Inverted papilloma of the bladder with recurrence in prostatic urethra

Urothelial inverted papilloma is usually a solitary lesion with rare recurrences. Its behaviour is unclear, its potential for recurrence or progression is not well-known. We present a case of inverted papilloma of the bladder with recurrence in prostatic urethra after four years of follow-up. We review etiology, clinical presentation, diagnose, treatment and the present discussion about its malignancy ability.     

Inverted papilloma of the prostatic urethra: a report of two cases

Two men with inverted papilloma of the prostatic urethra are reported. Case 1 was a 67-year-old man with complaints of gross hematuria and urinary retention. Urethroscopy revealed a smooth-surface tumor with a stalk at the prostatic urethra. Case 2 was a 76-year-old man with complaints of gross hematuria and urinary retention. In these cases, the tumors were resected transurethrally and were consistent with inverted papilloma histopathologically.     

Inverted papillomas of the prostatic urethra

Inverted papillomas of the genitourinary tract are uncommon benign neoplasms usually occurring in the urinary bladder and less frequently in the upper urinary tract. To date, there are scant data and no comprehensive studies of inverted papilloma originating in the prostatic urethra. We identified 21 cases and evaluated their demographic, clinical, and histopathologic features. Patients had a mean age of 65.1 years (range: 30 to 89 y), with 10/21 (47.6%) presenting with gross hematuria (n = 8) or irritative symptoms (n = 2) related to the inverted papilloma and 11/21 (52.4%) detected incidentally during work-up/treatment of prostate cancer (n = 6) or benign prostatic hypertrophy (BPH) (n = 5). Fourteen cystoscopically evaluated lesions measured 0.1 to 2.0 cm, and were described as polypoid (n = 9), papillary (n = 4), or an enlarged median lobe (n = 1). Lesions were diagnosed on transurethral resection (n = 8), biopsy/polypectomy targeted to the lesion (n = 6), radical prostatectomy for prostate cancer (n = 4), or biopsy unrelated to the lesion (n = 3). Histologically, 14/21 cases (67%) displayed classic inverted papilloma architecture. The remaining cases showed foci of squamous metaplasia with moderate atypia (n = 4), rare true papillary fronds in a classic inverted papilloma background (n = 2), or both (n = 1). Eleven cases with prostatic tissue revealed adenocarcinoma of the prostate [n = 6; Gleason score 6 (n = 3) or 7 (n = 3)], high-grade prostatic intraepithelial neoplasia (n = 1), benign prostatic hypertrophy (n = 3), or adenosis (n = 1). No patients had a prior history of either inverted papilloma or urothelial carcinoma, whereas 2 patients were diagnosed with high-grade urothelial carcinoma of the bladder synchronous with their inverted papilloma diagnosis. Only 1 of the 18 patients with available follow-up had a recurrence of inverted papilloma in the prostatic urethra. None of the other patients had local recurrences or recurrences at other locations in the urinary tract (mean follow-up 39.9 mo; range: 3 to 120 mo). Inverted papillomas of the prostatic urethra are benign lesions that are commonly detected incidentally and are not associated with a history of urothelial malignancy. Although urothelial carcinoma elsewhere in the genitourinary tract may occur simultaneously, malignant transformation or recurrence as a malignant lesion has not been identified in inverted papilloma of the prostatic urethra.     

A case of inverted papilloma of the prostatic urethra

A 59-year-old male with a complaint of gross hematuria was found to have a pedunculated and non-papillary tumor on the prostatic urethra. The tumor was resected transurethrally. The pathological finding was inverted papilloma. Although the majority of the cases of inverted papilloma have been found in the bladder, we reported the 32nd case located on the prostatic urethra in Japan.     

Inverted papilloma of the urothelium

The authors report 4 cases inverted papilloma of the urothelium. They describe the clinical, evolutive and pathological aspects of this rare tumor.     

Inverted papilloma of the ureter

We report a case of inverted papilloma of the ureter. To date it is the 12th case documented. The lesion was treated by conservative surgery; negative controls following the excision for 5 years represent a further proof of the benign nature of these tumors.     

Inverted papilloma of the ureter

Two cases of ureteral inverted papilloma are reported. Case 1: A 48-year-old male had asymptomatic gross hematuria and filling defect of left middle ureter on intravenous pyelography. Segmental resection of ureter was performed. The specimen was a 1 cm polypoid lesion with histologic features resembling "multifocal bud-like proliferation", which was reported as the initial stage of the inverted urothelial tumor by Kunze et al. Case 2: A 64-year-old female with asymptomatic gross hematuria and complete obstruction of left middle ureter on ante- and retrograde pyelograms. Total nephroureterectomy was performed. A 4 cm lobulated and pedunculated lesion with histologic features of typical inverted urothelial papilloma was resected. Twenty-one cases of ureteral inverted papilloma in the literature, including our cases, are analyzed.     

Inverted papilloma of the ureter

The inverted urothelial papilloma described herein is the fourth case developing in the ureter. The association with a well-differentiated conventional papilloma of the renal pelvis is the noteworthy feature of this case.     

Inverted papilloma of ureter

Two cases of inverted papilloina of the ureter are reported. The possible etiology and clinical significance of this previously unreported lesion are discussed.     

Inverted papilloma of bladder

The fifth reported case of a rare variant of transitional papillary tumor of the bladder termed inverted papilloma is reported with a brief review of the literature. This tumor is likely to be confused with invasive malignant papillary carcinoma although it has a distinct histologic pattern, and it is for this reason that attention is drawn to the entity.     

Inverted papilloma of bladder

A case of inverted papilloma of the urinary bladder in a forty-six-year-old man is presented. The lesion is rare but may be easily misdiagnosed as transitional-cell carcinoma.     

Inverted papilloma of ureter

We report a case of an inverted papilloma of the ureter. The clinical presentation, biological behaviour and management of this extremely rare lesion are reviewed. Although behaving benignly, their malignant potential remains to be established. These tumors should be part of the differential diagnosis in ureteral tumors.     

Inverted papilloma of the urinary bladder

Five cases of inverted papilloma in the bladder are reported. All cases were males complaining of dysuria or hematuria. Total cystectomy with construction of ileal conduit was carried out in the first case, and transurethral resection in the other cases. Every surgical specimen was histologically diagnosed as inverted papilloma. The inverted papilloma is a distinct lesion characterized by its rarity compared to frequency of the other vesical papillomas. The prognosis is generally benign, but the possibility of recurrence and malignant transformation indicates the necessity of a close periodical follow-up.