Indian Journal of Urology
CASE REPORT
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

Correspondence Address:
C L Subudhi
Department of Genito-Urinary Surgery, V.S.S. Medical College, Burla (Sambalpur) - 768 017
India

Abstract

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 2019 Oct 19 ];18:166-168
Available from: http://www.indianjurol.com/text.asp?2002/18/2/166/37629


Full Text

 Introduction



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.

 Case Report



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.

 Discussion



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.[3]

References

1Goluboff ET. O'Toole K. Sawczuk IS. Leiornyorna of bladder : re­port of case and review of literature. Urology 1994; 43: 238-241.
2Vargas AD, Mendez R. Leiomyoma of bladder. Urology 1983; 21: 308-309.
3Knoll LD, Segura JW, Scheithauer BW. Leiomyoma of the bladder. J Urol 1986; 136: 906-908.