Gordetsky Jennifer, Gennaro Kyle H, Selph John P, Rais-Bahrami Soroush
University of Alabama at Birmingham, Department of Pathology, Birmingham, AL; University of Alabama at Birmingham, Department of Urology, Birmingham, AL.
University of Alabama, School of Medicine, Birmingham, AL.
Urology. 2016 Sep;95:29-33. doi: 10.1016/j.urology.2016.04.032. Epub 2016 Apr 29.
To review the diagnosis and management of nephrogenic adenoma (NA), an uncommon benign lesion found in the urinary tract. This lesion arises from a proliferation of implanted renal tubular cells. Although more common in adults, it can occur in all ages. NAs can recur and cause significant morbidity in patients. NAs are also a potential diagnostic pitfall as they can clinically and histologically mimic malignancy in the urinary tract.
We performed an Institutional Board Review approved search of our surgical pathology database from 2005 to 2015 for cases of NA. A retrospective chart review was performed with a focus on the clinical, pathologic, and radiographic findings in these patients.
We identified 32 cases of NA in 31 patients. Lesions were most common in Caucasian males (male-to-female ratio of 2:1) with an average age at diagnosis of 55 years (range 25-77). Bladder was the most common site of occurrence (81.2%), followed by ureter (9.4%), urethra (6.3%), and intrarenal collecting system (3.1%). Most patients (72%) were symptomatic and presented with hematuria (41%), lower urinary tract symptoms (28%), pelvic or flank pain (6%), hydronephrosis (19%), or urinary incontinence (13%). NA was asymptomatic and identified incidentally in 9 (28%) patients. One patient (3%) had a renal transplant and 8 (26%) patients had diabetes mellitus. Twenty-six (84%) patients were managed with endoscopic resection of their tumors.
NAs are benign lesions that may cause significant morbidity and mimic malignant tumors. There should be increased suspicion in patients with predisposing factors.
回顾肾源性腺瘤（NA）的诊断与管理，NA是一种在泌尿道发现的罕见良性病变。该病变由植入的肾小管细胞增殖形成。虽然在成年人中更常见，但可发生于各年龄段。NA可复发并给患者带来严重的发病情况。NA也是一个潜在的诊断陷阱，因为它们在临床和组织学上可模仿泌尿道恶性肿瘤。
我们对2005年至2015年的手术病理数据库进行了经机构审查委员会批准的搜索，以查找NA病例。进行了回顾性病历审查，重点关注这些患者的临床、病理和影像学表现。
我们在31例患者中识别出32例NA。病变在白人男性中最常见（男女比例为2:1），诊断时的平均年龄为55岁（范围25 - 77岁）。膀胱是最常见的发生部位（81.2%），其次是输尿管（9.4%）、尿道（6.3%）和肾内集合系统（3.1%）。大多数患者（72%）有症状，表现为血尿（41%）、下尿路症状（28%）、盆腔或侧腹疼痛（6%）、肾积水（19%）或尿失禁（13%）。9例（28%）患者的NA无症状，是偶然发现的。1例患者（3%）进行了肾移植，8例患者（26%）患有糖尿病。26例（84%）患者接受了肿瘤的内镜切除术。
NA是良性病变，可能导致严重发病情况并模仿恶性肿瘤。对于有易感因素的患者应提高警惕。
