Tubular adenoma with high-grade dysplasia in the ileal segment 34 years after augmentation ileocystoplasty: report of a first case

Abstract

Neoplasms of the urinary bladder following augmentation ileocystoplasty are rare. We present the case of a 39-year-old male with a tubular adenoma with high-grade dysplasia in the ileal segment 34 years after augmentation ileocystoplasty to enlarge a post-chemoradiation-induced shrunken bladder. He presented with gross hematuria. Cystoscopy revealed a papillary tumor at the site of ileovesical anastomosis, and transurethral resection was performed. Histologic examination revealed a tubular adenoma with high-grade dysplasia. There are only two previous reports of tubulovillous adenoma in ileal segment after ileocystoplasty, both without high-grade dysplasia. Our observation supports the hypothesis that an ileal neobladder may undergo all the morphologic and molecular changes observed in the development of gastrointestinal adenocarcinoma. Therefore, patients who had an ileal neobladder created should be closely followed.

The Genitourinary Pathology Society Update on Classification and Grading of Flat and Papillary Urothelial Neoplasia With New Reporting Recommendations and Approach to Lesions With Mixed and Early Patterns of Neoplasia

“…Molecular studies also demonstrate that intestinal metaplasia and dysplasia are associated with APC , PRKDC , ROS1 , ATM , and KMT2D mutations, and are distinct from urothelial CIS 44. Similar dysplastic lesions may be identified in the setting of bladder augmentation from the intestinal tract and may involve either the native bladder or the intestinal mucosa 45–47. Despite these findings, the evidence still supports that cystitis glandularis with intestinal metaplasia (in the absence of dysplasia) is not an obligate precursor lesion and does not significantly increase the risk for a subsequent malignancy 43,48.…”

“…44 Similar dysplastic lesions may be identified in the setting of bladder augmentation from the intestinal tract and may involve either the native bladder or the intestinal mucosa. [45][46][47] Despite these findings, the evidence still supports that cystitis glandularis with intestinal metaplasia (in the absence of dysplasia) is not an obligate precursor lesion and does not significantly increase the risk for a subsequent malignancy. 43,48 The presence of intestinal metaplasia with high-grade dysplasia, harboring oncogenic genetic variants associated with both urothelial carcinoma and primary adenocarcinoma of the bladder, further supports the notion that it represents a precursor lesion.…”

A case of tubular adenoma developing after bladder augmentation: Case report and literature review

“…The incidence of adenoma after ECP is rare. To the best of our knowledge, there are 11 cases of adenoma reported in the literature, including our present case [4] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] . Here we report our rare case and review the literature on cases of benign tumors that occurred after ECP.…”