Idiopathic localised bladder amyloidosis: rare cause of haematuria

Bladder triangle amyloidosis: A case report and literature review

RATIONALE

Amyloidosis is a group of benign lesions characterized by extracellular deposition of amyloid proteins. Amyloidosis lesions can occur in various organs of the body, but rarely in the urinary system. Amyloidosis in the bladder trigone is extremely rare.

PATIENT CONCERNS

An 80-year-old female patient presented with painless whole-course gross hematuria with reddish urine and no blood clots, accompanied by right lumbar discomfort.

DIAGNOSIS

Based on the patient's medical history and cystoscopy findings, the relevant literature was reviewed and a preoperative diagnosis of bladder tumor was made, although bladder amyloidosis was not excluded. Postoperative pathology ultimately revealed bladder amyloidosis.

INTERVENTIONS

The patient underwent resection of bladder tumor and ureteral stent implantation. Postoperatively, the patient was maintained on antibiotics and oral colchicine treatment.

OUTCOMES

Two months after surgery the patient reported that the gross hematuria had disappeared, and that the right lumbar discomfort was significantly relieved.Cystoscopy showed no obvious recurrence in the operative area, but magnetic resonance imaging (MRI) suggested recurrence. The patient refused partial cystectomy, and the ureteral stent was removed.

LESSON

The clinical manifestations of bladder amyloidosis are nonspecific, and under cystoscopy can be easily confused with bladder tumors. Accurate diagnosis of bladder amyloidosis relies on histopathology. Transurethral resection of bladder tumors or partial cystectomy is an option for surgical treatment; the latter should be performed if the ureteral opening is involved.

Localised primary amyloidosis of the urinary bladder: case series of two patients

Isolated amyloidosis of the lower urinary tract is rare. This report presents localised primary amyloidosis of the urinary bladder as a rare cause of macroscopic haematuria. Treatment of bladder amyloidosis mainly consists of controlling the haematuria. For small localised lesions, the favoured approach is transurethral resection (TUR) of the lesion.

Localized amyloidosis of the urinary tract: Case series of nine patients

OBJECTIVES

To report 9 cases of primary localized amyloidosis of the urinary tract and correlate the pathologic findings with clinical and cystoscopic information.

METHODS

Patients diagnosed with amyloidosis of the ureters, urinary bladder, or urethra from 1976 to 2003 were identified. Their medical records were reviewed, and histochemical and immunoperoxidase stains were performed on the tissue.

RESULTS

Eight cases of amyloidosis of the urinary bladder and one of the renal pelvis/ureter were identified. None of our cases showed evidence of systemic amyloidosis. Of the 8 patients with amyloidosis of the urinary bladder, 5 presented with gross hematuria and 1 with irritative bladder symptoms and 2 had amyloidosis detected during cystoscopic follow-up for urothelial carcinoma. The patient with amyloidosis of the renal pelvis/ureter presented with flank pain and gross hematuria. The clinical impression was malignancy in 75% of the bladder cases. Most patients with bladder involvement were treated with localized bladder resection; however, 1 patient required total cystectomy for symptom control. Of 5 patients with follow-up information, 2 developed recurrence. The pathologic assessment diagnosed amyloid deposits consistent with primary or AL type amyloid in all cases. Immunoperoxidase stains revealed lymphoid cells in the vicinity of the amyloid deposits to be lambda-restricted in 78% of cases.

CONCLUSIONS

Primary amyloidosis of the urinary tract is a rare condition that mimics malignancy in its clinical presentation and cystoscopic appearance and on diagnostic imaging. In our study, all cases of urinary amyloid deposits represented localized amyloidosis rather than manifestations of systemic amyloidosis. Monoclonal lymphoid populations evolving from chronic inflammation in the urinary tract may be the source of the amyloid AL proteins.

Localized amyloidosis: a survey of 35 French cases

Since the prognosis of localized amyloidosis remains unclear, we conducted a survey to define the characteristics and the course of this disease. The charts of 35 patients with either laryngeal (14 patients), tracheobronchial (10 patients), colonic (1 patient), or lower urinary tract amyloidosis (10 patients) were analyzed. The average age at diagnosis was 52.7+/-12 years (range 33-73 years). The amyloid protein type was specified to be amyloid light chain (AL) in 15 cases. All patients had undergone additional biopsies (accessory salivary glands, rectal, fat pad and bone marrow aspirates) to rule out a systemic disease. Symptomatic treatments included endoscopic excision and laser therapy. Colchicine and chemotherapy with prednisone and melphalan were prescribed with limited success. During a mean follow-up period of 6.1+/-5.3 years no patient developed a systemic form of amyloidosis. Six deaths were reported, one related to the disease because of a fatal airway hemorrhage. We suggest that immunolabeling studies should be more routinely performed. There was no risk of developing a systemic disease from local amyloid deposits in our survey. However, local evolution can be life-threatening. Such patients should be referred to specialist centers for further evaluation. Management requires close follow-up to exclude recurrence and to determine the appropriate symptomatic treatment.