Presentation
Incidental finding in overactive bladder with urinary urgency, frequency, intermittency and hesitancy. Normal PSA.
Patient Data
Transrectal and suprapubic ultrasound
Ultrasound shows a well-defined smooth roundish unilocular submucosal cystic lesion about 10 mm in bladder floor, in the midline near the left ureteral orifice. No color Doppler flow signal is seen within this lesion. Prostate is not significantly enlarged without suspected lesions.
Cystoscopy: cyst-like mass with regular surface at the posterior floor of the urinary bladder in the midline.
Surgical report: laparoscopic partial cystectomy approximately 1 cm away from the outer margin of the lesion under cystoscopic guidance. The urachus was removed.
Histological report: cystic lesion with mainly denuded urothelium with multiple cystically dilated submucosal von Brunn nests consistent with a Brunn cyst.
Case Discussion
The two common inverted lesions in the urinary bladder are von Brunn's nests and cystitis cystic/cystitis glandularis, which are considered normal variants of the urothelium.