Nephrogenic adenoma of the ureter in a teenager with history of leukemia

Abstract

Nephrogenic adenomas represent a suspected metaplastic response of the uroepithelium to chronic inflammation and are typically associated with recurrent urinary tract infections, stones, prior radiation therapy and other irritative factors, more commonly seen in adults. Nephrogenic adenoma (also known as nephrogenic metaplasia) usually involves the bladder in adults and represents a rare lesion that can easily be misdiagnosed as a malignancy. We present the case of a 14-year-old male with prior history of acute lymphoblastic leukemia (ALL) who presented with a several month history of vague flank pain which increased in intensity, leading to an emergency department presentation with the only significant finding on exam being microhematuria. Subsequent imaging showed a tumor like replacement of the right ureter with proximal hydronephrosis, initially felt to represent recurrent leukemia. Pathology revealed the tumor like ureteral replacement to represent a nephrogenic adenoma, a benign entity which often responds to conservative management, though not previously reported in the ureter in pediatrics.

Bilateral Ureteral Nephrogenic Adenoma: An Unusual Mimicker of Malignancy

“…The exact pathogenesis of NA is still unclear, and various theories have been proposed. One prevalent theory suggests that NA may arise from metaplastic changes in the urothelium, possibly as a result of chronic inflammation or previous urothelial injury [ 4 , 6 ]. Another theory suggests that it may originate from shed renal tubular cells that reimplant and proliferate in areas of denuded urothelium [ 7 ].…”

“…The treatment approach for ureteral NA depends on various factors, including the size and location of the lesion, as well as the presence of symptoms. In many cases, conservative management is sufficient, and the lesion may regress or remain stable over time [ 6 ]. However, in some cases, intervention may be necessary to alleviate symptoms or prevent complications.…”

“…However, in some cases, intervention may be necessary to alleviate symptoms or prevent complications. Surgical options for the treatment of ureteral NA include transurethral resection, laser ablation, and partial or complete excision of the affected ureter [ 6 ]. The choice of surgical approach depends on the extent and location of the lesion, as well as the patient's overall health and preferences.…”