Bladder leiomyoma: Presentation, evaluation and treatment

Abstract

Background: Bladder leiomyomas are benign mesenchymal neoplasms and very rare urinary tumours that represent <0.5% of all bladder tumours, with only 250 cases reported worldwide to date. The importance of recognising their characteristic features, leading to their correct treatment, is fundamental. Therefore, we reviewed reports of leiomyomas of the urinary bladder, their causes, clinical presentations, imaging methods and surgical management, updated to 2012.

Methods: We retrospectively reviewed articles published in the USA, Europe and Asia, from 1953 to date, using PubMed, Medscape, Medline and the several major journals. We report areas of controversies and well-established guidelines.

Results: We reviewed 36 articles that confirmed, with a high level of evidence-based medicine, that the male to female ratio is equal, the cause of bladder leiomyomas remains unknown, and their most common presentation is obstructive uropathy; endovesical tumours are the most common. Their radiological diagnosis can be made by ultrasonography, computed tomography or magnetic resonance imaging. Complete surgical resection is a very effective treatment, associated with almost no recurrence.

Conclusion: In symptomatic patients a complete surgical resection can give a very good outcome, with almost no recurrence.

Keywords: Benign tumour; Bladder; Diagnosis; Leiomyoma; TURBT, transurethral resection of the bladder tumour; US, ultrasonography.

Figure 1

Bladder leiomyoma on pelvic US, showing a smooth endovesical bladder lesion with peripheral hyperechogenicity (yellow arrow).

Figure 2

A bladder leiomyoma on CT of the abdomen and pelvis with intravenous contrast medium, showing a well-delineated endovesical bladder tumour, 6 cm × 4.2 cm, arising from the left posterolateral bladder wall.

Figure 3

A bladder leiomyoma on CT of the abdomen and pelvis with intravenous contrast medium (coronal view), showing an endovesical bladder tumour, arising from the left lateral bladder wall.

Fig. 4

A bladder leiomyoma on CT of the abdomen and pelvis with intravenous contrast medium (sagittal view), showing an endovesical bladder tumour.

Figure 5

Histopathological studies show that there is a proliferation of spindle-shaped cells, in addition to an eosinophilic cytoplasm and fibres (haematoxylin and eosin, x), with no evidence of mitotic changes or atypia (A). Leiomyomas of the urinary bladder also stain negatively for Ki-67 (B), but they are positive for smooth muscle staining (actin) (C).

Figure 6

Enhanced CT of the abdomen and pelvis showing left hydronephrosis and a left ‘extra-renal’ pelvis, due to the bladder leiomyoma obstructing the left ureteric orifice.