International Uroloyy and Nephroloyy 24 (1), pp. 27--30 (1992)
Ureteral Fibroma: An Unusual Clinical Symptomatology K. SARICA, J. FRICK, E. DORINGER,* t. CHANDRA Department of Urology, *Department of Radiology, Salzburg General Hospital, Salzburg, Austria (Accepted March 8, 1991)
The authors describe a case of ureteral fibroma. The aetiology, clinical symptomatology and diagnosis are discussed, and differentiation between benign and malignant lesions is emphasized.
Case report A 32-year-old male was first admitted in May 1985withleft scrotal pain. On clinical examination left variocele was detected and left varicocelectomy was carried out. At the same time, however, radiologic evaluation revealed a small tilling defect in the right ureter, level with the third lumbal vertebra. Both kidneys were urographically normal and no dilatation of the right kidney's collecting system was seen. Sonography and CT scan did not confirm the filling defect in the right ureter. After varicocelectomy the patient was discharged from the hospital and advised to have a check-up after three months, however, he did not return until December 1989. At this time the patient complained about slight vertebral pain and pains in the right flank. He presented no other urological symptoms such as haematuria or dysuria. Urinalysis showed no single white and/or red blood cells. Nephrosonography was normal and intravenous pyelogram (IVP) now revealed a 5 cm long regular filling defect in the proximal part of the right ureter (Fig. 1). CT examination also confirmed these findings (Fig. 2); no obstruction of the right upper urinary tract system was shown by either IVP or CT. Cystoscopy showed an uneventful bladder; cytology was negative. The right ureter was then explored (January 18, 1990) from a flank incision. The movable ureteral tumour was easily palpable. The ureter was incised around the pedicle of the tumour which was fairly large in diameter. The pedicle was excised from the ureter and the attached floating tumour removed in toto. The ureter was reconstructed upon a double-J splint. Postoperative course was normal and the double-J splint was removed four weeks after surgery. Control IVP revealed a norVSP, Utrecht Akaddmiai Kiad6, Budapest
28
Sarica et aL : Uretera] fibroma
Fig. 1. IVP showing right ureteral tumour without evident dilatation of the pelvic system maI upper urinary tract. Histology revealed the fibroma to be in connection with some rests o f a haemangioma. The 6 cm long turnour was covered by a single layer of urothelium (Fig. 3).
Fig. 2. Computed tomography demonstrates right ureteral tumour (arrow) International Urology and Nephrology 24, 1992
Sarica et aL : Ureteral fibroma
29
Fig. 3. Histological appearance of ureteral fibroma. Stroma, capillaries and papillary epithelium are seen (HE, original magnification • 400) Discussion
In the clinical presentation of loin pains with or without haematuria and a ureteral filling defect, differential diagnosis might come to multiple conclusions including benign and]or malignant tumours, non-opaque stones, thrombus, sloughed papillae and inflammatory lesions [1 ]. Most important is the differentiation between benign and malignant lesions, as in benign lesions the therapy of choice is conservative surgery. Fibroepithelial tumours constitute about 20% of benign tumours of the ureter. The lesions are common in the proximal part of the ureter [2]. To date, the aetiology of ureteral fibromas has not been determined and inflammation, trauma, infection, chronic irritation, obstruction, hormonal imbalance and developmental defects are reported as possible aetiological factors [2, 3]. Clinical symptomatology in these tumours is non-specific, and in about 75 % of the patients gross haematuria is the most common symptom [3]. IVP, CT scan and ultrasound are the most meaningful preoperative diagnostic procedures. None of these methods, however, can reveal the exact nature of the tumour. In most cases, the exact diagnosis is confirmed at the time of surgery. Conservative surgery and en bloc resection of the tumour-bearing segment of the ureter is the therapy of choice in these cases [3].
International Urology and Nephrology 24, 1992
30
Sarica et aL : Uretera! fibroma
References 1. Bahnson, R. R., Blum, M. D., Carter, M. F. : Fibroepithelial polyps of the ureter. J. UroL, 132, 343 (1984). 2. Fiorelli, C., Durval, A., Di Cello, V. : Ureteral intussusception by a fibroepithelial polyp. J. UroL, 126, II0 (1981). 3. Van Poppel, H., Nuttin, B., Oyen, R. : Fibroepithelial polyps of the ureter. Eur. UroL, 12, 174 (1986).
