Concurrence of villous adenoma and non-muscle invasive bladder cancer arising in the bladder: a case report and review of the literature.

BACKGROUND: Villous adenoma arising in the urinary tract is rare tumor. Most cases have been identified as benign neoplasm in the colon. Villous adenoma of the gastrointestinal tract is thought arise from premalignant polyps. Here, we report a case of concurrence of villous adenoma and non-muscle invasive bladder cancer. CASE PRESENTATION: An 85-year-old woman presented at our office because of gross hematuria. Cystoscopic examination detected two papillary tumors in the bladder. Each tumor was resected and diagnosed, respectively. Histopathology confirmed that the resected one tumor was a villous adenoma, and the other was urothelial carcinoma (T1, high grade). Immunostaining for cytokeratin (CK) 7, CK20 and Ki-67 confirmed that CK7: (-), CK20: (+) and Ki-67: (<=30%) in villous adenoma while CK7: (+), CK20: (+), and Ki-67: (70%) in urothelial carcinoma. Three months later from TUR, urothelial carcinoma recurred in the trigone. She received adjuvant intravesical immunotherapy with BCG post TUR for the recurrence site. CONCLUSION: There were no specific findings on ultrasonography, CT, MRI or cystoscopic examination morphologically. Therefore, pre-pathological villous adenoma of the bladder is extremely difficult to diagnose. There are some case reports of solitary villous adenoma in the bladder or with coexisting adeno carcinoma. However, to the best of our knowledge, this is only the second report of villous adenoma in the bladder of coexisting urothelial carcinoma that has been published in the literature. Premalignant villous adenoma of the bladder is extremely rare and difficult to diagnose without histologic examination. Any suspicious lesion of the bladder should be biopsied and/or resected to confirm histology.

McKittrick-Wheelock syndrome: acute renal failure by a colorectal adenoma. A case study.

A case of acute renal failure because of chronic watery diarrhoea is presented. The cause is a secretory villous adenoma. The triad chronic diarrhoea, electrolyte disturbance and prerenal renal failure due to a villous adenoma, known as the McKittrick-Wheelock syndrome is a rare entity. The patient can evolve to acute renal failure, shock and death. Initially, the patient is medically treated to restore the fluid and electrolyte balance, but the surgical removal of the polyp is necessary to obtain a definite recovery.

Un nuevo caso de carcinoma de células de Merkel / A new case of MErkel´s cell carcinoma

Presentamos el caso de una paciente de 80 años a la que le fue extirpada una voluminosa tumoración localizada en la región axilar derecha. El diagnóstico histológico fue de carcinoma neuroendocrino primario de piel (carcinoma de células de Merkel).El estudio de extensión realizado encontró un adenoma velloso de sigma con displasia severa. Tras la cirugía se realizó tratamiento de radioterapia. Posteriormente comentamos algunos aspectos clínicos, diagnósticos y terapéuticos de esta infrecuente neoplasia (AU)

Síndrome de McKittrick-Wheelock. A propósito de 2 casos / McKittrick-Wheelock syndrome. Report of two cases

Los adenomas vellosos colorrectales son tumores frecuentes que normalmente provocan una escasa sintomatología. Presentamos por su rareza 2 casos clínicos, en los cuales debido al gran tamaño tumoral se produjeron graves alteraciones hidroelectrolíticas, originando el denominado síndrome de McKittrick-Wheelock. Se revisan someramente los posibles mecanismos etiopatogénicos. Asimismo, se hace hincapié en el tratamiento con indometacina como paso previo a la intervención quirúrgica (AU)

Villous adenoma of the urinary tract: a report of 23 cases, including 8 with coexistent adenocarcinoma.

Villous adenoma originating in the urinary tract is uncommon. We present the first study of a large number of cases of villous adenoma of the urinary tract with clinical follow-up. Our series consisted of 15 patients with isolated villous adenoma and 8 patients with coexistent adenocarcinoma. The tumors occurred in elderly patients and had a predilection for the urachus, dome, and trigone of the urinary bladder. The typical clinical presentation was hematuria and irritative symptoms, and endoscopic examination usually identified a tumor growth. There was no gender predominance. Light microscopic examination showed morphologic similarity to colonic villous adenoma in all cases. Each tumor was composed of pointed or blunt finger-like processes lined by pseudostratified columnar epithelium. The epithelial cells displayed nuclear stratification, nuclear crowding, nuclear hyperchromasia, and occasional prominent nucleoli and mitotic figures. There was intense carcinoembryonic antigen immunoreactivity on the luminal surfaces (89%). Most cases (78%) contained cytoplasmic acid mucin, demonstrated by Alcian blue periodic acid-Schiff stain. Cytokeratin 20 was positive in all cases, cytokeratin 7 was positive in 56% of cases, and epithelial membrane antigen was positive in 22% of cases. Recurrence or invasive adenocarcinoma did not develop in any patient with isolated villous adenoma during a mean follow-up of 9.9 years. Lung metastasis developed in one patient with coexistent adenocarcinoma and multiple recurrences in another (mean follow-up, 3 years). We conclude that the prognosis is excellent in patients with isolated villous adenoma, and complete surgical resection is curative. Patients with coexistent adenocarcinoma may experience recurrence or distant metastasis, and more aggressive treatment may be indicated.

