Simple melanosis of the bladder: a rare entity

Urinary Bladder "Melanosis": A Case Report and Review of the Literature

Melanosis of the urinary bladder, so-called melanosis vesicae, is a rare condition characterized by dark, velvety bladder mucosa observed by cystoscopy examination. Up to 20 examples have been reported in the English literature, and the etiology of this disease still needs to be discovered. We present an 82-year-old woman with a history of pelvic organ prolapse-associated urinary symptoms. The patient was found to have pigmented urinary bladder mucosa on cystoscopy and underwent a total hysterectomy and bladder mucosal biopsy. Histologically, pigmented granules were evident in the bladder stroma and epithelium, highlighted by Periodic Acid-Schiff (PAS) stain, suggestive of lipofuscin in nature. We outline the diagnostic features of bladder melanosis, discuss the diagnostic mimickers, and thoroughly review the literature on the subject.

Melanosis of the Bladder: Possible Pathogenetic Mechanisms

Melanin accumulation within the bladder urothelium and/or macrophages in the lamina propria (melanosis of the bladder) is a very rare phenomenon of unknown pathogenesis. Its rarity argues for a complex, likely multifactorial, causation. We describe bladder melanosis developing after Botox therapy in an elderly woman with a history of overactive bladder, treated grade 2 uterovaginal prolapse, and episodes of urinary tract infection and speculate that one factor (probably of many) in its pathogenesis may be a derangement of local neurourothelial interactions.

Unusual case of simple urinary bladder melanosis with complete resolution

A 66-year-old man presented with a long history of recurrent attacks of urinary retention and lower urinary tract symptoms. Flexible cystoscopy showed a urethral stricture. Follow-up cystoscopy 7 years later for recurrent symptoms demonstrated unusual extensive mucosal brown to black pigmentation, which proved histopathologically to be a simple bladder melanosis. Follow-up demonstrated complete resolution over a period of 1 year with no specific treatment. In this report, we highlighted a rare bladder abnormality with uncertain natural history.

[Melanosis of the urinary bladder]

Melanosis of the bladder is rare. Only 10 cases have been described in the literature. We present the case of an 80-year-old woman with neurogenic lower urinary tract dysfunction due to spinal paralysis. During the diagnostic work-up which included cystoscopy, black spots in the bladder wall were observed. Histopathological evaluation revealed a benign suburothelial melanosis. Thus, with cystoscopic suspicion of a malignancy (melanoma), a biopsy is mandatory and regular cystoscopic follow-up is recommended.

A case of benign vesica melanosis – four-year follow-up

Benign vesica melanosis (BVM) is a rare condition with only 15 reported cases in the literature (Table 1). There is limited understanding of its aetiology. Here we present a four-year follow-up of a case of BVM in a 53-year-old Caucasian male presenting with lower urinary tract symptoms.

Urinary tract transitional cell carcinoma and melanosis of the bladder: a case report and review of the literature

Melanosis vesica is a rare condition and thought to be benign. We report the case of a 50-year-old man who presented with haematuria and was found to have a diffusely pigmented bladder on cystoscopy and high grade transitional cell carcinoma of his upper and lower renal tract. This required a laparoscopic nephroureterectomy and pathology confirmed a diagnosis of melanosis vesica. Melanosis vesica has only been associated with high grade transitional cell carcinoma in one previous case. We recommend that any patient presenting with bladder melanosis is monitored for the development of upper or lower urinary tract transitional cell carcinoma.