Polypoidal Intestinal Metaplasia and Dysplasia of the External Urethral Meatus

Urethral mucosa with intestinal metaplasia and dysplasia is a rare occurrence. To date only a single case has been reported in a male with long-standing urethral stricture. We present a 33-year-old female with polypoid intestinal metaplasia and dysplasia of the external urethral meatus in the absence of an inciting factor. Intestinal metaplasia of the urethral mucosa may undergo dysplasia, emphasizing the necessity of a high degree of clinical suspicion and vigilant pathological examination of these lesions. 1. Introduction Intestinal metaplasia of the urethral mucosa is extremely rare with very few cases documented in females [1–4] and is still rarer in males [5, 6]. We present a 33-year-old female patient with polypoid intestinal metaplasia with dysplasia of the external urethral meatus, presenting clinically as urethral caruncle. To the best of our knowledge, this is the first case of dysplasia arising in a polypoid intestinal metaplasia to be reported in a female patient in English literature. 2. Case Report A 33-year-old female patient presented to the Urology clinic with complaints of poor stream of urine and bleeding per urethra since 8 days. There was no history of fever, hematuria, or dysuria. On examination, a polypoid mass measuring ？cm was seen in the external urethral meatus. Routine urine microscopy, hematological and biochemical investigations were normal. No abnormalities were detected in ultrasound abdomen. A clinical diagnosis of urethral caruncle was proffered. The mass was excised and sent for histopathological examination. Microscopy revealed an ulcerated polypoidal lesion lined by squamous epithelium with extensive intestinal metaplasia and dysplasia (Figure 1). The metaplastic intestinal glands were lined by columnar cells and goblet cells which were demonstrated by Periodic acid Schiff with Alcian blue (Figure 2). The final diagnosis of polypoidal intestinal metaplasia with dysplasia was rendered. The patient is currently asymptomatic after 1 month of follow-up. Figure 1: Ulcerated polypoidal epithelium showing extensive intestinal metaplasia and dysplasia (H&E, 10x). Figure 2: Metaplastic epithelium showing glands lined by goblet cells (periodic acid Schiff with Alcian blue, 20x). 3. Discussion The mucosa of the urinary tract, commonly the urinary bladder and occasionally the ureter and renal pelvis, may undergo intestinal metaplasia secondary to chronic infections, schistosomiasis, calculi, or exstrophy. Intestinal metaplasia of the urethra is extremely rare. Columnar epithelial metaplasia associated with goblet cells alone is