A Patient with Fibroepithelial Polyp of the Ureter—A Rare Condition Mimicking Malignancy: A Case Report

A 61-year-old man presented with hematuria and intermittent right pelvic pain. Intravenous urography showed a tubular filling defect and ureteroscopy a tumor in the right mid ureter. Urine cytology and tumor biopsy showed nonmalignant results. Open surgery was performed, and an intraoperative frozen section revealed a fibroepithelial polyp of the right mid ureter. A fibroepithelial polyp is a rare benign lesion that can occur in childhood but is an important differential diagnosis of an upper urinary tract urothelial cell carcinoma in adults. 1. Background The upper urinary tract urothelial cell carcinomas (UUT-UCCs) account for only 5–7% of UCCs. Of these only 25% are located in the ureter. In western countries, the incidence is 1-2 cases per 100,000 per year [1]. Typical symptoms are gross hematuria (80%) and flank pain (30%) and often caused by clots passing down the ureter. Males are affected three times as common as women. The incidence increases with age and smoking confers a two-fold risk [1]. Diagnosis is usually made combining with urine cytology, intravenous urography (IVU), or multidetector computed tomographic urography. Ultrasound is excellent for detecting renal parenchymal tumors, but not tumors of the renal pelvis or ureter. Further investigations are selective ureteric urine cytology, retrograde pyeloureterography, or flexible uretero-renoscopy [1]. The gold standard treatment for invasive UUT-UCCs, regardless of the location of the tumor in the UUT, is radical nephroureterectomy (RNU) with excision of a bladder cuff. We describe the case of a patient with symptoms and findings mimicking features of an UUT-UCC. 2. Case Presentation A 61-year-old man presented to our department with symptoms of gross hematuria and intermittent right pelvic pain. He had a past medical history of arterial hypertension, psoriasis, an annealed lung Tbc, and a smoking history of 60 pack years. Urine analysis showed microscopic hematuria. Biochemical data were within normal limits. Ultrasound and cystoscopy were normal. Intravenous urography (IVU) demonstrated a tubular filling defect with partial obstruction of the right mid ureter. Retrograde ureteropyelography confirmed a 5？cm long tubular mass in the mid ureter proximal to the iliac vessels (Figure 1). Further investigation was done by flexible ureteroscopy showing a pediculated tumor of the ureter with a vulnerable surface (Figure 2). Urine cytology and biopsy of the tumor and the renal pelvis were taken. A pigtail catheter was inserted. Results of urine cytology and the biopsy were negative for