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Kaltsas A, Zachariou A, Tien DMB, Takenaka A, Sofikitis N. An Atypical Case of Bladder Lipoma Presenting as Gross Hematuria: A Case Report. Cureus 2023; 15:e42471. [PMID: 37521590 PMCID: PMC10375420 DOI: 10.7759/cureus.42471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/01/2023] Open
Abstract
While conventional lipomas represent the most commonly seen benign mesenchymal tumor in adults, their occurrence in the bladder wall is exceptionally rare. This report details a rare case of a bladder lipoma, a benign tumor primarily composed of mature adipocytes, presenting as gross hematuria in a 68-year-old male. Despite the patient's previous history of left nephrectomy, no significant pathological findings were initially observed. The bladder lipoma was detected via cystoscopy as a polypoid mass on the posterior bladder wall and confirmed through transurethral resection of the bladder tumor (TUR-BT). Histopathological analysis verified the mass as a bladder lipoma composed of mature adipocytes. Following a specific postoperative follow-up period, no recurrence of the tumor was observed, suggesting successful treatment. This case underscores the clinical significance of considering bladder lipoma in differential diagnoses of bladder tumors, especially in patients presenting with gross hematuria, given its exceptional rarity.
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Affiliation(s)
- Aris Kaltsas
- Department of Urology, University of Ioannina, Ioannina, GRC
| | | | - Dung Mai Ba Tien
- Department of Andrology, Binh Dan Hospital, Ho Chi Minh City, VNM
| | - Atsushi Takenaka
- Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago, JPN
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Hu X, Wang K, Sun M, Li C, Wang H, Guan J. Quantitative MRI in distinguishing bladder paraganglioma from bladder leiomyoma. Abdom Radiol (NY) 2023; 48:1051-1061. [PMID: 36690715 DOI: 10.1007/s00261-023-03812-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/25/2023]
Abstract
PURPOSE To investigate the feasibility of quantitative MRI in the differentiation of bladder paraganglioma from bladder leiomyoma. METHODS From 2014 to 2021, 11 patients with bladder paraganglioma and 14 patients with bladder leiomyoma confirmed by surgical pathology were retrospectively collected. All patients underwent multiparametric scanning with a 3.0 T MR system. Quantitative parameters including the SI-ratio on T1WI between the solid component of tumours and piriformis, ADC value and E-rate of the solid component of tumours were assessed. Independent sample t test or Mann-Whitney U test was used to compare these parameters between the two groups. The diagnostic efficiency of the parameters was examined using ROC curve analysis and the DeLong test. RESULTS There were significant differences in SI-ratio on T1WI (P < 0.001), ADC value (P = 0.002) and the E-rate (P = 0.040) between the paraganglioma group and the leiomyoma group. The cutoff value of SI-ratio on 3 leiomyoma was 1.241, and the AUC was 1.000 (0.858-1.000). The cutoff value of the ADC value was 0.979 × 10-3mm2/s, and the AUC was 0.907 (0.717-0.987). The cutoff value of E-rate was 98.7%, and the AUC was 0.714 (0.495-0.878). The AUCs of the SI-ratio on T1WI and ADC value were significantly higher than the E-rate AUC (P = 0.015 and 0.034, respectively). CONCLUSION Quantitative MRI can effectively distinguish bladder paraganglioma from bladder leiomyoma with the SI-ratio on T1WI or ADC value.
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Affiliation(s)
- Xiaoxiao Hu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58 Zhongshanerlu Road, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Ke Wang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58 Zhongshanerlu Road, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Mengya Sun
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58 Zhongshanerlu Road, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Chang Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58 Zhongshanerlu Road, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Huanjun Wang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58 Zhongshanerlu Road, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Jian Guan
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58 Zhongshanerlu Road, Guangzhou, 510080, Guangdong, People's Republic of China.
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Yoon JW, Park SB, Lee ES, Park HJ. Multidetector computed tomography evaluation of bladder lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2023; 54:35. [DOI: 10.1186/s43055-023-00987-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 02/05/2023] [Indexed: 09/27/2023] Open
Abstract
Abstract
Background
Urinary bladder tumors are the most common type of tumors detected in patients with gross hematuria. Multidetector computed tomography (MDCT) is an accurate method for detecting bladder lesions. This review aims to describe the features of MDCT and the possible values for distinguishing these lesions in the bladder.
Main body
In this review, we discuss the role of MDCT in the evaluation of patients with bladder cancer and describe a broad spectrum of bladder lesions, including malignant bladder lesions beyond bladder cancer, benign bladder lesions, and diffuse bladder wall thickening.
Short conclusion
Familiarity with the clinical presentations and imaging features of bladder lesions can lead to more accurate diagnosis and appropriate management.