International Urology and Nephroloyy 24, 1992
Ureteral Fibroma: An Unusual Clinical Symptomatology K. SARICA, J. FRICK, E. DORINGER,* t. CHANDRA Department of Urology, *Department of Radiology, Salzburg General Hospital, Salzburg, Austria (Accepted March 8, 1991)
The authors describe a case of ureteral fibroma. The aetiology, clinical symptomatology and diagnosis are discussed, and differentiation between benign and malignant lesions is emphasized.
Case report A 32-year-old male was first admitted in May 1985withleft scrotal pain. On clinical examination left variocele was detected and left varicocelectomy was carried out. At the same time, however, radiologic evaluation revealed a small tilling defect in the right ureter, level with the third lumbal vertebra. Both kidneys were urographically normal and no dilatation of the right kidney's collecting system was seen. Sonography and CT scan did not confirm the filling defect in the right ureter. After varicocelectomy the patient was discharged from the hospital and advised to have a check-up after three months, however, he did not return until December 1989. At this time the patient complained about slight vertebral pain and pains in the right flank. He presented no other urological symptoms such as haematuria or dysuria. Urinalysis showed no single white and/or red blood cells. Nephrosonography was normal and intravenous pyelogram (IVP) now revealed a 5 cm long regular filling defect in the proximal part of the right ureter (Fig. 1). CT examination also confirmed these findings (Fig. 2); no obstruction of the right upper urinary tract system was shown by either IVP or CT. Cystoscopy showed an uneventful bladder; cytology was negative. The right ureter was then explored (January 18, 1990) from a flank incision. The movable ureteral tumour was easily palpable. The ureter was incised around the pedicle of the tumour which was fairly large in diameter. The pedicle was excised from the ureter and the attached floating tumour removed in toto. The ureter was reconstructed upon a double-J splint. Postoperative course was normal and the double-J splint was removed four weeks after surgery. Control IVP revealed a norVSP, Utrecht Akaddmiai Kiad6, Budapest
28
Sarica et aL : Uretera] fibroma
Fig. 1. IVP showing right ureteral tumour without evident dilatation of the pelvic system maI upper urinary tract. Histology revealed the fibroma to be in connection with some rests o f a haemangioma. The 6 cm long turnour was covered by a single layer of urothelium (Fig. 3).
Fig. 2. Computed tomography demonstrates right ureteral tumour (arrow) International Urology and Nephrology 24, 1992
Sarica et aL : Ureteral fibroma
29
Fig. 3. Histological appearance of ureteral fibroma. Stroma, capillaries and papillary epithelium are seen (HE, original magnification • 400) Discussion
In the clinical presentation of loin pains with or without haematuria and a ureteral filling defect, differential diagnosis might come to multiple conclusions including benign and]or malignant tumours, non-opaque stones, thrombus, sloughed papillae and inflammatory lesions [1 ]. Most important is the differentiation between benign and malignant lesions, as in benign lesions the therapy of choice is conservative surgery. Fibroepithelial tumours constitute about 20% of benign tumours of the ureter. The lesions are common in the proximal part of the ureter [2]. To date, the aetiology of ureteral fibromas has not been determined and inflammation, trauma, infection, chronic irritation, obstruction, hormonal imbalance and developmental defects are reported as possible aetiological factors [2, 3]. Clinical symptomatology in these tumours is non-specific, and in about 75 % of the patients gross haematuria is the most common symptom [3]. IVP, CT scan and ultrasound are the most meaningful preoperative diagnostic procedures. None of these methods, however, can reveal the exact nature of the tumour. In most cases, the exact diagnosis is confirmed at the time of surgery. Conservative surgery and en bloc resection of the tumour-bearing segment of the ureter is the therapy of choice in these cases [3].
International Urology and Nephrology 24, 1992
30
Sarica et aL : Uretera! fibroma
References 1. Bahnson, R. R., Blum, M. D., Carter, M. F. : Fibroepithelial polyps of the ureter. J. UroL, 132, 343 (1984). 2. Fiorelli, C., Durval, A., Di Cello, V. : Ureteral intussusception by a fibroepithelial polyp. J. UroL, 126, II0 (1981). 3. Van Poppel, H., Nuttin, B., Oyen, R. : Fibroepithelial polyps of the ureter. Eur. UroL, 12, 174 (1986).
International Urology and Nephroloyy 24, 1992
