E138Intestinal type villous adenoma of the renal pelvis AbstractIntestinal type villous adenomas are uncommon in the genitourinary tract. Most reported cases have been located in the urinary bladder or urachus. Villous adenoma arising in the renal pelvis or ureter is very rare. We present a case of an 81-year-old female who presented with difficulty voiding and mucosuria. A computed tomography scan identified right-sided hydronephrosis, renal parenchymal atrophy, nonobstructing calculi and a lower pole renal mass. She underwent open right nephrectomy. Histopathologic examination of the kidney revealed an intestinal type villous adenoma of the renal pelvis with high-grade dysplasia and focal areas suspicious for invasive adenocarcinoma. We review the four previously reported cases of intestinal type villous adenoma in the renal pelvis and discuss diagnosis and management of this unusual neoplasm.
male at birth but who identify as female will be referred to as 'transgender women'. It is important for a health care provider to inquire what pronouns patients' use to ensure the appropriate language is used and to establish trust. Pronouns can include "she/her", "he/him", "they/them" and others. Terminology is ever changing. Staying current on trans competent language may lead to improved patient care. The transition process Gender dysphoria/ incongruence is defined as distress that may accompany the incongruence between one's gender identity and one's assigned sex at birth.(5) Transition is a term used to describe the process one might take to express their felt gender identity. Transition may involve, social, medical or surgical elements. Social transition can include aspects such dressing in clothing that reflects their gender identity, name/ pronoun change, and changing government identification. Social transitioning alone may alleviate distress from gender dysphoria with improved quality of life and well-being. (6) Medical transition generally refers to starting hormone therapies. Surgical transition can include many possible surgeries to alter one's primary and secondary sex characteristics. There is not one way that a TGNB individual transitions. The process is individualized. For many TGNB patients, social, medical and surgical transition can greatly improve gender dysphoria.(7) In Ontario, the TransPULSE study surveyed 433 participants regarding the transition process.(8) Of those surveyed, 30% had not undertaken any steps in the transition process, while 23% were living in their felt gender but without any medical intervention. Forty-six percent of transgender women and 39% of transgender men were currently using hormones for a medical transition. Twenty-three percent reported having completely transitioned, which was self-defined and could include medical or surgical measures. Of surgical interventions, orchiectomy was most common, reported by 21% of transgender women. Vaginoplasty was reported in 15% of transgender women. In contrast, only 0.4 % of transgender men had undergone phalloplasty. The study confirmed this population represents a heterogeneous group in terms of accessing different aspects of transition. This study also suggested that we may be at the 'tip of the iceberg' in terms of the numbers of patients going through this process. Hormonal and medical therapies Many patients choose to pursue medical treatments to address their gender dysphoria. Hormonal therapy is generally overseen by the patient's primary care provider or endocrinologist. Hormonal modulation has quality of life benefits for transgender patients.(9, 10) Criteria for the prescription of hormone therapy includes: gender incongruence, capacity to make informed decisions, and reasonable control of associated mental health conditions.(11) For transgender men, masculinizing hormonal treatment is primarily exogenous testosterone therapy. Transdermal, subcutaneous and intramuscular (IM) formulations are most CUAJ-Review Ander...
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