Recurrent nephrogenic adenoma in bladder diverticulum: case report and literature review

Abstract

Nephrogenic adenoma is an uncommon benign lesion of the urinary tract induced by chronic irritation of the vesical mucosa, due to infection, trauma, surgery, calculi, foreign bodies and chemical agents. A 68-year-old male was admitted to our linic for a periodical cystoscopic evaluation as part of a follow-up initiated due to a past transitional cell carcinoma. The scheduled cystoscopy revealed, within a bladder diverticulum, an unexpected and completely asymptomatic nephrogenic adenoma that we removed by transurethral resection. We followed up the patient at 24 months, then later we made the diagnosis of nephrogenic adenoma. During this time, the patient experienced three relapses within the same diverticulum, always involving a nephrogenic adenoma we persistently treated by transurethral resections. As the nephrogenic adenoma is considered a benign lesion without any direct evidence of a possible evolution to an overt cancer, we successful attempted a half-yearly cystoscopic follow-up to control the growth of a highly recurrent benign entity, interposing between controls a periodical imaging. This paper represents the second report of a nephrogenic adenoma within a bladder diverticulum, but the first case of a nephrogenic adenoma highly recurrent within the same diverticulum and managed conservatively by regular transurethral resection scheduled over the time.

Rare cause of macroscopic hematuria in a pediatric patient: Nephrogenic adenoma of the bladder

“…Typical histology includes tubular, tubulocystic, polypoid and/or papillary features, and most common forms are tubular and in 96% of cases . The macroscopic appearance of the lesion varies but is generally highly vascularized …”

“…4,8 The macroscopic appearance of the lesion varies but is generally highly vascularized. 3 Recognition of the characteristic patterns and awareness of the unusual architectural and cytologic features are critical to make a diagnosis of NA, and to distinguish this lesion from malignant neoplasms occurring at the same site. The following features favor NA: absence of necrosis, lack of significant atypia or mitotic activity, presence of a mixture of tubular and papillary components and edematous/inflammatory stroma.…”

“…NA arise mostly in the bladder (80%), and at other urinary tract sites including urethra (15%), ureter (5%) and rarely in the renal pelvis (1%). Also some reports have shown that it could be detected at bladder extrophy, urethral diverticula, in an ileal conduit, bowel portion of an augmented bladder and bladder diverticula . Hematuria, dysuria and urinary frequency are usually the first and the most common presenting symptoms.…”

“…Also some reports have shown that it could be detected at bladder extrophy, urethral diverticula, in an ileal conduit, bowel portion of an augmented bladder and bladder diverticula. 2,3 Hematuria, dysuria and urinary frequency are usually the first and the most common presenting symptoms. This report describes an adolescent patient who was admitted with macroscopic hematuria and subsequently had diagnosis of NA after cystoscopy.…”