urethral villous adenoma

Urethral Villous Adenoma: A Rare Benign Tumor

Urethral villous adenoma is a rare and benign tumor that occurs in the urinary tract, specifically in the urethra. It is characterized by a villous architectural pattern, which means it has finger-like projections or villi on its surface.

Key Features:

• Rare occurrence: Urethral villous adenomas are extremely rare, with only a few cases reported in the English literature.
• Benign nature: Despite their rarity, these tumors are considered benign and have an excellent prognosis when isolated.
• Age and gender predilection: They typically occur in patients older than 50 years, with a male predominance.
• Symptoms: Affected individuals may present with hematuria (blood in the urine), irritative voiding symptoms, and mucosuria (mucus in the urine).
• Association with malignancy: While not established, some case series studies suggest a possible association between bladder villous adenoma and malignancy.

Pathogenesis:

The exact pathogenesis of urethral villous adenomas is unclear. However, it is believed to involve metaplastic changes in the urothelium, leading to the formation of intestinal-type epithelial cells.

Differential Diagnosis:

It is essential to distinguish urethral villous adenoma from other urinary tract tumors, such as metastatic adenocarcinoma derived from the colon. A thorough diagnostic workup, including imaging studies and histopathological examination, is necessary to confirm the diagnosis.

References:

• [1] Villous adenoma of the urethra is a rarely encountered but important clinical entity to be recognized by the urologic surgeon.
• [3] Primary villous adenoma originating from the urinary tract is an extremely rare benign urethral tumor.
• [13] Villous adenoma is a rare neoplasm in the urinary tract, usually occurring in patients older than 50 years with a male predominance.

Common Signs and Symptoms of Urethral Villous Adenoma

Urethral villous adenoma, a rare benign tumor, can manifest with various symptoms. The most common signs and symptoms include:

• Painless hematuria: This is the most common symptom, where patients experience blood in their urine without any pain or discomfort [3][5].
• Irritative voiding symptoms: Patients may experience frequent urination, urgency, or difficulty starting to urinate [6].
• Mucosuria: Some patients may notice mucus or debris in their urine.
• Storage lower urinary symptoms: In some cases, patients may experience symptoms such as frequency, urgency, or nocturia.

It's essential to note that these symptoms can be similar to those experienced by patients with bladder cancer. Therefore, it is crucial to consult a doctor for an accurate diagnosis and treatment plan [13].

References:

• [3] SY Ho · 2022 · Cited by 2 — The patient usually presents with painless hematuria.
• [5] Sep 21, 2022 — They generally are sessile structures that appear as velvety or cauliflowerlike projections.
• [6] by SV Pramod · 2019 · Cited by 2 — They may also present clinically with hematuria, irritative voiding symptoms, mucosuria, passage of debris in urine and storage lower urinary symptoms.

Diagnostic Tests for Urethral Villous Adenoma

Urethral villous adenoma, a rare neoplasm in the urinary tract, requires accurate diagnosis to determine its malignant potential and guide treatment. The following diagnostic tests are commonly used:

• Cystoscopy: A cystoscope examination is the first line of investigation for urethral lesions, including villous adenomas [2]. This procedure allows visualization of the urethra and bladder, enabling direct observation of the tumor.
• Imaging studies: Imaging modalities such as MRI can also play a role in diagnosing urethral lesions. However, the appearance of villous adenomas on imaging studies can be nonspecific [3].
• Biopsy: A biopsy is essential for histopathological diagnosis, which is usually needed to confirm the presence of a villous adenoma. The biopsy sample should be thoroughly examined to rule out malignancy.
• Immunohistochemical stains: Immunohistochemical stains such as CK7, CK20, EMA, CEA, and CDX2 can aid in establishing a definitive diagnosis of clear cell adenocarcinoma or villous adenoma [9].

Key Points

• A preoperative diagnosis of urethral villous adenoma is not always considered on imaging studies [6].
• The malignant potential of urethral villous adenomas has not been established, but some case series suggest a possible association [1].
• Any urinary tract lesion diagnosed by biopsy as villous adenoma must be completely excised and thoroughly sampled to rule out malignancy [12].

References

[1] Context 1 [2] Context 2 [3] Context 3 [6] Context 6 [9] Context 9 [12] Context 12

Treatment Options for Urethral Villous Adenoma

While surgical resection has been the traditional treatment for urethral villous adenomas, there are some cases where drug treatment may be considered. According to recent studies [6][7], radiation therapy and oral capecitabine have been successfully used to treat urethral villous adenomas.

• Radiation Therapy: This type of treatment has been shown to be effective in treating urethral villous adenomas, especially when combined with other treatments like chemotherapy [6].
• Oral Capecitabine: This medication has also been used to treat urethral villous adenomas, particularly in cases where surgery is not feasible or desired [7].

It's worth noting that these treatment options are still relatively rare and may not be suitable for all patients. Surgical resection remains the most common treatment approach for urethral villous adenomas.

References:

[6] by AJ Corsi · 2024 — The presence of villous adenoma in the urinary tract ... urethra that was successfully treated with radiation therapy and oral capecitabine. [7] Jul 18, 2024 — Although villous adenomas of the urinary tract have been almost exclusively treated with surgical intervention in the literature, we present a ...

Differential Diagnoses of Urethral Villous Adenoma

Urethral villous adenomas are rare tumors that can be challenging to diagnose due to their similarity in appearance to other urinary tract lesions. The differential diagnoses for urethral villous adenoma include:

• Cystitis glandularis: A condition characterized by the presence of gland-like structures in the bladder lining, which can mimic the appearance of a villous adenoma.
• Adenocarcinoma: A type of cancer that originates from glandular tissue, which can be difficult to distinguish from a villous adenoma based on histopathological examination alone.
• Villous adenoma with dysplasia: A variant of villous adenoma that shows abnormal cell growth, which can make it harder to diagnose.
• Prostatic-type polyp: A type of benign tumor that originates from the prostate gland, but can also occur in the urethra and mimic a villous adenoma.

Key Points

• Urethral villous adenomas should be considered as one of the differential diagnoses for urethral lesions, especially if they have similar magnetic resonance imaging features as their colonic counterpart [5].
• The differential diagnosis includes cystitis glandularis and adenocarcinoma, which can be challenging to distinguish from a villous adenoma based on histopathological examination alone [7].
• Complete surgical resection of the urinary tract is curative for urethral villous adenomas [3].

References

[1] Villous adenomas of the genitourinary tract have been reported, but generally in small case series or reviews of case reports. [2] VAs must be considered in the differential diagnosis when many glandular cells or mucinous cells without atypia are recognized in the urine. [3] Immunohistochemistry is important for differential diagnosis of villous adenoma of the urinary system. Complete surgical resection of the urinary tract is curative. [5] Villous adenoma should be considered as one of the differential diagnoses of urethral lesions, especially if it has similar magnetic resonance imaging features as their colonic counterpart. [7] The differential diagnosis includes cystitis glandularis and adenocarcinoma.