Med Journal October 2020 - Page 17

Table 1
Average Age
Presenting Symptoms
Pathogenesis
Villous Adenoma of the Urinary Tract Features
Distinguishing Histologic Features
69.6 years
Hematuria , mucosuria , irritative voiding symptoms , obstructive urinary symptoms
Two proposed mechanisms : 1 . Shared embryologic origin of rectum and urogenital tract , with possible cloacal remnants left behind leading to a glandular neoplasm . 2 . Chronic irritation-metaplasia-dysplasia-carcinoma sequence .
Positive for CK20 , CEA , and CK7 ( differentiates urogenital from intestinal villous adenomas )

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Treatment
Surgical resection
nomas . 1 , 8 Immunohistochemistry was not performed in this case .
Studies have shown that villous adenomas can coexist or potentially transform into malignant tumors such as adenocarcinoma in situ , invasive adenocarcinomas , and urothelial carcinomas . 1 , 2 , 9 , 10 Cases of pure villous adenomas usually have good prognosis with surgical resection considered curative . Patients who present with co-existent invasive carcinomas may require more aggressive treatments and have a higher risk for recurrence . 1 , 2 A case series by Seibel et al . had 18 reported cases of villous adenoma , three ( 16.7 %) of which involved the prostatic urethra . All three were associated with coexistent adenocarcinoma , and one of which developed local recurrence . 2 Another case series by Cheng et al . examined 23 cases of urinary tract villous adenoma , of which only two ( 8.7 %) involved the urethra . One of these two cases developed multiple recurrence over a six-year follow-up period 1 . In addition , a case report by Zarineh et al ., described an isolated villous adenoma of a female urethra that displayed features of high-grade dysplasia that reoccurred following transurethral resection . 7 These findings suggest that villous adenomas of the urethra may have higher rates of co-existing malignancies and subsequently higher rates of recurrence as compared to villous adenomas located elsewhere along the urinary tract . In our case , pathology did not show any coexistent carcinomas and the patient remains disease free at latest follow-up .
Conclusion In conclusion , villous adenomas of the urinary tract are rare lesions that share many histological similarities with their colonic counterparts . They have been associated with coexistent malignancies and possible malignant transformation . For this reason , it is important for the clinician to identify this uncommon lesion , excise it completely , and thoroughly sample the urinary tract for a possible co-malignancy . Close follow-up of these patients is also imperative .
References
1 . Cheng , L . M . D . M ., Rodolfo M . D .; Bostwick , David G . M . D ., Villous Adenoma of the Urinary Tract : A Report of 23 Cases , Including 8 with Coexistent Adenocarcinoma . The American Journal of Surgical Pathology , 1999 . 23 ( 7 ): p . 764 .
2 . Seibel , J . L ., et al ., Villous adenoma of the urinary tract : a lesion frequently associated with malignancy . Hum Pathol , 2002 . 33 ( 2 ): p . 236-41 .
3 . Sung , W ., et al ., Villous adenoma of the urinary bladder . Int J Urol , 2008 . 15 ( 6 ): p . 551-553 .
4 . Atik , E ., et al ., Villous adenoma of the urinary bladder : rare location . Contemp Oncol ( Pozn ), 2012 . 16 ( 3 ): p . 276-7 .
5 . Adegboyega , P . and A . Adesoken , Tubulovillous adenoma of the urinary bladder . Modern pathology : an official journal of the United States and Canadian Academy of Pathology , 1999 . 12 ( 7 ): p . 735-8 .
For more references , email ams @ arkmed . org
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Volume 117 • Number 4 october 2020 • 89