Endovesical leiomyoma of bladder: a case report

Abstract

Benign mesenchymal tumors cover 0,04-0,5% of all bladder tumors and their major part consists of leiomyomas. Having the smooth muscle tissue origin, these tumors can exhibit intramural, endovesical and extravesical localization in the bladder. Clinically, the irritative and obstructive symptoms, hematuria accompany endovesical leiomyomas. Along side being asymptomatic, intramural and extravesical leiomyomas can sometimes be characterized by mass formation, hematuria, and irritative symptoms, rarely by obstructive symptoms. In the diagnostic process histopathology is of great importance, especially in exclusion of radiologically and cystoscopically indistinguishable lesions. A case of endovesical leiomyoma of bladder in 49 year-old male patient admitted to the hospital with a complaint of hematuria and irritative symptoms is presented. Transurethral resection is performed for the patient with the purpose of treatment and diagnosis, and follow-up with ultrasonography was deemed appropriate once every three months. In the macroscopic examination of the material 4,0 cc of white-and-pink-colored, soft tissue fragments from 0,5 to 1,8 cm in diameter were observed. A well-vascularized tumor tissue composed of spindle cells with uniform and elongated nucleuses and normal urothelial epithelium with no specific features on its surface was observed in the microscopic examination. Recurrence wasn`t observed during 32-month follow-up. As bladder leiomyoma is a rare pathology, generally accepted follow-up scheme for this disease after the treatment isn't reported. For this reason, we did the follow-up of the patient in a minimally invasive way that doesn't comply with the EAU guidelines - ultrasonography of urinary tract was performed on the patient on quarterly basis. After the 32 month-follow-up, no recurrence was seen. As a result, the bladder leiomyoma is a rare, and it requires careful pathological examination. Due to the lack of knowledge about this tumor large scale of studies.