Ureteral Fibroepithelial Polyp

Abstract

Fibroepithelial polyps of the ureter are a rare benign neoplasm that can mimic other ureteral pathologies and lead to inaccurate diagnosis and treatment. The sonographic features of a vermiform and mobile solid ureteral mass may be suggestive of the diagnosis. We report a case of distal ureteral fibroepithelial polyp incidentally discovered at pelvic sonography in a young woman. Case Report A 39-year-old woman with a history of irregular menstrual bleeding was referred for pelvic sonogram for evaluation of possible uterine polyps. The patient reported occasional colicky right flank pain. Pelvic sonogram showed an incidental vermiform solid mass in the urinary bladder near the right ureterovesical orifice (Figure 1). The mass was mobile, and appeared to arise from the right distal ureter, with portion of the mass protruding into the urinary bladder. A small amount of color flow was detected in the mass with color Doppler imaging. While the predominant mass was detected within the bladder, its exophytic and vermiform shape were felt to be atypical for a primary bladder tumor. No focal bladder wall thickening or hydroureteronephrosis was seen on sonography. The uterus and adnexa were normal. The patient subsequently underwent CT urography for further evaluation of the ureteral and bladder mass. CT showed an elongated filling defect with a corkscrew appearance within the distal one third of the right ureter, with the mass protruding into the bladder (Figure 2). The filling defect measured at least 8cm in length with smooth margin, and showed mild enhancement. On the CT, there was mild right hydronephrosis. Both the sonographic and CT findings were consistent with a ureteral fibroepithelial polyp. The patient subsequently underwent cystoscopy and ureteroscopy which confirmed the presence of a right distal ureteral polyp. The polyp was ureteroscopically excised intact (Figure 3), and histology confirmed a fibroepithelial polyp.