Polypoid arteriovenous malformation of the ureter mimicking a fibroepithelial polyp, a case report

Abstract

BackgroundArteriovenous malformations (AVM) of the urinary tract are extremely rare. To the best of our knowledge, only three case of AVM of the ureter have been described in the literature so far.Case presentationWe present an additional, fourth case of an AVM of the ureter, clinically presented as asymptomatic haematuria and an obstructive process in the left ureter. Ureteroscopic evaluation revealed a fibroepithelial polypoid-like lesion in the proximal ureter. After biopsy showed a benign lesion, the lesion was treated with the 2-μm continuous wave (cw) thulium laser. Histopathological examination revealed a polypoid laesion caused by a circumscribed arteriovenous malformation. Almost four years after operation the patient remains asymptomatic and free of recurrence.ConclusionArteriovenous malformations of the urinary tract are extremely rare. We presented a fourth case of a arteriovenous malformation of the ureter.Electronic supplementary materialThe online version of this article (doi:10.1186/s12894-017-0237-z) contains supplementary material, which is available to authorized users.

Arteriovenous malformation of the ureter diagnosed by CT urogram

“… 3 Despite the extent of this AVM, our patient was essentially asymptomatic, while prior reports have described more dramatic clinical presentations including flank pain, gross hematuria, and anemia. 3 , 4 , 5 Differences in clinical presentation likely relate to differences in lesion location; previous reports describe pedunculated intra-ureteral lesions, while our patient's lesion was predominantly extra-ureteral without ureteral filling defects on excretory phase images.…”

“…Ureteral AVM is a known cause of hematuria that has been described in only a small number of prior case reports. 2 , 3 , 4 , 5 The diagnosis of AVM can be confirmed by catheter angiography or histology; however, as our case demonstrates, CTU can also diagnose ureteral AVM when characteristic imaging features are seen. In this case, the presence of a feeding artery and draining veins, and the presence of characteristic contrast enhancement and washout were sufficient to diagnose AVM.…”

“…The few existing case reports of ureteral AVM have been diagnosed by ureteroscopy and biopsies. 3 , 4 , 5 While ureteroscopy has the advantage of being both diagnostic and therapeutic, invasive studies may not be necessary or desirable in cases of asymptomatic AVM associated hematuria.…”

Arteriovenous malformation of ureter presenting without hematuria: An unusual presentation of a rare disease

“…Histopathological examination of the excision biopsy specimen revealed similar findings as the first case. The fourth case was reported by Ten Donkelaar et al [ 5 ] in 2017, a 41-year-old female who was incidentally noted to hematuria during in-vitro fertilization. Urine cytology revealed atypical transitional cells.…”