Indian Journal of Urology
CASE REPORT
Year
: 2002  |  Volume : 18  |  Issue : 2  |  Page : 168--169

Primary localized amyloidosis of urinary bladder : A case report


Anil Kumar Goswami, Purshotam Kumar Puri, Bishan Dass Radotra, Shrawan Kumar Singh, Surinder Kumar Sharma 
 Department of Urology and Pathology, Postgraduate Institute of Medical Education & Research, Chandigarh, India

Correspondence Address:
Anil Kumar Goswami
Department of Urology, Postgraduate Institute of Medical Education & Research, Chandigarh - 160 012
India




How to cite this article:
Goswami AK, Puri PK, Radotra BD, Singh SK, Sharma SK. Primary localized amyloidosis of urinary bladder : A case report.Indian J Urol 2002;18:168-169


How to cite this URL:
Goswami AK, Puri PK, Radotra BD, Singh SK, Sharma SK. Primary localized amyloidosis of urinary bladder : A case report. Indian J Urol [serial online] 2002 [cited 2020 Aug 10 ];18:168-169
Available from: http://www.indianjurol.com/text.asp?2002/18/2/168/37630


Full Text

Primary localized amyloidosis of the urinary bladder is a rare disease, of unknown etiology and no standard treat­ment has been established so far. [1],[2],[3] We report a case of primary localized amyloidosis of the urinary bladder di­agnosed by absence of amyloid deposition elsewhere and immunoperoxidase stain showing immunoreactivity to anti-AL antibodies.

 Case Report



G.R. a 42-year-old male, known diabetic type-II for the last 7 years on oral hypoglycemic drug, presented with his­tory of two episodes of painless, gross, total haematuria. Clinical examination was unremarkable. Routine investi­gations like haemoglobin, total and differential leukocyte counts, erythrocyte sedimentation rates, blood sugar, blood urea, serum creatinine, electrolytes, liver associated en­zymes, electrocardiogram and chest X-rays were normal. Urine culture was negative. Voided urinary cytology for malignant cells was negative. An excretory urogram demon­strated normal urinary tract. Ultrasound KUB revealed mini­mal bladder wall irregularity near the bladder neck.

At cytoscopy, an irregular, haemorrhagic, oedematous lesion involving the trigone was noted. Lesion was resected. During resection submucosal yellowish deposits were seen [Figure 1].

The biopsy specimen revealed deposits of pale, acellu­lar, amorphous material, involving subepithelial area of bladder, having apple-green birefringence under polarized light after staining with congo-red. There was no evidence of malignancy. Using the potassium permanganate pre­treatment method and immunohistochemical staining, the amyloid protein was characterized as a immunoglobulin of AL-type (composite [Figure 2]). Investigations for systemic amyloidosis - Bence Jones protein assay, serum electro­phoresis, rectal biopsy, abdominal fat pad aspiration, buc­cal mucosal biopsy, chest radiograph, echocardiogram, liver were all negative. On follow-up upto 9 months, there was no recurrence.

 Discussion



Primary amyloidosis of the bladder is a rare clinico-patho­logical entity of unknown etiology. The condition is of in­terest to the urologists since the signs and symptoms resemble those of neoplasm. The major presenting symp­tom is gross haematuria, though some patients experience lower urinary tract symptoms such as increased urinary fre­quency, dysuria and lower abdominal pain or discomfort. [2]

A definite diagnosis of the disease can be made only by histological examination of biopsy material in which ap­ple-green birefringence can be recognized under polar­ized light after staining with congo-red. There have been few reports on the immuno-histochemical type determi­nation of amyloid protein in primary localized vesical amyloidosis. The pathogenesis of amyloid deposition is still not clear. A thorough search for possible underlying disease and associated secondary amyloidosis should be made.

Most of the reported patients with primary localized amyloidosis of the bladder have been treated with transure­thral resection. Cystectomy has been performed in few cases with uncontrollable haematuria and diffuse lesions. Dimethyl sulfoxide has been successfully used both orally as well as by bladder instillation. [3] Because of the risk of recurrence, a close follow-up is mandatory.

References

1Auge BK, Haluszka MM. Primary amyloidosis of the bladder. J Urol 2000; 163: 1867-1868.
2Kono M. Komatsu K. Nagasaka Y, Namiki M. Primary A-type amy­loidosis of the urinary bladder: A case report. Hinyokika Kiyo 2000; 46: 197-199.
3Tokunaka S, Osanai H, Morikawa M, Yachiku S. Experience with Dimethyl Sulfoxide treatment for primary localized amyloidosis of the bladder. J Urol 1986: 135: 580-582.