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| | | Year : 2008 | Volume : 19 | Issue : 2 | Page : 232-235 | | | Leiomyoma of Bladder | | | PJ Sudhakar1, Neelam Malik1, Ashok Malik2
1 Department of Radiology, Salmaniya Medical Complex, Bahrain
2 Department of Pathology, Salmaniya Medical Complex, Bahrain
Click here for correspondence address and email | |      | |  Abstract | | | A case of leiomyoma of urinary bladder, a rare benign tumor, is presented. The patient was a 45-year-old woman with long duration history of dysuria. Intravenous urography (IVU), ultrasound (US), computed tomography (CT) and biopsy diagnosed this case accurately. The clinical presentation, imaging findings and management of this benign tumor are discussed. Keywords: Leiomyoma, Urinary bladder, Imaging How to cite this article:
Sudhakar P J, Malik N, Malik A. Leiomyoma of Bladder. Saudi J Kidney Dis Transpl 2008;19:232-5 |
| Introduction | |  |
Leiomyoma is a rare tumor of bladder, even though it is the most common benign neoplasm accounting for 0.43% of bladder tumors. [1] Approximately 75% of the patients are young and middle aged. [2] Common presenting features are usually obstructive in nature. It exhibits characteristics similar to those of uterine myomas on ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). [3] We present a rare case of leiomyoma of urinary bladder in a female with brief review of literature regarding diagnosis and management.
| Case report | | |
A 45-year-old woman presented with nearly 3-year history of difficulty in passing urine. She also complained of frequency, urgency and intermittent incontinence of urine for the past 4 months. She denied any other medical problems. Physical examination was unremarkable. Routine urine examination showed few WBC and was negative for RBC. Blood urea and serum creatinine were within normal limits. US revealed a small right kidney, hydronephrotic left kidney and a large hypoechoic mass in the bladder with reflective surface. Intra venous urography (IVU) revealed gross hydronephrosis and hydroureter on the left side, [Figure - 1]. A large filling defect was noted within the bladder. Contrast enhanced CT scan illustrated a large moderately enhancing mass of 10 x 8 x 7 cms. size with few small non enhancing degenerative areas, arising from the bladder wall on left side and filling the lumen [Figure - 2],[Figure - 3]. The left uretero-vesical junction was involved resulting in hydroureteronephrosis, [Figure - 3]. Right kidney was small with irregular outline indicating chronic pyelonephritis. The patient underwent cystoscopy, which revealed a large intraluminal mass with intact mucosa.
Biopsy of the mass disclosed a submucosal neoplasm composed of fascicles of smooth muscle proliferation with focal hyaline and microscopic degeneration suggesting a leiomyoma. In view of the large size of the mass, partial cystectomy, hysterectomy, and augmentation cystoplasty was performed with reimplantation of the left ureter. Histopathological examination showed characteristic features of a giant leiomyoma, focal squamous metaplasia of the overlying urothelium along with chronic cystitis, [Figure - 4],[Figure - 5].
| Discussion | | |
Mesenchymal tumors of urinary bladder are heterogenous group of neoplasms arising from the mesenchymal tissues normally found in the bladder and constitute 1 to 5% of all bladder neoplasms. [4] Leiomyoma is the most common benign neoplasm of urinary bladder arising from submucosa, but growth can be submucosal (7%), intravesical (63%), or extravesical (30%). [5] Histologically, Leiomyomas are noninfiltrative smooth muscle tumors lacking mitotic activity cellular atypia and necrosis. Equal incidence in men and women has been reported [5] as well as female preponderance, [6] which may be attributed to the increased use of pelvic sonography in female patients. [1] Leiomyomas may be asymptomatic but usually present with obstructive symptoms (49%), irritative symptoms (38%), and hematuria (11%). [7]
Imaging can diagnose leiomyomas preoperatively including IVU, US, and CT scan. [7],[8] However, MRI offers superior spatial and contrast resolution and is the best radiological modality regarding tissue characterrization of leiomyomas. Non degenerative leiomyomas are characterized on MRI as low intensity masses both on T1 and T2 weighted sequences with smooth surface that resemble uterine leiomyomas. Variable pattern of enhancement is observed after injecting gadolinium, some leiomyomas are homogenously enhanced, while others are not. [2],[3],[8] Areas of cystic degeneration may appear as hyperintense signal on T2 and do not enhance with contrast.
The present case showed characteristic features consistent with leiomyoma on imaging, i.e. smooth filling defect on IVU and a well circumscribed bladder mass on CT smooth outer margins. Important clues to the pre operative diagnosis included absence of involvement of extravesical structures on CT despite the large size of the tumor and the prolonged history of the obstructive urinary symptoms. Long standing urinary retention could have resulted in chronic cystitis and chronic pyelonephritic changes in the right kidney.
In conclusion, imaging is important to diagnose and delineate the extent of leiomyomas. These tumors have a benign nature and good outcome.
| References | | |
| 1. | Cornella JL, Larson TR, Lee RA, Magrina JF, Kammere-Doak D. Leiomyoma of the female urethra and bladder: Report of twenty three patients and review of literature. Am J Obstet Gynecol 1997;176(6):1278-85.  | | 2. | Chen M, Lipson SA, Hricak H. MR Imaging of benign mesenchymal tumours of the urinary bladder. AJR Am J Roentgenol 1997;168(2):399-403. | | 3. | Wong-You-Cheong JJ, Woodward PJ, Manning MA, Sesterhenn IA. From the archives of the AFIP: Neoplasms of the urinary bladder: Radiologic-pathologic correlation. Radiographics 2006;26(2):553-80. | | 4. | Campbell EW, Gislason GJ. Benign mesothelial tumors of the urinary bladder: Review of the literature and a report of a case of leiomyoma. J Urol 1953;70(5):733-41. | | 5. | Knoll LD, Segura JW, Scheithaeur BW. Leiomyoma of bladder. J Urol 1986;136 (4):906-8. | | 6. | Kabala JN, Freiha FS, Niebel JD. Leiomyoma of the bladder: Report of two cases and demonstration of ultrasonic appearance. Urology 1990;35(3):210-2. | | 7. | Goluboff ET, O'Toole K, Sawczuk IS. Leiomyoma of the bladder: Report of a case and review of the literature. Urology 1994; 43(2):238-41. | | 8. | Wong FK, Wong YF, Ma KF, Lui CY. Urinary bladder leiomyoma. J HK Coll Radiol 2002;5:193-6. |
Correspondence Address:
P J Sudhakar
Department of Radiology, Salmaniya Medical Complex, P.O. Box 12
Bahrain
PMID: 18310873
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5] | |
| This article has been cited by | | 1 | Leiomyoma of the bladder | | | Muoka, O.E. and Muoka, O. and Daruwalla, P. | | BMJ Case Reports. 2013; (008749) | | [Pubmed] | | | 2 | Leiomyoma of the bladder presenting as acute urinary retention in a female patient: Urodynamic analysis of lower urinary tract symptom; A case report | | | Matsushima, M. and Asakura, H. and Sakamoto, H. and Horinaga, M. and Nakahira, Y. and Yanaihara, H. | | BMC Urology. 2010; 10(13) | | [Pubmed] | |
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