Fibroepithelial polyp of the renal pelvis: nephron-sparing surgery after false-positive biopsy for transitional cell carcinoma

Myxoma of the renal pelvis masquerading pelviureteric stenosis: conservative limited resection with renal preservation: case presentation and literature review

BACKGROUND

Myxoma is a relatively rare mesenchymal tumor seen mainly in the heart and skin. Renal myxomas in particular are exceptionally rare where only 17 cases were previously reported in the English Language literature. Only 2 of the 17 reported cases were located in the renal sinus/pelvis.

CASE PRESENTATION

This is a case of an 18-year-old male patient who complained of right, colicky flank pain associated with abdominal pain and discomfort. Imaging findings revealed right kidney hydronephrosis with a provisional diagnosis of pelviureteric junction (PUJ) stenosis. On computed tomography, there was a very faint thin walled mass abutting the calyces, camouflaged within the dilated renal pelvis. During surgery, a polypoid mass was found at the pelviureteric junction, causing the obstruction. Histological examination showed a hypocellular, paucivascular myxoid neoplasm, with few spindle cells displaying serpentine nuclei and inconspicuous nucleoli. The tumor cells expressed immunoreactivity for vimentin, but not for S100, CD34, actin, or desmin. This will qualify as the third case of renal pelvis myxoma.

CONCLUSION

Myxomas in the renal pelvis/sinus are extremely rare and can present with hydronephrosis and subtle radiological findings mimicking a PUJ stenosis. Being aware of this entity can save the patient unnecessary nephrectomy with possible preservation of the kidney.

Treatment of large fibroepithelial polyps in the proximal ureter with antegrade plus retrograde endoscopic laser polypectomy

The diagnosis and treatment of large fibroepithelial polyps in the proximal ureter have been the clinical challenges. This study retrospectively summarized the clinical diagnosis and treatment of fibroepithelial polyps >5 cm in length in the proximal ureter of 6 patients who received treatment in the Affiliated Renji Hospital of Shanghai Jiaotong University School of Medicine between December 2010 and February 2017. The length of fibroepithelial polyps ranged from 5.8 to 8.2 cm. There were 4 males and 2 females with the mean age of 32.6 ± 9.8 years. Unilateral polyps were found in all patients (right: n = 4; left: n = 2). Hydronephrosis of different extents was noted in these patients, 4 complained of back pain and 2 were diagnosed with hydronephrosis by ultrasonography. 1 patient had macroscopic hematuria. All these patients received antegrade plus retrograde endoscopic laser polypectomy after admission. Symptoms were significantly improved after surgery, and ultrasonography showed hydronephrosis was attenuated to different extents 2 weeks later. Three months later, computed tomography urography revealed favorable recovery in 5 patients and deterioration of hydronephrosis due to ureteropelvic stenosis in 1 patient.

Upper urinary tract lipoma: A case report

Upper urinary tract (UUT) benign tumours are rare. We present a case of UUT lipoma in a 41-year-old man with left flank pain. A computed tomographic urography scan revealed an irregular thickening of the left renal collecting system wall extending from the upper calices to the renal pelvis. The diagnosis of UUT was made and the patient underwent a nephroureterectomy with bladder cuff excision, as standard treatment. However, macroscopic and histological examination revealed a lipomatous tumour with no sign of malignancy. To our knowledge this is the first reported case of its kind of a UUT managed first with a minimally invasive approach.

Benign fibroepithelial polyp of the ureter

Benign tumors of the ureter are rare and most often appear in the form of fibroepithelial polyps [1]. Fibroepithelial polyps represent from 2 to 6% of all benign tumors of the urinary tract [2]. The Authors report on two cases of fibroepithelial polyps of the ureter, which they treated between 1993–2009. One case was presented by acute urinary retention and gross hematuria. In the second case, hematuria and flank pain were observed. The first case was treated with open surgery and partial resection of the ureter, the second was treated endoscopically when the base of the polyp was well identified.

