Fibroepithelial polyp is a benign neoplasm of a mesodermal origin that arises in the wall of the ureter, renal pelvis, bladder or urethra1. Here we report a case of a fibroepithelial polyp of the ureter in a young adult.
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Caassee RReeppoorrtt
A 20-year-old girl was admitted to another institution with gross painless hematuria. Her physical examination was within normal limits. Abdominal ultrasound examination demonstrated an echogenic structure with polypoid projections extended into the bladder suggesting bladder tumor (Figure-1). The patient was then referred for cystoscopy to our institution. At cystoscopy a papillary tumor was seen protruding from the left ureteral orifice. An intravenous pyelogram confirmed the above finding and revealed a large obstructing filling
defect located in the distal third of the left ureter. Rigid ureterorenoscopy was then undertaken to obtain tissue sample for pathological examination. Ureterorenoscopy of this lesion revealed a polypoid ureteral lesion starting from the distal third of the left ureter and protruding into the bladder, a biopsy of which was done and the remainder protruding part was excised. Pathologic examination of the tissue specimen confirmed a fibroepithelial polyp.
Then the patient lost follow-up. After admitted 5 months later, she underwent an uneventful left ureterotomy and an 8 cm fibroepithelial polyp that stemmed from a single stalk was excised (Figure-2) and a partial ureterectomy with an end-to-end anastomosis was performed. A double-J stent was placed at the end of the procedure and removed 2 months postoperatively. At follow-up, the patient was asymptomatic and had no 161 BEDREDD N SE K N, SELAHATT N BED R, FAHR S MER, SERDAR G KTA , DO AN ERDURAN
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* GMMA Department of Urology, Resident ** GMMA Department of Urology, Specialist
*** GMMA Department of Urology, Associate Professor **** GMMA Department of Urology, Professor
–––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Received: Nov 19, 2002 Accepted: May 01, 2003
JOURNAL OF ANKARA MEDICAL SCHOOL Vol 25, No 3, 2003 161-164
SSUUMMMMAARRYY
We report a case of primary fibroepithelial polyp of the left ureter. The patient was a 20-year-old-girl. During ureteroureterostomy a fibroepithelial polyp in the left ureter was found and resection of the polyp from the left ureter and a partial ureterectomy with an end-to-end anastomosis was performed.
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Keeyy WWoorrddss:: Fibroepithelial Polyp, Üreter, Ureteroureterostomy
Ö ÖZZEETT
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Geennçç EErriişşkkiinnddee GGöörrüülleenn ÜÜrreetteerraall FFiibbrrooeeppiitteellyyaall PPoolliipp Sol üreterinde primer fibroepitelyal polip tespit ettiğimiz bir vakayı sunuyoruz. Hasta 20 yaşında bir bayan idi. Ureteroureterostomi sırasında sol üreterde fibroepitelyal polip bulundu ve sapıyla birlikte rezeke edildi. Daha sonra parsiyel üreteroktomi ve uç uça anastomoz gerçekleştirildi.
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Annaahhttaarr KKeelliimmeelleerr:: Fibroepitelyal Polip, Üreter, Üreteroüreterostomi
162 FIBROEPITHELIAL POLYP OF THE URETER IN A YOUNG ADULT
evidence of disease on cystoscopy and IVP for one year.
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Diissccuussssiioonn
Ureteral fibroepithelial polyps are rare neoplasms(1). These lesions can occur at any age and has been reported even in a neonate(2). Most patients present with hematuria and/or flank pain(1). Ureteral fibroepithelial polyps are usually located in the proximal third of the ureter(1). In our case the polyp was in the distal third of the ureter.
Radiologic appearance is variable according to the gross appearance of the tumor. Intravenous urography may show an intraluminal lesion that is smooth or polypoid and does not cause marked dilatation of the urinary tract. If identification cannot be made by intravenous urography, retrograde and/or antegrade pyelography should be made(3). Preoperative radiologic examination was important in this patient because it directed the proper mode of therapy. Ureteroscopy can differentiate clearly the smooth, regular surface of pedunculated fibroepithelial polyps from the irregular, friable appearance of urethelial carcinoma(4). Appropiate treatment of these tumors is by local excision with or without segmental resection(5).
In our case, the polyp was removed completely with its stalk so that an obstructing base would not be left. Recurrences have not been reported in spite of observations of up to 15 years(3). Although our follow-up is minimal (one year), no recurrence is noted.
FFiigguurree 11:: Preoperative USG showing a tumor projecting into bladder lumen
FFiigguurree 22:: Intraoperative photograph of left ureter showing single strand of 8 cm polyp Thin arrow showing left ureter and thick arrow showing
163 BEDREDD N SE K N, SELAHATT N BED R, FAHR S MER, SERDAR G KTA , DO AN ERDURAN
1. Kim H, Kim DK, Lee SJ, Chang SG: Fibroepithelial ureteral polyp: a case report; endoscopic removal of large ureteral polyp. J Korean Med Sci 1996;11(1):80-83.
2. Debruyne FMJ, Moonen WA, Daenekindt AA, Delaere KPJ: Fibroepithelial polyp of ureter. Urology 1980;16:355-359.
3. Francis FB, Sonny LJ, Rodney JM, Thomas JI: Bilateral fibroepithelial polyps of ureter in a child. Urology 1990;35(6):519-522.
4. Bahnson RR, Blum MD, Carter MF: Fibroepithelial polyps of the ureter. J Urol 1984;132:343-344. 5. Oesterling JE, Liu HY, Fishman EK: Real time,
multiplanar computerized tomography: a new diagnostic modality used in the detection and endoscopic removal of a ureteral fibroepithelial polyp and adjacent calculus. J Urol 1989;142:1563-66.
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