Presentation
Stone former with right flank pain. No hematuria, fever or weight loss.
Patient Data
Well-defined benign looking lobulated exophytic mass along the right anterolateral wall of the urinary bladder, which is likely a leiomyoma. It measures 3.2 x 5.3 cm and has minimal internal vascularity on the color Doppler ultrasound examination. Non-obstructive renal calculus measuring 8 mm at the lower pole of the right kidney.
Well-defined pedunculated exophytic poorly enhancing mass lesion seen arising from the anterior wall of the urinary bladder measuring about 4 x 5.2 x 4.4 cm. No calcifications or significant cystic degeneration/necrosis is seen within it. A linear hypredensity is seen within the posterior urinary bladder which is likely a resolving hematoma, related to the TURBT done four weeks ago. Average size spleen with a well-defined non-enhancing hypodense lesion measuring about 3.5 x 2.7 cm, which is likely a splenic cyst/splenic pseudocyst. Non-obstructive radiopaque renal calculi measuring 9 mm & 5 mm noted at the lower poles of the right & left kidney respectively. Small fat containing umbilical hernia.
Case Discussion
Procedure: Trans-urethral resection of bladder tumor (TURBT).
Microscopy: The material is composed almost entirely of smooth muscle with only occasional areas showing lining urothelium which is benign. There is no evidence of necrosis, nuclear pleomorphism or mitotic activity.
Immunohistochemistry: CD34 and Bcl2 are negative, whereas Desmin and smooth muscle actin are strongly positive.
Diagnosis: Leiomyoma.
One month after the initial ultrasound examination, the patient underwent TURBT, which was later followed by the staging CT scan. Finally, after the CT scan, the patient underwent open partial cystectomy.