Benign fibroepithelial polyp of renal pelvis in a patient with familial adenomatous polyposis: a successful percutaneous nephroscopic management strategy

We present a rare case of a benign fibroepithelial polyp of the renal pelvis in a patient with familial adenomatous polyposis. In our paper we describe a new minimally invasive technique developed in our unit using an amplatz goose neck snare via a percutaneous nephroscope sheath in the management of the benign fibroepithelial polyp of the renal pelvis and present a current review of management strategies in literature.

Laparoscopic Management of Large Ureteral Fibroepithelial Polyp

Fibroepithelial polyps of the ureter are rare benign mesothelial tumors. Most polyps are small; however, very rare large polyps have also been reported. Currently, most investigators encourage endoscopic management in these patients. Nevertheless, endoscopic resection can be difficult in patients with a long or large polypoid lesion. We describe our experience and laparoscopic technique for treatment of a symptomatic 42-year-old woman who presented with a 17-cm-long fibroepithelial polyp in the proximal ureter associated with ureteral obstruction. To our knowledge, this is the first reported case of laparoscopic management of a large ureteral fibroepithelial polyp.

Lasers in the upper urinary tract for non-stone disease

Though the most common use for lasers in the genitourinary tract is for urolithiasis, a number of other urologic conditions can be treated with lasers because of their unique ablative, destructive and hemostatic properties. This paper reviews the advantages and disadvantages of laser technology for a number of non-stone indications.

Ureteral polyps: an etiological factor of hydronephrosis in children that should not be ignored

To better define the demographics, urothelial distribution and typical gross anatomic and radiologic appearances of fibroepithelial polyps of the ureter in children. We reviewed 15 cases of fibroepithelial polyps of the ureter with hydronephrosis from the archives of our department. Data were collected from radiographic studies, gross anatomic pathology and pathology and radiology reports and categorized by age, sex, clinical presentation, lesion size and location. The mean patient age was 9.1 years, and 80% were male. All of them presented with hematuria and/or flank pain. The polyps were located in the upper ureter or ureteropelvic junction (UPJ) and pelvis. Of the polyps, 60% were multiple polyps or filiform, and 40% were single or bilobed and 1-6 cm in size. Only four cases showed typical filling defect on intravenous urography. In five cases, sonography showed a mildly echogenic structure extending into the ureter from the renal pelvis. Enhanced CT revealed soft tissue filling UPJ or/and proximal ureter in six cases, and hydroureter was found in one case by three-dimensional (3D) image. Fibroepithelial polyps were diagnosed in all cases by postoperative histological examination. Fibroepithelial polyps are the most common benign tumors of the ureter. Congenital factor may be associated with the origin of fibroepithelial polyps in children. The preoperative diagnosis of ureteral polyps is difficult. A history of flank pain, hematuria or both, other than abdominal mass, light-to-moderate hydronephrosis with soft-tissue in UPJ or upper ureter, shown by sonography and radiological examination, may help in the diagnosis of ureteral polyps in children. Ureteral polyps should be recognized as an important etiology for hydronephrosis in children.

Percutaneous nephroscopic resection of renal pelvic fibroepithelial polyp

Benign fibroepithelial polyps of the renal pelvis are extremely rare, and are frequently mistaken for transitional cell carcinoma. Diagnosis is usually made following nephrectomy or nephroureterectomy for an assumed malignancy of the renal pelvis. We report a 56-year-old female with a right renal pelvic fibroepithelial polyp successfully treated by percutaneous nephroscopic resection.

Endoscopic management of 10 separate fibroepithelial polyps arising in a single ureter

INTRODUCTION

Fibroepithelial polyps of the ureter, usually of congenital or inflammatory origin, are rare entities. These polyps are often solitary, but cases of multiple polyps have also been reported. Treatment of these entities has evolved with emerging surgical techniques and technologies.

