Inflammatory myofibroblastic tumor of the urinary bladder: A prognostically favorable spindle cell neoplasm

A rare case of inflammatory myofibroblastic tumor of the bladder with local invasion of the cervix and right ovary

Inflammatory myofibroblastic tumors (IMT) are rare spindle cell neoplasms derived from mesenchymal cells. Primary genitourinary IMTs share morphological and molecular features with various malignant spindle cell sarcomas, which introduces a diagnostic challenge. We present the case of a 50-year-old female who was referred for evaluation of hematuria and nonspecific urinary symptoms and was found to have a mass originating from the urinary bladder that involved the cervix and right ovary. Transurethral resection of bladder tumor (TURBT) and immunohistochemical analysis revealed an IMT. To our knowledge, this is the first documented case of primary genitourinary IMT with cervical and ovarian involvement.

Inflammatory myofibroblastic tumour: case report of a rare form of bladder tumour

Introduction and importance

Inflammatory myofibroblastic tumour (IMT) is a rare tumour with malignant potential and has been described in many major organs with the most frequent site being the lungs. However, bladder is an extremely rare location. IMT presents a unique diagnostic challenge because of the characteristics it shares with malignant neoplasms.

Case presentation

Here we report the case of a 47-yearold male who presented with storage lower urinary tract symptoms associated with non-specific lower abdominal pain for one month duration. Contrast-enhanced computed tomography of abdomen and pelvis revealed a 6 cm tumour at the dome and left side anterior wall of the bladder. He underwent laparotomy and partial cystectomy. Histopathology results were consistent with an IMT.

Clinical discussion

Even though bladder IMT is indolent in course, typical IMTs can be locally aggressive. Due to the lack of specificity in clinical symptoms, it is not easy to arrive at a precise diagnosis before surgery. Hence, the final diagnosis depends on histomorphological features and the immune histochemical profile.

Conclusion

It can be challenging to distinguish IMT from malignant neoplasms both clinically and histologically. As such, local surgical resection with close follow-up remains the mainstay of treatment for urinary tract IMT.

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Occurrence of IMT is rarely encountered in the urinary tract.

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A 47-year old male with urinary bladder tumour was histopathologically revealed to be of IMT type.

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Tumour was at the dome of the bladder and left side anterior bladder wall abutting the sigmoid colon.

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The final diagnosis depends on histomorphological features and the immune histochemical profile.

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Local surgical resection with close follow-up remains the mainstay of treatment for urinary tract IMT.

A Conservative Approach to Inflammatory Myofibroblastic Tumor of the Bladder: A Case Report and Review of Literature

Inflammatory myofibroblastic tumors (IMTs) are particularly rare tumors that have been described in various anatomic locations, of which the urinary bladder is the most common. These benign tumors are amendable to conservative therapy but are notoriously difficult to diagnose given their mimicry of malignant sarcomas and sarcomatoid carcinomas, making an accurate diagnosis paramount to spare a patient radical and unnecessary treatment. We hereby present the case of a 37-year-old female patient who was diagnosed with an IMT of the urinary bladder during workup for painless gross hematuria. Patient was successfully managed with a laparoscopic partial cystectomy and is free of recurrence 5 years after surgery. IMTs are rare benign tumors that share the same clinical presentation as malignant bladder tumors. Deep biopsy and experienced pathologist are crucial in establishing diagnosis and avoiding patient radical treatment. This case is a classical demonstration of a remarkably rare tumor that was adequately managed with conservative therapy, achieving excellent clinical outcomes.