, New York
ABSTRACT
The eighth case of multiple fibroepithelial polyps in children is presented. The mode of presentation, disease course and treatment modalities are discussed. CASE REPORT
During the last several years benign tumors of the ureter and renal pelvis have been reported with increasing frequency.1-3 Fibroepithelial polyps, accounting for about 25 per cent of these tumors, seldom appear in children. Only 7 cases
An 11-year-old white boy was hospitalized with a history of left costovertebral angle stabbing pain l month in duration and pyuria on 2 occasions. Urinalysis was within normal limits. An excretory urogram revealed left hydronephrosis. Left retrograde pyelography showed a narrowing of the ureteropelvic junction, a corkscrewed ureter and numerous radiolucent ureteral filling defects (fig. 1). Left flank exploration revealed a markedly dilated renal pelvis and ureter. Ureterotomy showed numerous obstructing polypoid lesions (fig. 2). Frozen sections revealed the possibil-
FIG. 2. Ureterotomy demonstrates obstructing polypoid lesions
ity of transitional cell carcinoma and nephroureterectomy was performed. The final pathological diagnosis was benign fibroepi thelial polyps of the ureter. Convalescence was uneventful and the patient is asymptomatic. DISCUSSION
When the diagnosis of benign tumor in a child is established we believe a conservative to therapy is indicated. If the lesion is solitary or multiple, involving a small of the ureter, a partial ureterectomy, polypectomies or simple fulguration may be performed. With extensive ureteral involvement ureteral substitution by small bowel may be indicated, particularly if there is well preserved renal tissue or if there is a solitary kidney present. However, a nephroureterectomy ultimately may be required if the kidney is damaged severely, the lesion is too extensive or a benig-n diagnosis is doubtful.
FIG. 1. Left retrograde pyelogram demonstrates corkscrewed ureter with numerous filling defects.
REFERENCES
have been reported thus far in the first decade. Herein we present the eighth case of multiple fibroepithelial polyps of the ureter in a child. A review of the literature and discussion of treatment are included. Accepted for publication January 28, 1977. 793
1. Parker, D. J.: A fibrous polyp of the ureter in childhood. Brit. J. Urol., 40: 418, 1968. 2. Bose, B. and Williams, J. P.: Benign polypoidal tumour of the ureter. Brit. J. Surg., 58: 149, 1971. 3. Soderdahl, D. W. and Schuster, S. R.: Benign ureteral polyp in the newborn. J.A.M.A., 207: 1714, 1969.
Copy:·ight ,Q ; 977
The 'I/Jilliar:1s .& Vlilkins
THE PEDIATRIC AG.h: GROUP: CASE REPORT JOSEPH EILENBERG, WILLIAM SEERY
AND
ANDREW COLE
From the Department of Surgery, Division of Urology, Long Island Jewish-Hillside Medical Center, New Hyde Park, New York
ABSTRACT
The eighth case of multiple fibroepithelial polyps in children is presented. The mode of presentation, disease course and treatment modalities are discussed. CASE REPORT
During the last several years benign tumors of the ureter and renal pelvis have been reported with increasing frequency.1-3 Fibroepithelial polyps, accounting for about 25 per cent of these tumors, seldom appear in children. Only 7 cases
An 11-year-old white boy was hospitalized with a history of left costovertebral angle stabbing pain l month in duration and pyuria on 2 occasions. Urinalysis was within normal limits. An excretory urogram revealed left hydronephrosis. Left retrograde pyelography showed a narrowing of the ureteropelvic junction, a corkscrewed ureter and numerous radiolucent ureteral filling defects (fig. 1). Left flank exploration revealed a markedly dilated renal pelvis and ureter. Ureterotomy showed numerous obstructing polypoid lesions (fig. 2). Frozen sections revealed the possibil-
FIG. 2. Ureterotomy demonstrates obstructing polypoid lesions
ity of transitional cell carcinoma and nephroureterectomy was performed. The final pathological diagnosis was benign fibroepi thelial polyps of the ureter. Convalescence was uneventful and the patient is asymptomatic. DISCUSSION
When the diagnosis of benign tumor in a child is established we believe a conservative to therapy is indicated. If the lesion is solitary or multiple, involving a small of the ureter, a partial ureterectomy, polypectomies or simple fulguration may be performed. With extensive ureteral involvement ureteral substitution by small bowel may be indicated, particularly if there is well preserved renal tissue or if there is a solitary kidney present. However, a nephroureterectomy ultimately may be required if the kidney is damaged severely, the lesion is too extensive or a benig-n diagnosis is doubtful.
FIG. 1. Left retrograde pyelogram demonstrates corkscrewed ureter with numerous filling defects.
REFERENCES
have been reported thus far in the first decade. Herein we present the eighth case of multiple fibroepithelial polyps of the ureter in a child. A review of the literature and discussion of treatment are included. Accepted for publication January 28, 1977. 793
1. Parker, D. J.: A fibrous polyp of the ureter in childhood. Brit. J. Urol., 40: 418, 1968. 2. Bose, B. and Williams, J. P.: Benign polypoidal tumour of the ureter. Brit. J. Surg., 58: 149, 1971. 3. Soderdahl, D. W. and Schuster, S. R.: Benign ureteral polyp in the newborn. J.A.M.A., 207: 1714, 1969.
