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

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.

Synchronous melanosis of upper and lower urinary tract

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.

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.

Acquired childhood bladder melanosis

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.

Do We Need Surveillance Urethro-Cystoscopy in Patients with Neurogenic Lower Urinary Tract Dysfunction?

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.

[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.

Metastasis of Malignant Melanoma to Urinary Bladder: A Case Report and Review of the Literature

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.

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.