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Song J, Song H, Kim YW. Recurrent atypical leiomyoma in bladder trigone, confused with uterine fibroids: A case report. World J Clin Cases 2022; 10:10728-10734. [PMID: 36312486 PMCID: PMC9602212 DOI: 10.12998/wjcc.v10.i29.10728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/18/2022] [Accepted: 09/08/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Tumors originating from the posterior bladder wall can be challenging to diagnose because they may mimic a mass from the uterine cervix. Atypical leiomyoma of the bladder trigone is extremely rare, with few reported cases, and requires caution during surgery to avoid damage to the adjacent ureter. Diagnostic surgery and confirmational pathology are essential to assess whether the tumor is malignant and relieve clinical symptoms. Herein, we describe a case of recurrent leiomyoma with focal atypia in the bladder trigone.
CASE SUMMARY A 29-year-old woman with a uterine fibroid incidentally found at a regular checkup was referred to our hospital. Based on magnetic resonance imaging, either urinary bladder leiomyoma or protrusion of pedunculated uterine cervical fibroid into the bladder was suspected. This leiomyoma in the trigone of the bladder was completely excised by laparotomy, and the patient was discharged without complication. Follow-up outpatient ultrasonography identified tumor recurrence after four years. As focal atypia was identified previously, laparotomy was performed to confirm the pathology. A round solid mass was resected from the posterior bladder wall without injuring either ureteric orifice. This tumor was pathologically diagnosed as a leiomyoma without atypia. Three-year follow-up ultrasonography has revealed no recurrence.
CONCLUSION Atypical leiomyoma in bladder trigone is rare and could be easily mistaken for fibroid in the uterine cervix. To confirm histopathology, surgical excision is mandatory and regular follow-up is necessary to detect recurrence.
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Affiliation(s)
- Jeonghwa Song
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Incheon St. Mary’s Hospital, Incheon 21431, South Korea
| | - Heekyoung Song
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Incheon St. Mary’s Hospital, Incheon 21431, South Korea
| | - Yong-Wook Kim
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Incheon St. Mary’s Hospital, Incheon 21431, South Korea
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AlHalak R, Alkabbani S, Nasseif H, Oghanna N, Janahi F. Bladder leiomyoma treated with transurethral resection of bladder tumor (TURBT): Case report. Int J Surg Case Rep 2022; 98:107464. [PMID: 36007408 PMCID: PMC9424341 DOI: 10.1016/j.ijscr.2022.107464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/26/2022] [Accepted: 07/26/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Rouzy AlHalak
- 5th year medical student at Mohammed Bin Rashid University for Medicine and Health Sciences, Dubai, United Arab Emirates.
| | - Sarah Alkabbani
- 5th year medical student at Mohammed Bin Rashid University for Medicine and Health Sciences, Dubai, United Arab Emirates.
| | - Hala Nasseif
- 4th year medical student at Mohammed Bin Rashid University for Medicine and Health Sciences, Dubai, United Arab Emirates.
| | - Neshteman Oghanna
- Consultant Hispathologist/Cytopathologist, Pathology and Laboratory Medicine department, Mediclinic City Hospital, Dubai, United Arab Emirates.
| | - Farhad Janahi
- Department of Urological Surgery, Mediclinic City Hospital, Dubai Healthcare City, Dubai, United Arab Emirates; Mohammed Bin Rashid University for Medicine and Health Sciences, Dubai, United Arab Emirates.
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Zhang Z, Shi F, She J. Robot-assisted tumorectomy for an unusual pelvic retroperitoneal leiomyoma: A case report. Medicine (Baltimore) 2022; 101:e29650. [PMID: 35945744 PMCID: PMC9351892 DOI: 10.1097/md.0000000000029650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Extrauterine leiomyoma occasionally occurs in rare locations with unusual growth patterns, especially pelvic retroperitoneal leiomyoma, which brings great challenges for surgeons to make a diagnosis. It is essential to distinguish benign from malignant retroperitoneal neoplasms according to the imaging manifestations. Laparotomy and laparoscopy are the common options for pelvic retroperitoneal neoplasms, while they may cause side effects during operation such as secondary damage. Appropriate surgical techniques should be adopted to ensure the complete excision of neoplasms meanwhile preserve the urination, defecation, and sexual function. PATIENT CONCERNS A 30-year-old woman was referred to our hospital because of dull pain in the perianal region for 1 month. Laboratory results including tumor markers were all within normal limits. The digital rectal examination revealed a huge and tough mass with smooth mucosa protruding into the rectal cavity from the rear area of rectum. DIAGNOSIS Imaging examinations were performed. Contrasted computed tomography (CT) of pelvis showed an enhanced retroperitoneal solid mass in the space between sacrum and rectum, and very close to the levator ani muscle. The mass was about 11.0*8.0 cm in size. Computerized tomography angiography (CTA) showed the distal branches of bilateral internal iliac artery went into the mass. Endoscopic ultrasonography (US) showed the mass compressed the rectum, as well as a clear boundary to the rectal wall. A histopathologic examination confirmed the mass was a pelvic retroperitoneal leiomyoma. INTERVENTIONS The patient underwent an operative resection with da Vinci Si surgical system after routine preoperative preparation. Anorectal motility was weekly monitored postoperation. No additional adjuvant therapy was performed. OUTCOMES The patient could walk after 1 day and defecate normally on the third day after operation. She was discharged on the seventh postoperative day. No adverse events including pelvic floor hernia or defecation dysfunction occurred in the follow-up period. At 4 weeks follow-up, the patient was pain-free and recovered well. LESSONS Although imaging examinations were crucial for retroperitoneal neoplasms, histopathological examination remains the "gold standard" for making a definite diagnosis. This case highlights the possibility of retroperitoneal leiomyoma occurring in a woman of reproductive age and the advantages of robotic surgical system in pelvic retroperitoneal surgeries.
