Year : 2002 | Volume
: 18 | Issue : 2 | Page : 166--168
Leiomyoma of the urinary bladder
CL Subudhi, S Panda, D Pradhan, N Pati
Department of Genito Urinary Surgery & Pathology, V.S.S. Medical College, Burla, Sambalpur, India
C L Subudhi
Department of Genito-Urinary Surgery, V.S.S. Medical College, Burla (Sambalpur) - 768 017
A rare case of leiomyoma of the urinary bladder in a 13-year-old girl is reported and its management discussed.
|How to cite this article:|
Subudhi C L, Panda S, Pradhan D, Pati N. Leiomyoma of the urinary bladder.Indian J Urol 2002;18:166-168
|How to cite this URL:|
Subudhi C L, Panda S, Pradhan D, Pati N. Leiomyoma of the urinary bladder. Indian J Urol [serial online] 2002 [cited 2020 Aug 5 ];18:166-168
Available from: http://www.indianjurol.com/text.asp?2002/18/2/166/37629
Mesenchymal tumors account for 1-5 percent of all bladder tumors. Of these, leiomyomas account for 35 percent and are the most common benign mesenchymal tumors. However, leiomyomas of the urinary bladder are rare with less than 200 cases reported. There is distinct predominance of adult female population suffering from this lesion but it is very rare in female children.
A 13-year-old girl presented with increasing dysuria, frequency and occasional haematuria of 6-months' duration. She had not attained menarche. Examination of the abdomen revealed a vague non-tender palpable suprapubic lump. Digital rectal examination revealed a big lemon sized bimanually palpable non-tender firm lump in the pelvis. Rest of the physical examination was unremarkable. Urianalysis revealed 20-40 RBCs/HPF and pus cells 10-20/HPF. Hemoglobin was 9.8 gm% and serum creatinine was 0.9 mg%. Ultrasound study of the urinary tract revealed a 7-cm diameter globular solid SOL arising from the right wall of the urinary bladder and upper tracts were normal. A cystogram showed a globular filling defect occupying 3/41th of the bladder and distinct from bladder wall except on the right side [Figure 1]. Cystoscopy revealed a lobulated pedunculated mass attached to the right posterolateral wall of the bladder above the ureteric orifice and was covered by normal bladder mucosa with few necrotic areas. Endoscopic biopsy taken from the mass revealed features consistent with leiomyoma. The mass was excised by partial cystectomy [Figure 2] preserving the right ureteric orifice. The patient had an uneventful recovery. Histopathological examination of the excised mass showed interlacing bundles of smooth muscle cells interspersed with connective tissue and hyaline material and absence of malignant cells [Figure 3]. The patient remains asymptomatic with no evidence of recurrence two years postoperatively.
Leiomyomas of the bladder can be categorized as endovesical (submucosal), intramural and extravesical (subserosal) and are usually situated in the vicinity of the trigone. These are usually 5 cm or less in diameter at the time of presentation. About 60% of the tumors are found to project into the bladder. The endovesical tumors are common and usually present with irritative and/or obstructive urinary symptoms. Rarely the tumor can obstruct the orifice or the bladder neck. Cystography may reveal a filling defect as seen in this case. CT scan and ultrasonography help to determine size, location and adjacent organ involvement. Cystoscopically the endovesical form can be sessile or pedunculated and is usually covered with normal vesical mucosa. The pathology of leiomyoma of the bladder is similar to that of leiomyoma of uterus. Although malignant leiomyoma must be ruled out histologically, the clinical behaviour of leiomyoma of the bladder is by definition, completely benign. Leiomyomas are encapsulated and their treatment depends on the location and size. Small endovesical tumors can be managed with transurethral resection as a definitive modality. Larger tumors of any category are managed with partial cystectomy with excellent prognosis as no malignant degeneration has been reported.
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