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Cao Q, Goldenberg M, Aron M, Wang T. Urinary Bladder "Melanosis": A Case Report and Review of the Literature. Int J Surg Pathol 2024; 32:104-108. [PMID: 37016968 DOI: 10.1177/10668969231166301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
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.
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Affiliation(s)
- Qi Cao
- Department of Pathology and Laboratory Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mitchell Goldenberg
- Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - Manju Aron
- Department of Pathology and Laboratory Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tiannan Wang
- Department of Pathology and Laboratory Medicine, University of Southern California, Los Angeles, CA, USA
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2
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Alzubaidi AN, Sekoulopoulos S, Birk A, Pham JT, Washburn E, Knoedler JJ. Synchronous melanosis of upper and lower urinary tract. Urol Case Rep 2022; 46:102309. [PMID: 36619659 PMCID: PMC9817159 DOI: 10.1016/j.eucr.2022.102309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/14/2022] [Accepted: 12/24/2022] [Indexed: 12/31/2022] Open
Abstract
Urothelial melanosis is an exceptionally rare diagnosis, with less than 25 cases being reported in the literature. Melanosis of the urothelium is characterized by abnormal melanin deposition within tissues, producing a black, velvety appearance to the urothelial mucosa. We present a 67-year-old male undergoing cystoscopy during a routine percutaneous nephrolithotomy (PCNL), who was found to have diffuse bladder melanosis extending up the ureter and into the renal pelvis. To our knowledge, this is the first reported case of synchronous melanosis of upper and lower urinary tract.
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Affiliation(s)
- Ahmad N. Alzubaidi
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Stephen Sekoulopoulos
- Penn State College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Alexander Birk
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jonathan T. Pham
- Penn State College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Erik Washburn
- Department of Pathology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - John J. Knoedler
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA,Corresponding author. Department of Urology, Milton S. Hershey Medical Center, Penn State College of Medicine, 500 University Drive, Hershey, PA, 17033, USA.
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3
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Melanosis of the Bladder: Possible Pathogenetic Mechanisms. Case Rep Urol 2022; 2022:6221499. [PMID: 35754918 PMCID: PMC9225889 DOI: 10.1155/2022/6221499] [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: 02/17/2022] [Accepted: 06/04/2022] [Indexed: 11/22/2022] Open
Abstract
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.
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Varik RS, Al-Adhani M, Taghizadeh A. Acquired childhood bladder melanosis. ANNALS OF PEDIATRIC SURGERY 2022. [DOI: 10.1186/s43159-022-00172-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Bladder melanosis is rare. It has previously been described only in the fifth decade of life or beyond; it has not been described in childhood. Previous descriptions have generally been case reports, and so the natural history is poorly understood. Urinary symptoms present at the time of cystoscopy have frequently been attributed to bladder melanosis. A possible suggested aetiology is aberrant migration of melanocyte migration during embryogenesis.
Case presentation
We present the first case of bladder melanosis in a child. He had been under our care since the age of 5 years with urinary incontinence and at that time, had undergone cystoscopy demonstrating normal bladder mucosa. A diagnosis of idiopathic detrusor overactivity with underactive voiding had been made. After other unsuccessful treatments, intravesical botulinum toxin was proposed. At the age of 13, repeat cystoscopy prior to botulinum toxin, demonstrated widespread pigmented areas in the bladder mucosa. Histology showed bladder melanosis. Our finding is important for several reasons. This is the first reported case of bladder melanosis to affect a child. The previous normal cystoscopy in our patient would refute the explanation that bladder melanosis is a congenital condition. Furthermore, the development of melanosis on the background of stable symptoms raises the possibility that the condition may be asymptomatic.
Conclusions
This unique finding of bladder melanosis in a child has provided further insight into this rare and poorly understood condition.
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Ibrahim Y, Hawary AM. Melanosis of the bladder; a urology MDT dilemma: case report and review of literature. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415818794579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Amr M Hawary
- Great Western Hospitals NHS Foundation Trust, Swindon, UK
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Atieh M, McIntire PJ, Kilic I, Picken MM, Flanigan RC, Barkan GA, Pambuccian SE. Lipofuscin pigmentation (so called "melanosis") of the bladder. Diagn Cytopathol 2019; 47:968-971. [PMID: 31148387 DOI: 10.1002/dc.24204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/22/2019] [Accepted: 04/22/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Mohammed Atieh
- Department of Pathology, Loyola University Medical Center, Maywood, Illinois
| | - Patrick J McIntire
- Department of Pathology, Loyola University Medical Center, Maywood, Illinois
| | - Irem Kilic
- Department of Pathology, Loyola University Medical Center, Maywood, Illinois
| | - Maria M Picken
- Department of Pathology, Loyola University Medical Center, Maywood, Illinois
| | - Robert C Flanigan
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
| | - Guliz A Barkan
- Department of Pathology, Loyola University Medical Center, Maywood, Illinois
| | - Stefan E Pambuccian
- Department of Pathology, Loyola University Medical Center, Maywood, Illinois
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Tudor ECG, Qureshi F, Oxley J. Melanosis bladder: Two rare cases of a pigmented bladder. JOURNAL OF CLINICAL UROLOGY 2017. [DOI: 10.1177/2051415817736233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Farukh Qureshi
