Nephrogenic adenomas of the urinary system: a clinicopathologic analysis of 30 cases

Abstract

Objective: Nephrogenic adenomas (NA) are benign lesions that may occur in several sites throughout the urinary tract, from the renal pelvis to urethra, and especially in the bladder. They are strongly associated with urinary tract irritation, chronic inflammation, previous urologic surgery, and intravesical instrumentations. Our study aims to evaluate and present the clinicopathologic characteristics and findings of cases that were diagnosed with nephrogenic adenoma accompanied by relevant information from the literature.

Material and Methods: Our study includes 30 patients who were pathologically diagnosed with NA from February 2005 to November 2017.

Results: Among these patients, 63.3% were males and mean age was 60 years. The most common site of occurrence was the bladder (86.6%), followed by the ureter (6.7%) and the urethra (6.7%). Most patients presented with hematuria (36.7%). History of concurrent bladder cancer was present in 26.7% of patients, but there were no cases of de novo bladder cancer diagnosed after NA. Recurrence of NA after initial resection occurred in only 10% of patients who underwent follow-up cystoscopy. Nephrogenic adenoma is a rare lesion associated with nonspecific symptoms and endoscopic features. Definite diagnosis must be made after histological analysis of resected specimens.

Conclusion: Nephrogenic adenoma is a rare lesion associated with nonspecific symptoms and nonspesific endoscopic features. A definite diagnosis must be after histological analysis of resected specimens. 

Keywords

• Nephrogenic adenoma
• urothelial lesion
• bladder
• ureter

Üriner sistemin nefrojenik adenomları: 30 vakanın klinikopatolojik analizi

Abstract

Amaç: Nefrojenik adenom (NA), en sık mesane olmak üzere üriner sistemin değişik yerlerinde oluşan benign bir lezyondur. Üriner sistem irritasyonu, kronik inflamasyon, geçirilmiş ürolojik cerrahi ve intravezikal enstrümantasyon ile ilişkilidir. Çalışmamızda, nefrojenik adenom tanısı almış olguların klinikopatolojik özelliklerinin ve sonuçlarının güncel literatür bilgileri eşliğinde incelenerek sunulması amaçlanmıştır.

Gereç ve Yöntemler: Çalışmamıza Şubat 2005- Kasım 2017 yılları arasında Nefrojenik adenom patolojik tanısı almış 30 hasta dahil edildi.

Bulgular: 30 hastanın % 63,3’ü erkekti ve ortalama yaş 60 olarak bulundu. Olgular mesane (%86,6), üreter (%6,7) ve üretra (%6,7) yerleşimliydi. En sık hematüri (%36,7) klinik bulgusu görülmüştü. Hastaların %26,7’sinde eşlik eden mesane kanseri öyküsü mevcuttu ancak hiçbir hastada nefrojenik adenom tanısı sonrası yeni gelişen mesane kanseri mevcut değildi. İlk rezeksiyon sonrası takip sistoskopilerinde %10 hastada rekürrens görüldü.

Sonuç: Nefrojenik adenomlar nonspesifik semptom ve endoskopik bulgular gösteren nadir lezyonlardır. Bu nedenle doğru tanı rezeksiyon materyalinin histolojik değerlendirilmesi ile konulmalıdır.

Keywords

• Nefrojenik adenom
• ürotelyal lezyon
• mesane
• üreter

References

1. 1. Gordetsky J, Gennaro KH, Selph JP, Rais-Bahrami S. Nephrogenic Adenoma: Clinical Features, Management, and Diagnostic Pitfalls. Urology. 2016;95:29-33.
2. 2. Venyo AK. Nephrogenic Adenoma of the Urinary Bladder: A Review of the Literature. Int Sch Res Notices. 2015 Feb 2;2015:704982
3. 3. Kuzaka B, Pudełko P, Powała A, Górnicka B, Radziszewski P. Nephrogenic adenoma of the urinary bladder: a report of three cases and a review of the literature. Ann Transplant. 2014 Apr 1;19:153-6.
4. 4. Rensing AJ, Koenig JF, Vricella GJ, Sehn JK. Nephrogenic adenoma of the pediatric ureter. J Urol. 2015;193:1377-8.
5. 5. Kunju LP. Nephrogenic adenoma: report of a case and review of morphologic mimics. Arch Pathol Lab Med. 2010 Oct;134(10):1455-9.
6. 6. Davis TA. Hamartoma of the urinary bladder. Northwest Med. 1949;48:182-5.
7. 7. Friedman NB, Kuhlenbeck H. Adenomatoid tumors of the bladder reproducing renal structures (nephrogenic adenomas). J Urol. 1950;64:657-70.
8. 8. López JI, Schiavo-Lena M, Corominas-Cishek A, Yagüe A, Bauleth K, Guarch R, Hes O, Tardanico R. Nephrogenic adenoma of the urinary tract: clinical, histological, and immunohistochemical characteristics. Virchows Arch. 2013;463:819-25.

9. 9. Turcan D, Acikalin MF, Yilmaz E, Canaz F, Arik D. Nephrogenic adenoma of the urinary tract: A 6-year single center experience. Pathol Res Pract. 2017 Jul;213(7):831-35.
10. 10. Porcaro AB, D'Amico A, Ficarra V, Balzarro M, Righetti R, Martignoni G, Cavalleri S, Malossini G. Nephrogenic adenoma of the urinary bladder: our experience and review of the literature. Urol Int. 2001;66(3): 152–5.
11. 11. Oliva E, Young RH. Nephrogenic adenoma of the urinary tract: a review of the microscopic appearance of 80 cases with emphasis on unusual features. Mod Pathol. 1995;8(7):722–30.
12. 12. Dropkin BM, Giannico GA, Reisz PA, Penson DF, Hsi RS. Fibromyxoid Nephrogenic Adenoma in the Ureter. J Endourol Case Rep. 2018 Jul 1;4(1):97-99.
13. 13. Safaei A, Farzaneh MR, Amin Sharifi AR. Immunohistochemistery study in a case of nephrogenic adenoma of bladder. Iran J Med Sci. 2012 Jun;37(2):137-40.
14. 14. A.S. McDaniel, A.M. Chinnaiyan, J. Siddiqui, J.K. McKenney, R. Mehra. Immunohistochemical staining characteristics of nephrogenic adenoma using the PIN-4 cocktail (p63, AMACR, and CK903) and GATA-3, Am. J. Surg. Pathol. 38 (2014) 1664–71. Doi: 10.1097/PAS.0000000000000267
15. 15. Herawi M, Drew PA, Pan CC, Epstein JI. Clear cell adenocarcinoma of the bladder and urethra: cases diffusely mimicking nephrogenic adenoma. Hum Pathol. 2010;41(4):594–601.
16. 16. Hartmann A, Junker K, Dietmaier W, Schröder S, Lopez D, Hofstädter F, Blaszyk H. Molecular evidence for progression of nephrogenic metaplasia of the urinary bladder to clear cell adenocarcinoma. Hum Pathol. 2006;37(1):117–20.
17. 17. Pycha A, Mian C, Reiter WJ, Brössner C, Haitel A, Wiener H, Maier U, Marberger M. Nephrogenic adenoma in renal transplant recipients: a truly benign lesion? Urology. 1998;52(5):756–61.
18. 18. Yi Y, Wu A, Cameron AP. Nephrogenic adenoma of the bladder: a single institution experience assessing clinical factors. Int Braz J Urol. 2018 May-Jun;44(3):506-11.