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| CASE REPORT |
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| Year : 2016 | Volume
: 6
| Issue : 3 | Page : 183-185 |
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Villous adenoma of renal pelvis with muconephrosis: A case report
Sachin Madhukar Bote1, Md Ayub Karam Nabi Siddiqui1, Venkat Arjunrao Gite1, Saurabh Ramesh Patil1, Santosh Menon2
1 Department of Urology, Grant Govt. Medical College and Sir J.J. Hospital, Mumbai, Maharashtra, India
2 Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| Date of Web Publication | 17-Mar-2017 |
Correspondence Address:
Sachin Madhukar Bote
Department of Urology, Grant Govt. Medical College and Sir J.J. Hospital, Mumbai, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2278-9596.202364
Intestinal-type villous adenomas are rare in the genitourinary tract. Among genitourinary tract, the most common location is urinary bladder followed by urethra, prostate, vagina, and vulva. Only few cases of villous adenoma of renal pelvis have been reported so far in the literature. We present a case of villous adenoma of the kidney presenting as muconephrosis with nonfunctioning kidney, along with renal stone, which was one of the largest muconephrotic kidney with villous adenoma removed. Keywords: Muconephrosis, renal stone, villous adenoma
How to cite this article:
Bote SM, Siddiqui MA, Gite VA, Patil SR, Menon S. Villous adenoma of renal pelvis with muconephrosis: A case report. Arch Int Surg 2016;6:183-5 |
| Introduction | |  |
Intestinal-type villous adenomas are rare in the genitourinary tract. Among genitourinary tract, the most common location is urinary bladder followed by urethra, prostate, vagina, and vulva.[1] Only few cases of villous adenoma of the renal pelvis have been reported so far in the literature.[2],[3]
| Case Report | | |
A 60-year-old male presented with a dull aching, right-sided abdominal pain since 2 months along with a lump in the right upper abdomen. There was no fever, hematuria, and lower urinary tract symptoms.
On examination, there was palpable mass in the right lumbar region extending to the hypochondrium and iliac region. The Mass was nontender and irregular in consistency. Serum creatinine was 1.2 mg/dl and urea was 35 mg/dl. Ultrasonography (USG) revealed right hydronephrotic kidney with large staghorn calculus with thin out cortex. Computerized tomogram–intravenous urography (CT-IVU) showed a right nonexcreting hydronephrotic kidney with a 5 cm right renal calculus [Figure 1]. | Figure 1: CT scan shows right hydronephrotic nonfunctioning kidney with calculus
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Right nephrectomy was done as the patient had symptomatic large hydronephrotic kidney with renal stone. Right kidney (approximate size 25 × 12 × 8 cm) was full of mucus and had a large stone [Figure 2]. Pelvicalyceal system was markedly dilated. There was a small irregular mass approximately 3 × 2 cm in size in the pelvis of the right kidney, with multiple small intracystic papillary excrescences [Figure 3]. Histopathological examination showed mucin and villous adenoma of right kidney with no invasion or malignant changes [Figure 4]. The patient was doing well at the end of 10-month follow up. | Figure 3: Cut open section of the right kidney showing calculus with multiple small masses
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 | Figure 4: Histopatholgy of villous adenoma of renal pelvis: Villous adenoma of renal pelvis revealing typical villi with extracellular mucin (a). Higher power of the villi showing dysplastic adenomatous epithelium (b and c). Areas of complex villoglandular pattern were seen (d)
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| Discussion | | |
Muconephrosis term was first used by Park et al.[2] Intestinal metaplasia of urothelium is mostly due to chronic irritation caused by stone or infection, which leads to mucus production. Urinary tract villous adenomas are uncommon, and are most common in urinary bladder and urethra.[4] Renal pelvic villous adenomas are rare. Risk factors for villous adenoma formation are chronic inflammation and irritation due to urinary tract infection [2] and calculus.[3]
It is difficult to diagnose villous adenoma clinically or on imaging because of lack of specific features. Patients are usually middle aged or elderly males. Usually, the patients present with dull abdominal pain and abdominal lump. On imaging, hydronephrotic kidney with calculi can be seen.
It is imperative for the pathologist to examine the entire specimen to exclude malignant changes and associated dysplasia. In diagnosed cases of villous adenoma, it is essential to rule out local extension before surgery. Inadequate and improper management can lead to serious consequences on the prognosis of patients if invasive adenocarcinoma is found. Intestinal-type villous adenoma is a precursor to invasive adenocarcinoma of renal pelvis,[5] and hence complete excision by nephrectomy is advisable in all cases. Nephrectomy is also indicated in hydronephrotic nonfunctioning kidney, as in our case. In our case, CT IVU did not suggest pelvic tumor and the patient did not have hematuria, and hence, pelvic tumor was not suspected and nephrectomy was done for symptomatic large hydronephrotic kidney with renal stone.
| Conclusion | | |
Villous adenoma of renal pelvis is challenging to diagnose prior to surgery because of nonspecific clinical features and imaging findings.[2],[3] Because this neoplasm is a precursor to neoplasm and because of uncertainty of diagnosis, nephrectomy is advisable. If surgery is done for isolated villous adenoma of renal pelvis, prognosis is found to be good. Because this entity is rare, there is no standard established protocol for follow-up and management.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Cheng L, Montironi R. Villous adenoma of the urinary tract. Am J Surg Pathol 1999;23:764-31.  |
| 2. | Park S. Meng MV, Greenberg MS, Deng DY, Stoller ML. Muconephrosis. Urology 2002;60:344. |
| 3. | Bhat S, Chandran V. Villous adenoma of renal pelvis. Ind J Urol 2010;26:598-9. |
| 4. | Tamboli P, Ro JY. Villous adenoma of urinary tract: A common tumor in an uncommon location. Adv Anat Pathol 2007;7:79-84. |
| 5. | Spires SE, Banks ER, Cibull ML, Munch L, Delworth M, Alexander NJ. Adenocarcinoma of renal pelvis. Arch Pathol Lab Med 1993;117:1156-60. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
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