Inflammatory pseudotumor of the urinary bladder and sigmoid colon.

We report an unusual case of an inflammatory pseudotumor of the bladder. A biopsy specimen prior to surgical treatment suggested leiomyosarcoma, and computerized tomography and magnetic resonance imaging strongly suggested bladder tumor with sigmoid colon invasion. Accordingly, radical surgical treatment consisting of total cystectomy, anterior resection of the sigmoid colon, and ileal conduit was performed. After operation, however, histological examination revealed an inflammatory pseudotumor of bladder and sigmoid colon. These findings were confirmed by immunohistochemical staining for smooth muscle specific actin, desmin, S-100, and vimentin. Histological examination revealed a diverticulum of the sigmoid colon in the middle of the pseudotumor, and this diverticulum may have ruptured to cause the inflammatory pseudotumor of bladder and sigmoid colon.     

Regression of inflammatory pseudotumor of the bladder in a child with medical management

Inflammatory pseudotumor of the bladder is a benign proliferative lesion of the submucosal stroma that cannot be distinguished from malignant tumors of the bladder either endoscopically or radiographically. Although benign, the proliferative nature of the inflammatory pseudotumor histopathology has led others to recommend open surgical removal or complete transurethral resection for definitive treatment. A limited number of case reports have described inflammatory pseudotumor of the bladder in either adults or children. This is a case of biopsy-proven inflammatory pseudotumor in the bladder of a child that regressed after medical management alone.     

Inflammatory pseudotumor of the urinary bladder diagnosed using 3D-CT cystoscopy

Inflammatory pseudotumor of the urinary bladder is a rare benign entity of the submucosal stroma that can easily be mistaken for a malignant neoplasm both clinically and histologically. We report a case of an inflammatory pseudotumor of the urinary bladder in which 3D-CT cystoscopy aided in the diagnosis. A 38-year-old man presented with persistent miction pain, penile pain, and dysuria despite symptomatic treatment at another hospital. Cystoscopic examination, MRI and 3D-CT cystoscopy revealed a 3.0 X 3.0 cm wide-based nonpapillary tumor located at the anterior dome of the urinary bladder. Transabdominal biopsy and transurethral resection were performed and the tumor was suspected to be transitional cell carcinoma. A partial cystectomy and urachus excision were then performed for suspected urachal tumor based upon the radiological examinations. Careful examination of the specimen revealed an inflammatory pseudotumor. We discuss 20 cases of inflammatory pseudotumor of the urinary bladder including ours.     

膀胱前间隙炎性假瘤诊治分析(附四例报告)

目的　探讨炎性假瘤的临床特点及膀胱前间隙炎性假瘤的病因、临床特点和误诊情况。　方法　回顾 4例膀胱前间隙炎性假瘤的诊治经过 ,结合文献分析其临床特点。　结果　 4例膀胱前间隙炎性假瘤均累及膀胱前壁 ,其中术前误诊为膀胱肿瘤 2例 ,4例均成功地行肿块连同部分膀胱壁切除手术 ,随访 3个月～ 6年无复发。　结论　既往输卵管结扎术和感染是膀胱前间隙炎性假瘤的重要致病因素 ,结合病史、临床表现和特殊检查仔细分析可以避免误诊 ,手术切除效果佳 ,预后良好。     

Pseudomalignant spindle cell proliferation of the urinary bladder: an unusual cause of voiding symptoms in a young patient

A case of an unusually large pseudomalignant spindle-cell proliferation (or inflammatory pseudotumor) of the urinary bladder in a young man is presented. The only symptom was urinary frequency. The clinical and radiologic evaluation (ultrasonography, computed tomography, and magnetic resonance imaging) revealed a massive tumor (11 x 7.5 x 5.5 cm) arising from the bladder wall that was eventually resected without compromising bladder function. Although the histologic findings initially suggested a sarcoma, the immunohistochemical findings were consistent with that of an inflammatory pseudotumor. The patient remained asymptomatic, without evidence of recurrence, after 12 months of follow-up. Awareness of this inflammatory pseudotumor and its immunophenotypic characteristics is important to avoid an erroneous diagnosis and unnecessarily aggressive therapy.     