- Bristol Urological Institute, North Bristol NHS Trust, UK
| | - Jon Oxley
- Department of Cellular Pathology, Southmead Hospital, UK
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Yau SE, Singer EJ, Sun Y, Johnson MH. Bladder melanosis with concurrent urothelial carcinoma. Urol Case Rep 2017; 15:30-32. [PMID: 28932694 PMCID: PMC5596324 DOI: 10.1016/j.eucr.2017.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/02/2017] [Accepted: 09/07/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
- Susanna E. Yau
- Corresponding author. Johns Hopkins Hospital, 600 N. Wolfe Street/Marburg 148, Baltimore, MD 21287, USA.Johns Hopkins Hospital600 N. Wolfe Street/Marburg 148BaltimoreMD21287USA
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Sammer U, Walter M, Knüpfer SC, Mehnert U, Bode-Lesniewska B, Kessler TM. Do We Need Surveillance Urethro-Cystoscopy in Patients with Neurogenic Lower Urinary Tract Dysfunction? PLoS One 2015; 10:e0140970. [PMID: 26513149 PMCID: PMC4626398 DOI: 10.1371/journal.pone.0140970] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 10/01/2015] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To examine the value of surveillance urethro-cystoscopy in patients with neurogenic lower urinary tract dysfunction (NLUTD) in regard to the conflicting literature as it is generally agreed that patients with NLUTD are at increased risk for bladder cancer. MATERIALS AND METHODS In a cross-sectional study, a consecutive series of 129 patients (50 females, 79 males, mean age 51, range 18-88) suffering from NLUTD for at least 5 years was prospectively investigated using urethro-cystoscopy and bladder washing cytology at a single university spinal cord injury (SCI) center. RESULTS Due to suspicious urethro-cystoscopy and/or bladder washing cytology findings, 13 (10%) of 129 patients underwent transurethral resection of the bladder lesion and/or random bladder biopsies. Overall, 9 relevant histological findings were found in 5% (7/129) of our patients: bladder melanosis (n = 1), nephrogenic adenoma (n = 3), keratinizing squamous metaplasia (n = 1), intestinal metaplasia (n = 3), and muscle-invasive adenocarcinoma of the bladder (n = 1). CONCLUSIONS Using surveillance urethro-cystoscopy, we found relevant histological findings in 5% of our patients suffering from NLUTD for at least 5 years. Thus, surveillance urethro-cystoscopy might be warranted, although the ideal starting point and frequency remain to be determined in further prospective studies.
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Affiliation(s)
- Ulla Sammer
- Neuro-Urology, Spinal Cord Injury Center and Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Matthias Walter
- Neuro-Urology, Spinal Cord Injury Center and Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Stephanie C Knüpfer
- Neuro-Urology, Spinal Cord Injury Center and Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Ulrich Mehnert
- Neuro-Urology, Spinal Cord Injury Center and Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Beata Bode-Lesniewska
- Institute of Surgical Pathology, University of Zürich, University Hospital Zürich, Zürich, Switzerland
| | - Thomas M Kessler
- Neuro-Urology, Spinal Cord Injury Center and Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
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Abstract
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.
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Affiliation(s)
- J Wöllner
- Neuro-Urologie, Schweizer Paraplegiker Zentrum, Guido A. Zäch Straße 1, CH-6207, Nottwil, Schweiz.
| | - J Janzen
- Praxis für Histopathologie, Bern, Schweiz
| | - J Pannek
- Neuro-Urologie, Schweizer Paraplegiker Zentrum, Guido A. Zäch Straße 1, CH-6207, Nottwil, Schweiz
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11
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Metastasis of Malignant Melanoma to Urinary Bladder: A Case Report and Review of the Literature. Case Rep Pathol 2015; 2015:173870. [PMID: 26106499 PMCID: PMC4464585 DOI: 10.1155/2015/173870] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 05/19/2015] [Indexed: 11/17/2022] Open
Abstract
Aims. Metastatic malignant melanoma of the urinary bladder is a rare clinical entity, with only twenty-three published cases to date. We present a case of this rare entity, a thorough review of the literature, and differential diagnosis of melanoma in the bladder. Methods and Results. A 55-year-old woman with a history of malignant melanoma of the right thigh, excised eight years ago, presented with back pain, fatigue, and hematuria. She underwent computed tomography (CT) scan and was found to have metastases within the liver, spleen, lungs, and urinary bladder. She underwent cystoscopy and transurethral resection of three polypoid lesions. Histologic and immunohistochemical examination revealed metastatic malignant melanoma involving bladder mucosa. Conclusions. This case illustrates the importance of including malignant melanoma in the differential diagnosis of high grade neoplasms of bladder, especially in cases where the relevant clinical history is not available.
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Ahluwalia N, Mukhtar S, Fish D, Donohue JF. Simple melanosis of the bladder: Case report and review of the literature. JOURNAL OF CLINICAL UROLOGY 2014. [DOI: 10.1177/2051415814548260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Nikhil Ahluwalia
- Urology Department, Maidstone and Tunbridge Wells Hospitals NHS Trust, UK
| | - Saheel Mukhtar
- Urology Department, Maidstone and Tunbridge Wells Hospitals NHS Trust, UK
| | - David Fish
- Department of Histopathology, Maidstone and Tunbridge Wells Hospitals NHS Trust, UK
| | - John F Donohue
- Urology Department, Maidstone and Tunbridge Wells Hospitals NHS Trust, UK
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Manson-Bahr DA, Swamy R, Adshead JM. A case of benign vesica melanosis – four-year follow-up. JOURNAL OF CLINICAL UROLOGY 2013. [DOI: 10.1177/2051415813507053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
| | - Rajiv Swamy
- Department of Histopathology, Hertfordshire and South Bedfordshire Urological Cancer Centre, UK
| | - Jim M Adshead
- Department of Urology, Hertfordshire and South Bedfordshire Urological Cancer Centre, UK
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