Nephrogenic adenoma associated with cytomegalovirus infection of the ureter in a renal transplant patient: presentation as ureteral obstruction

Abstract

Nephrogenic adenoma (NA), a rare benign lesion of the urinary tract, is widely accepted to be a metaplastic reaction due to urothelial injury. It mainly occurs in the urinary bladder and rarely in the ureter. Renal transplant recipients are prone to the development of NA. However in those patients, NA was diagnosed exclusively in the bladder. Herein, we present the -to our knowledge -first case of NA involving a transplanted ureter. A 42-year-old female kidney transplant recipient suffered hematuria, oliguria, and acute renal failure and presented with ureteral obstruction and hydronephrosis of the renal transplant. To our surprise, evidence of cytomegalovirus (CMV) infection of the NA was demonstrated using special immunohistochemical staining. The findings in this case raise the possibility that CMV infection, as an irritant of the ureteral epithelium, may be an etiological factor of NA.

Acute post-renal kidney graft dysfunction due to cytomegalovirus-positive nephrogenic adenoma—case report and review of the literature

“…In our patient, nephrogenic adenoma of the ureter was found to be CMV-positive. We are aware of four previously reported cases of CMV-positive nephrogenic adenomas in kidney transplant recipients ( 18 – 21 ); while three of them affected the bladder, only one case involving the transplant ureter has been described so far ( Table 1 ). Most of the cases were diagnosed within 1 year post-transplant, all of them by histological analysis.…”

“…Management of the patient with ureteral nephrogenic adenoma reported by Hung et al included resection of the lesion and pyeloplasty, intravenous ganciclovir treatment for 2 weeks and withdrawal of the antimetabolite azathioprin ( 21 ). The optimal duration of antiviral treatment for CMV-related tissue-invasive disease is not known.…”