SURGICAL TECHNIQUE

We describe our surgical technique for minimally invasive treatment of multiple polyps arising in a single ureter. The base of each polyp is ablated with a 365-microm holmium laser fiber operating at 10 W, and each polyp is removed from the ureteral wall with 3F grasping forceps. Hemostasis is achieved with laser coagulation. Ureteral stones are removed concurrently with a 2.4F basket. A 12/14F ureteral access sheath is used to facilitate the multiple passes of the ureteroscope and the removal of the polyps and stones from the proximal ureter. All 10 polyps were removed from the proximal portion of a single ureter. The ureteral stent was removed at 6 weeks, and follow-up intravenous urography at 6 months and ureteroscopy at 11 months showed no residual polyps or stones. The wall of the ureter was well healed, with no evidence of stricture.

CONCLUSIONS

We have demonstrated a specific minimally invasive technique that can be used to treat even highly complex cases involving upper urinary tract fibroepithelial polyps.

Endoscopic treatment of fibroepithelial polyps of the renal pelvis and ureter

OBJECTIVES

To report our experience on the endoscopic treatment of large fibroepithelial polyps of the renal pelvis and ureter. Fibroepithelial polyps of the upper urinary tract are rare benign tumors that have traditionally been treated by open exploration and resection.

METHODS

Five patients underwent either percutaneous or ureteroscopic treatment of a renal pelvic or ureteral fibroepithelial polyp by electroresection or holmium:yttrium-aluminum-garnet laser resection.

RESULTS

All 5 patients were without recurrence after endoscopic resection. The mean follow-up was 19.6 months (range 6 to 41). The average length of stay was 3 days (range 2 to 5) and 0.5 day (range 0 to 1) for those undergoing percutaneous and ureteroscopic treatment, respectively. No major complications resulted from either approach, and no ureteral strictures have developed. All patients treated remain recurrence free.

CONCLUSIONS

Endoscopic management of large fibroepithelial polyps of the renal pelvis and ureter is an acceptable treatment modality with minimal morbidity and durable treatment results. The percutaneous approach offers the advantage of identifying the base of the polyp under direct visualization, allowing safe destruction of the stalk and efficient removal of the entire polyp. To our knowledge, this is the first reported series of percutaneous, antegrade excision of fibroepithelial polyps.

Conservative management of upper urinary tract tumors

PURPOSE

We determined the immediate and long-term results of endoscopic management of upper tract transitional cell in regard to rates of tumor recurrence and preservation of renal function.

MATERIALS AND METHODS

From January 1990 to July 1999, 61 patients (mean age 66.2 years) underwent endoscopic management of upper tract cell carcinoma. Of the patients 20 (32%) had a solitary kidney. Tumors were resected in a one time procedure by ureteroscopy only in 31.5%, by percutaneous nephroscopy in 29% or both in 8%; multiple treatment was necessary in 31.5% of cases using percutaneous nephroscopy only.

RESULTS

Immediate nephrectomy was done in six cases for high grade (three patients), insufficient local control (two cases) or patient's choices (one case). There were six cases of benign tumors excluded from survival Kaplan Meier analysis. With a mean follow-up of 39.9 months, the rate of kidney preservation, recurrence free rate, global survival and specific survival rates were, respectively, 81%, 68%, 77%, and 84%.

CONCLUSIONS

Nephron sparing percutaneous management of upper tract cell carcinoma is applicable in a significant number of patients with a filling defect of upper urinary tract TCC. In carefully selected patients the results are at least comparable to other forms of management of tumor control and preservation of renal function.

Benign fibroepithelial polyps of the renal pelvis

Benign fibroepithelial polyps of the renal pelvis are rare. Although many ureteral fibroepithelial polyps have been reported, there are, to our knowledge, only 20+ reported cases in the renal pelvis. We report herein the clinical and pathologic features of fibroepithelial polyp of the renal pelvis and provide a detailed review of the literature.