Villous adenoma of the bile ducts: a case report and a review of the reported cases in Korea.

Villous adenomas are benign epithelial lesions with malignant potential which can occur at any site in the gastrointestinal tract. They are usually encountered in the rectum and colon, less frequently in the small bowel and very rarely in the biliary trees. Nine cases of bile duct villous adenomas have been reported in the literature. However, 4 cases of bile duct villous adenomas have been reported in the Korean literature. Recently, we experienced a case of villous adenoma in the common hepatic duct in a 77-year-old man presenting with obstructive jaundice in which preoperative histologic diagnosis of villous adenoma played a critical role in managing this patient. Herein, we present a case report of bile duct villous adenoma and a review of the reported cases in Korea to help define and manage this rare disease entity in the bile ducts. In addition, confusing nomenclature of bile duct adenomas is discussed.

Villous adenoma of the bile ducts: a case report and a review of the reported cases in Korea

Villous adenomas are benign epithelial lesions with malignant potential which can occur at any site in the gastrointestinal tract. They are usually encountered in the rectum and colon, less frequently in the small bowel and very rarely in the biliary trees. Nine cases of bile duct villous adenomas have been reported in the literature. However, 4 cases of bile duct villous adenomas have been reported in the Korean literature. Recently, we experienced a case of villous adenoma in the common hepatic duct in a 77-year-old man presenting with obstructive jaundice in which preoperative histologic diagnosis of villous adenoma played a critical role in managing this patient. Herein, we present a case report of bile duct villous adenoma and a review of the reported cases in Korea to help define and manage this rare disease entity in the bile ducts. In addition, confusing nomenclature of bile duct adenomas is discussed.

[Villous bile duct adenoma with mucinous bile ]. / Villöses Gallengangsadenom mit gallertartiger Galle.

HISTORY AND ADMISSION FINDINGS: A 75-year-old woman was admitted because of colicky upper abdominal pain. Physical examination was unremarkable. INVESTIGATIONS: Alkaline phosphatase and gamma-glutamyl transpeptidase activities as well erythrocyte sedimentation rate were increased. Sonography revealed mild enlargement of the hepatocholedochal duct to 1.1 cm. Retrograde endoscopy showed a band-like immobile structure in the cystic duct. TREATMENT AND COURSE: At operation the hepatocholedochal duct was found to contain a greenish mucinous mass: no cause was discovered. Three years later a tumor, 1 x 0.5 cm, was found in the common hepatic duct at sonography, with clinical signs of recurrent chronic cholitis and early liver damage. Because of hepatic dysfunction and hypersplenism no surgical intervention was undertaken. When cholestasis progressed further, a partial full-thickness resection of the hepatic duct with removal of the tumor and the mucinous bile had to be performed two years later. Histological examination revealed a villous adenoma with slight epithelial dysplasia and mucus formation. CONCLUSIONS: Villous bile duct adenoma is a very rare cause of cholestasis. Mucous production can lead to mucinous bile, with resulting chronic cholecystitis and secondary biliary cirrhosis. The adenoma should be completely excised because of the danger of malignant transformation and risk of local recurrence.

[Villous rectal adenomas and secretory diarrhea]. / Villöse Rektumadenome und sekretorische Diarrhoe.

Hypersecretion following villous adenomatosis of the rectum is demonstrated by two single case studies. Both patients exhibited a secretory diarrhea with a 2.000-2.500 and 1.000 ml daily stool volume respectively, resulting in severe and life-threatening (first patient) loss of water and electrolytes. With increasing stool volume, rising concentrations of Na and Cl were observed in the stool and approached plasma levels. Consecutively the potassium concentration decreased to values between 15 and 23.4 mmol/l in the first severe case and to 28 and 31 mmol/l in the patient with the lowest stool volume. Elevated PG-E2 concentrations in the fluid moiety of the stool (up to 13.3 ng/ml and 0.98 ng/ml respectively) as well as the response to treatment with Indomethacin support the idea of a PG-E2 induced pathological loss of water and electrolytes. While 100 mg Indomethacin/day led to cessation of symptoms in the less severe case, even 400 mg Indomethacin/day were not able to reduce the massive rectal water loss in the first most severe patient to less than 1,000 ml/day. Surgical removal of villous adenoma showing hypersecretory activity is the only promising therapy. In case of inoperability, denial of surgical intervention or just for palliative treatment prior to surgery we recommend the inhibition of PG-synthesis with Indomethacin.