Inflammatory pseudotumor of the urinary bladder: a case report

A 52-year-old man presented with gross hematuria. He had neither history of urinary tract infection nor trauma. Cystoscopy revealed a bladder tumor with ulcer on a left lateral wall. Computed tomography confirmed a round solid mass 3 cm in diameter invading deeply into the muscle layer of the urinary bladder. Transurethral biopsy revealed an inflammatory pseudotumor of the urinary bladder. Partial cystectomy was performed. This is the 38th reported case of inflammatory pseudotumor of the urinary bladder in Japan. No local recurrence was seen 3 months after surgery.     

Inflammatory pseudotumor of the prostate: a case report

We report a rare case of inflammatory pseudotumor of the prostate. A 42-year-old man with a history of hematospermia and chronic prostatitis presented with difficulty in voiding. Cystoscopy demonstrated a large non-papillary tumor occupying the prostatic urethra along with two bladder stones. Magnetic resonance imaging (MRI) demonstrated a 7-cm prostatic mass protruding toward the bladder and the rectum. Transrectal biopsy of the prostate demonstrated a fibrous lesion containing inflammatory cells without evidence of malignancy. We performed transurethral resection of the prostatic lesion to release the bladder outlet obstruction, followed by cystolithotripsy. Histopathological examination of the surgical specimen demonstrated a benign fibromuscular lesion with spindle cell proliferation, leading to a diagnosis of inflammatory pseudotumor. Postoperatively, the patient voided normally without any signs of recurrence on follow-up at five months. Inflammatory pseudotumor is an unusual benign lesion of unknown etiology. Only 10 previous cases of the disease involving the prostate have been reported in English and Japanese literature. Prostatic involvement of inflammatory pseudotumor may show a presentation similar to malignant prostatic sarcoma. Thus, accurate identification of this benign process is important in order to avoid unnecessary radical surgery.     

Spontaneous regression of inflammatory pseudotumor of the urinary bladder

Inflammatory pseudotumor of the urinary bladder is a benign proliferative lesion of the submucosa and its treatment has not yet been established. Here we present a case of spontaneously regressed inflammatory pseudotumor of the urinary bladder.     

膀胱炎性假瘤：附五例报告

对临床上考虑为原发性恶性肿瘤而手术切除的５例膀胱炎性假瘤进行了临床和病理形态学观察。结果表明膀胱炎性假瘤是突入腔内呈团块状有蒂的良性病变。由细长的类似于横纹肌母细胞的梭形细胞所构成，光镜检查时易误诊为肉瘤，组织学上有的区域组织疏松，粘液样，但没有核深染，缺乏核分裂。免疫组织化学检查：Ａｃｔｉｎ和Ｖｉｍｅｎｔｉｎ均阳性，具有炎性增生性肿块特征。     

Inflammatory pseudotumor of the urinary bladder: a case report

A 65-year-old female was referred to our hospital with a complaint of urinary retention and macrohematuria. Ultrasongraphy, computed tomography, magnetic resonance imaging and cystoscopy revealed a 2 x 2 cm broad-based nonpapillary bladder tumor localized in the anterior wall of the urinary bladder. The clinical diagnosis was an invasive bladder tumor and transurethral resection of bladder tumor carried out for pathological investigation. Finally, we diagnosed it as inflammatory pseudotumor of urinary bladder. No local recurrence was seen 12 months after surgery. Inflammatory pseudotumor of urinary bladder is a relatively rare condition, and this is the 52nd case reported in the Japanese literature.     

Multicentric inflammatory pseudotumor

Inflammatory pseudotumor is a non-neoplastic process characterized by irregular growth of inflammatory cells. This type of tumor can arise in any part of the body; most are confined to a single site and are benign. We present the case of a 51-year-old man in whom a solitary pulmonary nodule was detected as an incidental finding. Right pulmonary lobectomy was performed and histopathological analysis led to a diagnosis of inflammatory pseudotumor. The patient subsequently developed tumors in the contralateral lung and cervix, the latter being highly aggressive. We found no reports of this association in the literature, prompting the present case report.     

Inflammatory pseudotumor of carotid artery: a case report.

Inflammatory pseudotumor is an uncommon round and spindle cell proliferative lesion of unknown etiology that occurs most commonly in the lung. But it also occurs in diverse extrapulmonary locations such as the abdomen, retroperitoneum, pelvis, heart, head and neck, upper respiratory tract, trunk, bladder and extremities. The extrapulmonary inflammatory pseudotumor is often larger, less well circumscribed and multinodular. Proximity of the tumor to vital structures or involvement of vital organs compromises the opportunity for complete resection, thus higher recurrence rates are often reported even after surgical treatment. The authors report a case of inflammatory pseudotumor originating from the common carotid artery in a 42-year-old female patient with a rapidly growing neck mass, treated by en-bloc resection of inflammatory pseudotumor and a long segment of common carotid artery followed by PTFE graft interposition.     

