|Year : 2015 | Volume
| Issue : 3 | Page : 665
Villous adenoma of the urinary bladder
Dilip Kumar Pal
Department of Urology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
|Date of Web Publication||9-Oct-2015|
Dilip Kumar Pal
Department of Urology, Institute of Post Graduate Medical Education and Research, 244, AJC Bose Road, Kolkata - 700 020, West Bengal
Source of Support: None, Conflict of Interest: None
Villous adenoma is a known entity in the gastrointestinal tract, but very rare in the urinary tract. It is a benign tumor with excellent prognosis, but its progression to adenocarcinoma is not established. Here, we report an additional case of villous adenoma of the urinary bladder.
Keywords: Tubulovillous adenoma, urinary bladder, villous adenoma
|How to cite this article:|
Pal DK. Villous adenoma of the urinary bladder. J Can Res Ther 2015;11:665
| > Introduction|| |
Villous adenoma of the urinary tract is very rare. ,,,, Most of the cases are reported as a case report, and until now only two case series are published. , Histopathologically it is identical to the villous adenoma of the intestinal tract. We report a case of villous adenoma of the urinary bladder with a successful outcome.
| > Case report|| |
A 45-year-old woman presented with two episodes of gross hematuria 2 months back. Since then, she suffered from irritable bladder symptoms. On physical examination, no abnormality was detected. Urinalysis was normal and urine culture revealed no growth. She was normoglycemic with normal renal biochemical parameters. On ultrasonography (USG), a large growth was found in the right posterolateral wall with a broad base. Contrast-enhanced computed tomography (CT) revealed a 5 cm × 3 cm enhancing polypoid mass in the right posterolateral wall of the urinary bladder without any extravesical extension [Figure 1]. Cystoscopy confirmed the same findings, transurethral resection of the tumor with coagulation of the base done. Histopathological examination suggested it to be a villous adenoma with focal dysplastic changes [Figure 2] and typical goblet cells without any muscular or lymphovascular invasion [Figure 3]. Immunohistochemistry showed positive staining for cytokeratine (CK)-7 and 20 and carcinoembryonic antigen (CEA).
|Figure 1: Contrast-enhanced computed tomography showing a bladder mass in the right posterolateral wall|
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|Figure 2: Microphotograph showing bladder muscle with stromal component with villous adenoma (H and E, ×40)|
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|Figure 3: Microphotograph showing bladder smooth muscle on one side with villous adenoma. The adenoma shows typical goblet cells without any invasion (H and E, ×400)|
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| > Discussion|| |
Villous adenoma of the urinary tract is rarely reported in the literature, and until now only 10 cases are reported.  The age of the reported cases ranged from 33 to 79 years with a median range of 57 years.  The usual clinical presentation is with hematuria and chronic irritative urinary symptoms. ,, There is no specific findings in USG, CT, magnetic resonance imaging or in cystoscopy to differentiate it preoperatively from usual urothelial carcinoma.  Histologically urinary tract villous adenomas are identical to the colonic villous adenomas. Both of them have rounded projection of pseudo-stratified columnar epithelium with goblet type mucin secreting cells.  Both these lesions are positive with immunohistochemical staining for CK-20 and CEA, but negative for epithelial membrane antigen. Only 50% of urinary tract villous adenomas show positivity for CK-7, in contrast to the most of the cases of intestinal origin.  The differential diagnosis of villous adenoma includes cystitis glandularis and well-differentiated adenocarcinoma. , Both of them do not show a well-formed villous structure, which is typical of villous adenoma, but the latter shows pseudostratified epithelium with enlarged hyperchromatic nucli, which is absent in cystitis glandularis.  Though coexisting adenocarcinoma with villous adenoma has been reported in two cases, , there is no evidence to support that villous adenoma may progress to adenocarcinoma.  Until now, there is only one case report of urethral villous adenoma, which has progressed to villous adenocarcinoma,  The prognosis of this tumor is excellent.  but follow-up cystoscopy is necessary in order to find any recurrence as well as a coexisting carcinoma. 
| > References|| |
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[Figure 1], [Figure 2], [Figure 3]