Bladder leiomyoma presenting as dyspareunia: Case report and literature review

Abstract

Introduction: Leiomyoma of the bladder is a rare tumor arising from the submucosa. Most patients with bladder leiomyoma may present with urinary frequency or obstructive urinary symptoms. However, there are a few cases of bladder leiomyoma coexisting with uterine leiomyoma presenting as dyspareunia. We herein report an unusual case of coexisting bladder leiomyoma and uterine leiomyoma presenting as dyspareunia.

Case presentation: A 44-year-old Asian female presented to urologist and complained that she had experienced dyspareunia over the preceding several months. A pelvic ultrasonography revealed a mass lesion located in the trigone of urinary bladder. The mass lesion was confirmed on contrast-enhanced computed tomography (CT). The CT scan also revealed a lobulated and enlarged uterus consistent with uterine leiomyoma. Then, the biopsies were then taken with a transurethral resection (TUR) loop and these biopsies showed a benign proliferation of smooth muscle in a connective tissue stroma suggestive of bladder leiomyoma. An open local excision of bladder leiomyoma and hysteromyomectomy were performed successfully. Histological examination confirmed bladder leiomyoma coexisting with uterine leiomyoma.

Conclusion: This case highlights a rare presentation of bladder leiomyoma, dyspareunia, as the chief symptom in a patient who had coexisting uterine leiomyoma. Bladder leiomyomas coexisting with uterine leiomyomas are rare and can present with a wide spectrum of complaints including without symptoms, irritative symptoms, obstructive symptoms, or even dyspareunia.

Figure 1

CT reveals round homogeneous solitary tumor protruding into the urinary bladder and lobulated enlargement of the uterus consistent with uterine leiomyoma: (A) bladder leiomyoma, (B) bladder, (C) uterine leiomyoma, (D) uterus. CT = computed tomography.

Figure 2

Grossly, the mass is white-gray in color. The specimen is 9.5 × 8.5 × 6.5 cm³ in size.

Figure 3

Bladder leiomyoma composed of intersecting fascicles of smooth muscle (HE, ×400). HE = hematoxylin and eosin.

Figure 4

Uterine leiomyoma shows morphopathological changes similar to those of bladder leiomyoma (HE, ×400). HE = hematoxylin and eosin.