Clinical versatility of the inflammatory pseudotumor in urology

ObjectiveThe inflammatory pseudotumor is a rare lesion, having benign behavior and some histological heterogeneity that appears in the genitourinary tract. A series of urogenital inflammatory pseudotumors are reviewed with emphasis on their clinicopathological and immunohistochemical characteristics.Material and methodsA retrospective study the causistics treated between January 1981 in December 2010 was performed. It identified the cases of inflammatory pseudotumor with urogenital localization. The variables age, gender, symptoms, topography, treatment and anatomopathological and immunohistochemical characteristics of each case were analyzed.ResultsA total of 8 cases of the urogenital-located inflammatory pseudotumor are described. Of these, 6 were located in the bladder, one in the kidney and one in the epididymis. Mean age of the patients was 46.75 (±19.84) years. Tumor presentation symptoms were macroscopic hematuria, single symptom or accompanied by symptoms of the lower urinary tract and inguinoscrotal mass. In regards to treatment in the cases of bladder localization, transuretheral ± cystectomy were performed. In the case of kidney localization, treatment was made by means of pyelotomy and exeresis, and in the case of epididymis localization, simple exeresis was performed. The anatomopathological study showed inflammatory pseudotumor in every cases, having a mesenchymal and myxoid appearance, with fusiform cells of eosinophil cytoplasm, with presence of frequent inflammatory cells. The most common immunohistochemical pattern shows positivity for the muscle-specific actin (HHF-35), vimentin and negativity for protein S-100. ALK-1 was positive and 87.5% of the cases.ConclusionThe inflammatory pseudotumor is a condition having good prognosis which, when there is a good histopathological and immunohistochemical diagnosis, every urologist should recognize and distinguish in order to carry out as conservative a surgical treatment as possible.     

A case report of inflammatory pseudotumor of the urinary bladder due to diverticulitis of the sigmoid colon

A 65-year-old female presented to our hospital with a 6-month history of pollakuria, low-grade fever and urgent incontinence. Cystoscopy revealed a nonpapillary bladder tumor that was 50 mm in diameter in the trigon. Computed tomography showed the abscess between the urinary bladder and sigmoid colon. Transurethral resection was performed and the histology consisted of inflammatory lesions with inflammatory cell infiltration, which was diagnosed as an inflammatory pseudotumor due to diverticulitis of the sigmoid colon. Sigmoidectomy was subsequently performed. A fistula between the urinary bladder and the sigmoid colon was not detected. Cystoscopy 2 months after the operation revealed no signs of a bladder tumor.     

Inflammatory pseudotumor of the bladder: a new case report

Inflammatory pseudotumor is a reactive benign lesion which can be very difficult to distinguish from some malignant bladder tumors like sarcomas or sarcomatoid carcinoma. Inflammatory pseudotumour (IPT) of the urinary bladder is a benign proliferate lesion which can simulate clinically and histologically a sarcoma. A case of an inflammatory pseudotumor of the urinary bladder in a 18-years-old man is presented. This patient presented with sudden onset of gross painless hematurial related to large polypoid and ulcerated bladder masses found on endoscopy. Initial pathological analysis was interpreted as rhabdomyosarcoma but subsequent reviews were consistent with a benign process resembling nodular fasciitis. This rare, benign and presumed non-neoplastic, reactive lesion must be differentiated from sarcomas of the urinary bladder. Immunohistochemistry seems to be the method of election in differentiating inflammatory pseudo-tumor from other spindle cell proliferations of the bladder. When diagnosis is certain, complete transurethral resection is the treatment of choice. However, if there is no total pathologic confirmation, if it is a very wide lesion or if it is recurring after endoscopic resection, a partial cystectomy is suggested.     