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Affiliation(s)
- Zhe Zhang
- Department of General Surgery, The First Affiliated Hospital of Xi’an Jiaotong University
- Center for Gut Microbiome Research, Med-X Institute, The First Affiliated Hospital of Xi’an Jiaotong University
- Department of High Talent, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Feiyu Shi
- Department of General Surgery, The First Affiliated Hospital of Xi’an Jiaotong University
- Center for Gut Microbiome Research, Med-X Institute, The First Affiliated Hospital of Xi’an Jiaotong University
- Department of High Talent, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Junjun She
- Department of General Surgery, The First Affiliated Hospital of Xi’an Jiaotong University
- Center for Gut Microbiome Research, Med-X Institute, The First Affiliated Hospital of Xi’an Jiaotong University
- Department of High Talent, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
- *Correspondence: Junjun She, The First Affiliated Hospital of Xi’an Jiaotong University, 277 West Yanta Road, 710061, Xi’an, Shaanxi, People’s Republic of China (e-mail: )
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AlAmri N, Abdullah H, AlIbrahim F, Eid K, AlShehri M. Imaging findings of atypical leiomyoma of urinary bladder simulating ureterocele. J Surg Case Rep 2022; 2022:rjac256. [PMID: 35769310 PMCID: PMC9218995 DOI: 10.1093/jscr/rjac256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 05/16/2021] [Indexed: 11/13/2022] Open
Abstract
Bladder leiomyomas are relatively rare benign tumors of the bladder. They represent <0.5% of all urinary bladder tumor. In the literature, only about 250 cases reported worldwide. They are commonly found in middle-aged females. Patients present with variety of clinical presentations with predominance of obstructive urinary symptoms. Ultrasound bladder is the first preferable diagnostic tool. Definitive diagnosis is made by histopathological examination. Surgical excision is almost highly effective, leaving a low recurrence rate. We report a 34-year-old male who presented with complaints of dysuria and incomplete voiding. Ultrasound showed a cystic fluid-filled bladder mass (ureterocele), which was excised through a transurethral resection. The histopathologic diagnosis was bladder leiomyoma.
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Affiliation(s)
- Nojoud AlAmri
- Department of Urology , King Abdullah bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh 11552 , Saudi Arabia
| | - Hussam Abdullah
- Department of Urology , King Abdullah bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh 11552 , Saudi Arabia
| | - Fawaz AlIbrahim
- Department of Urology , King Abdullah bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh 11552 , Saudi Arabia
| | - Khadijah Eid
- Department of Urology , King Abdullah bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh 11552 , Saudi Arabia
| | - Mohammed AlShehri
- Department of Urology , King Abdullah bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh 11552 , Saudi Arabia
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Baird BA, Ericson CA, Augustus A, Geldmaker L, Wajswol E, Young PR. Robotic transvesical bladder leiomyoma excision. Urol Case Rep 2022; 43:102054. [PMID: 35345668 PMCID: PMC8956799 DOI: 10.1016/j.eucr.2022.102054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/10/2022] [Accepted: 03/16/2022] [Indexed: 11/23/2022] Open
Abstract
Bladder leiomyomas are rare, benign tumors with a variety of clinical presentations. Surgical approach is typically based on symptomatology and leiomyoma location. Literature on robotic excision is limited. We present our case of a unique transvesical approach. The patient had rapid convalescence with no complications, suggesting robotic transvesical excision is a safe, effective treatment for bladder leiomyoma for suitable candidates.
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Affiliation(s)
- Bryce A. Baird
- Mayo Clinic Florida, Department of Urology, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States
- Corresponding author.
| | - Christian A. Ericson
- Mayo Clinic Florida, Department of Urology, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States
| | - Anderson Augustus
- Tulane University, School of Medicine, New Orleans, LA, United States
| | - Laura Geldmaker
- Mayo Clinic Florida, Department of Urology, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States
| | - Ethan Wajswol
- Mayo Clinic Florida, Department of Urology, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States
| | - Paul R. Young
- Mayo Clinic Florida, Department of Urology, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States
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