Tubular Adenoma of the Urinary Tract: A Newly Described Entity
Chia-Sui Kao, Jonathan I Epstein. Indiana University School of Medicine, Indianapolis, IN; Johns Hopkins Hospital, Baltimore, MD
Background: Villous adenoma involving the urothelial tract is a well-recognized entity, most commonly occurring in the bladder or urachus. Tubular adenomas (TA) in the urinary tract with the same appearance as those in the colon have not yet been described in the literature.
Design: 4 cases of TA in the urinary tract were identified in our surgical pathology files; all were consult cases. Immunohistochemical stains for GATA3, CDX2, CK20, CK7, and B-catenin were performed in 3 of 4 cases.
Results: This lesion was defined by the presence of a collection of small, round, tubular glands with intestinal-type epithelium showing moderate dysplasia, identical to the histology of tubular adenomas in the colon. None of the cases had any villous component, or would have been excluded from this study. Patients ranged from 37 to 63 years old (mean 45) with a predilection for male gender (M:F = 3:1). A detailed clinicopathologic summary is provided in Table 1. All 3 available cases consistently stained positive for CDX2 and CK20, while negative for GATA3 and CK7. 1 case showed positive (nuclear) B-catenin staining.
|Case||Significant Histology||Age/Sex||Site||Size (cm)||Presentation||Familial Adenomatous Polyposis||Follow-up|
|1||HGD*||38M||Prostatic urethra||0.3||Urethral polyps||N||No recurrence to date|
|2||None (usual TA)||37F||Right ureterovesical junction||0.5||Ureteral obstruction||Y||No recurrence to date|
|3||Dense intraluminal secretions||63M||Bladder||1.5||Hematuria and concurrent pT1 sigmoid adenocarcinoma with colonic TA with HGD*||N||2 mos. later with pT3b bladder adenocarcinoma and bladder TA at cystectomy|
|4||Paneth-cell metaplasia||41M||Bladder||N/A||N/A||N||Recurrent bladder TAs, 3 and 4 years after initial biopsy|