Endocrine Abstracts

A 60-year-old woman with a previous history of twice transsphenoidal pituitary surgery due to acromegaly,had a surgery with a presumed diagnosis of bladder stone. She was reevaluated after the surgery when her hematuria persisted. Percutaneous nephrolitotomy was planned. when multiple stones were identified in the left ureter, but the operation had to be postponed till the achievement of glycemic control. At the meantime endocrinological evaluation revealed a 30×15 mm macroadenoma in the pituitary invading both cavernose sinuses. Her random GH level was >40 ng/ml and IGF1:1225 ng/ml (age and sex adjusted reference range 71–263 ng/ml).

Octreotid LAR 30 mg/4 weeks was started and conventional radiotherapy was performed. When glycemic contol was maintained she underwent cystoscopy. A mass lesion was identified and resected. The pathology of the specimen revealed nephrogenic adenoma of the urinary bladder. Immunohistochemically lesion was cytoceratin 7 positive, CD 10, P63 and TTF-1 negative.

Nephrogenic adenoma, also referred to as nephrogenic metaplasia, is an uncommon benign lesion of the urothelial tract.It is a benign metaplastic response of the urothelium to injury or insult. It is most commonly seen in bladder (80%) however urethra (12%) or ureter (8%) can be involved. Nephrogenic adenoma can be a significant diagnostic pitfall as certain histologic features, such as the presence of enlarged nuclei with prominent nucleoli, degenerative nuclear atypia, tiny tubules with blue mucin simulating signet ring cells, and focal invasion into superficial muscle, when taken out of context, can mimic malignancy.

Up to date there is no reported case of acromegaly with nephrogenic adenoma of the bladder. Considering the increased neoplasia risk in acromegaly, more data are needed to explain if there is a causal relationship between acromegaly and nephrogenic adenoma, or if this is a coincidental finding.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.