A case of neuropathic bladder with inflammatory pseudotumor of the bladder

A 36-year-old woman was referred with urinary incontinence and recurrent episodes of pyelonephritis. Two years prior to her visit, she underwent transurethral resection of a bladder tumor, 5 cm in diameter. Total cystectomy was suggested, as the initial diagnosis was sarcoma. Close re-evaluation of the pathological specimen lead to the final diagnosis of a benign inflammatory pseudotumor of the bladder as the tumor consisted of smooth muscle cells with white blood cell infiltration but without mitotic figures. The tumor disappeared during the follow up period. A cystography revealed bilateral vesicoureteral reflux with marked trabeculated bladder. A cystometry showed loss of bladder sensation and a low compliance bladder without detrusor contraction. Neurological examination and a magnetic resonance imaging of the spinal cord failed to prove the presence of definite neurological abnormalities. She was finally diagnosed with neuropathic bladder of unknown origin. In this case, she had been suffering from recurrent cystitis about 6 years before the resection of bladder tumor and it was suggested that the occurrence of the inflammatory pseudotumor of bladder would be related with chronic urinary tract infection due to neuropathic bladder. Urinary incontinence and urinary tract infection were controlled successfully with clean intermittent self-catheterization and adequate administration of antimicrobial drugs. Vesicoureteral reflux was treated with injection of GAX collagen into the ureteral orifices. No tumor recurrence has been found up to the present time, 5 years after the resection of bladder tumor.     

Inflammatory pseudotumor in childhood. A diagnostic and therapeutic dilemma.

We describe a case of inflammatory pseudotumor of the lower abdomen in a young child. The urinary bladder and abdominal wall were involved, and the pseudotumor simulated a malignant sarcomatous tumor. Surgical excision was undertaken, and the outcome was favorable. This rare tumor simulates a true neoplasm both clinically and morphologically and presents a diagnostic and therapeutic dilemma. Our case and a review of the literature indicate that an effort should be made to perform a radical excision. This is considered the treatment of choice except if it requires a mutilating procedure.     

A rare lesion of the central nervous system: inflammatory pseudotumor

Inflammatory pseudotumor is an uncommon tumor, initially described in the lung, but which can involve various organs. It is a controversial entity. We report the case of a 19-year-old-man with an inflammatory pseudotumor localized in the central nervous system, revealed by epilepsy. Characteristically, the inflammatory pseudotumor is an inflammatory mass leading to manifestations related to its localization. Relatively ubiquitous, this tumor is seldom described in the central nervous system. This uncommon lesion is part of a heterogeneous group of entities which are difficult to diagnose for both surgical pathologists and clinicians.     

Pseudotumor of urinary bladder

The case of an old male is presented who had postoperative spindle cell nodule of urinary bladder. This benign condition mimics a sarcoma. However, the treatment modalities and the outcome are entirely different. Inflammatory pseudotumor/PSCN and leiomyosarcoma of the bladder overlap in clinical and immunohistochemical findings but are histologically as well as clinically distinct, correlating with different natural histories. Inflammatory Pseudotumor/PSCN are benign, not prone to metastasize, and is outside the spectrum of low-grade inflammatory sarcoma of urinary bladder.     

Inflammatory pseudotumor of the retroperitoneum removed via a retroperitoneoscopic approach

Background:

Inflammatory pseudotumors were mostly encountered in the lung. Retroperitoneal inflammatory pseudotumors are relatively rare. Although laparoscopic surgery with a modified flank position is widely performed for retroperitoneal tumors, we placed the patient in the supine position to maintain the normal anatomical view of the retroperitoneal space. We report a case of retroperitoneal inflammatory pseudotumor extracted via retroperitoneoscopic surgery in the supine position.

Methods and Results:

A 53-year-old man presented with back pain and frequent urination. Ultrasonographic examination revealed a solid tumor above the urinary bladder. This tumor was diagnosed as a primary retroperitoneal tumor by computed tomography, magnetic resonance imaging, and angiography. The retroperitoneoscopic procedure was adopted to remove this tumor. Histopathologic examination revealed an inflammatory pseudotumor. There was no evidence of recurrence 5 years after surgery.

Conclusions:

The diagnosis of the inflammatory pseudotumor is rarely made before histologic examination. Only pathologic examination allows the correct diagnosis. Consequently, most patients undergo surgical treatment. A recurrence rate of 25% has been reported for inflammatory pseudotumors. Thus, radical resection is needed. The retroperitoneal laparoscopic approach with the patient in the supine position is useful for surgically treating these primary retroperitoneal tumors located below the level of the renal vessels.