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 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.     

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.     

Multilocular cystic adenomyoma of the pelvic cavity: A rare clinical and histological entity in a young man

We report a large complex cystic pelvic mass encountered in a 16-year-old man complaining of perineal discomfort. A large and elastic hard mass was palpated on the right anterior wall of the rectum with no discernible prostate on digital rectal examination. Prostatic tumor markers were elevated. Excretory urography and urethrocystography showed a filling defect with a smooth edge on the right side of the bladder. Magnetic resonance imaging demonstrated a mass with a mosaic pattern between the right side of the bladder and the rectum. We performed ultrasound-guided transrectal needle core biopsy of the mass. The pathologist suspected hyperplastic glandular epithelium of prostatic origin with focal inflammatory cell infiltration, but there was no sign of malignancy. We thought that the tumor arose from the prostate. Surgery was successfully performed. The tumor was located on the right side of the pelvic cavity and adhered to the right lobe of the seminal vesicle. En bloc excision was performed. This lesion histologically proved to be a multilocular prostatic tissue with a seminal vesicle component, without communication to the surrounding tissue. Such a lesion has not previously been reported in the literature.     

Inflammatory pseudotumor of urachus mimicking invasive carcinoma of bladder

Inflammatory pseudotumor of the bladder is a rare benign lesion of unknown etiology. We present a new case of pseudotumor of the urachus in a 16-year-old boy with no significant urologic history. This benign condition mimics invasive malignant tumors of the urinary bladder, and aggressive surgery is the basic treatment modality.     

Renal-type clear cell carcinoma occurring in the prostate

Clear cell lesions of the urinary tract often present diagnostic challenges. We report a previously undescribed lesion in the prostate, occurring in a 73-year-old man who presented with hematuria and subsequently underwent transurethral resection of the prostate. A total of 24 g of tissue was removed, and in 4 of 17 blocks submitted a lesion morphologically and immunohistochemically similar to clear cell carcinoma of the kidney was noted. A thorough cystoscopic and full-body, radiologic workup was performed, but no renal tumor was discovered. Random cystoscopic biopsies of the bladder and prostatic urethra as well as bladder washings were benign. Subsequent needle biopsies of the prostate were also benign. The patient underwent a pelvic lymph node dissection with radical cystoprostatectomy and orthotopic Studer pouch diversion. There was organ-confined, ordinary-type prostatic adenocarcinoma (Gleason's 3 + 3) present bilaterally in the peripheral zone; no residual clear cell carcinoma was identified. All lymph nodes were negative, and the urinary bladder showed no dysplasia or neoplasia. We think this tumor represents a primary renal type of clear cell carcinoma arising in the prostate. To our knowledge, this type of tumor has not been previously reported to arise in an extrarenal location.     

A case of urinary bladder hernia]

A 77-year-old male visited our hospital complaining of swelling in the right scrotal and inguinal region, urinary urgency and difficulty of urination. Physical examination revealed an elastic soft mass in the right inguinal region toward the right scrotum. Rectal examination proved that the prostate was moderately enlarged. Cystogram and urethrography showed hernia of the bladder into the right scrotum and benign prostatic hyperplasia. Urodynamic studies demonstrated organic obstruction in the lower urinary tract. Transurethral resection of the prostate was done for benign prostatic hyperplasia. Later, surgical treatment for the bladder hernia was performed by replacing the bladder into the pelvic cavity and closing the hernial ring without resection of the bladder wall. The bladder hernia proved to be a para-peritoneal type. The postoperative course was uneventful. The previous reports of urinary bladder hernia are reviewed and the incidence, etiology, diagnosis the treatment are discussed.     

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.     

Inflammatory pseudotumor of the bladder.

Inflammatory pseudotumor of the bladder is an unusual benign lesion arising from the bladder submucosa. We present 2 cases and describe the clinical presentation, and radiographic and histological findings. This benign lesion must be differentiated histologically from several malignant lesions of the bladder. Complete surgical excision, either by transurethral resection or partial cystectomy, appears to be curative.     

Nonassociation of hyperamylasemia and prostatic disease.

The possible correlation of hyperamylasemia and prostatic disease was investigated in patients with benign prostatic hyperplasia, adenocarcinoma of the prostate, and in patients without clinical evidence of prostatic lesion. Our results indicate that prostatic lesions whether benign or malignant are not associated with either elevation of serum amylase or abnormal isozyme zymograms.     

Endoscopic balloon dilation of the prostate: early experience.

Coaxial balloon dilation catheters recently have been introduced for transurethral dilation of the prostate. We applied endoscopically a specially designed high pressure, large diameter balloon catheter to patients with benign prostatic hyperplasia or primary bladder neck hyperplasia who presented with symptomatic, cystoscopic and urodynamic evidence of obstruction. We report our preliminary experience with 42 patients: 28 with benign prostatic hyperplasia and 14 with bladder neck hyperplasia. Six months after dilation 46% of the patients demonstrated at least a 25% improvement in subjective (symptom score) and objective (corrected peak flow rate) parameters, while 6 (21%) experienced excellent (greater than 50%) symptomatic improvement despite unchanged corrected peak flow rates and 3 (11%) showed significant (greater than 50%) improvement in corrected flow rate alone. At 1, 3, 6 and 12 months the symptom scores decreased by 70, 67, 61 and 59% (median) from pre-treatment levels. Men with benign prostatic hyperplasia fared better than those with primary bladder neck hyperplasia (74 versus 58% decrease at 6 months). Objective evaluation by corrected peak flow rates demonstrated 25, 24, 28 and 2% median improvement at 1, 3, 6 and 12 months, respectively. Patients with primary bladder neck hyperplasia had substantially greater increases than those with benign prostatic hyperplasia (47 versus 27% at 6 months). Immediately after dilation the serum prostate specific antigen level increased by at least 1.5 ng. per ml. in 16 of 22 patients, indicating significant tissue trauma. Complications included mild bleeding and pain for the initial 24 hours and transient urinary retention in 2 patients. Our experience demonstrates the safety of an endoscopic approach to balloon dilation of the prostate that allows the urologist to maintain a central role in the assessment of a new approach to the treatment of obstructed voiding dysfunction.     

Can prostate stents be used to predict the outcome of transurethral resection of the prostate in the difficult cases?

PURPOSE OF REVIEW: Endoprosthesis has been used to maintain luminal patency in several different diseases and is well established in cardiovascular and gastrointestinal pathologies. The usefulness and application in prostatic pathology and benign prostatic hyperplasia are not as clear. This report reviews the development of overactive bladder in patients with bladder outlet obstruction due to benign prostatic hyperplasia. It also describes a new application of prostatic stents in patients with combined overactive bladder and bladder outlet obstruction. RECENT FINDINGS: Over the last few decades, interest has been focused on the pathology of overactive bladder due to bladder outlet obstruction. Persistent outlet obstruction can certainly induce overactivity in some cases. However, the significance of preoperative identification of the latter problem is still an open issue, and it is obviously of vital importance to find instruments to identify parameters of prognostic significance. Different prostatic stents have been used for a variety of purposes. Recent studies have demonstrated that prostatic stents are effective in relieving obstruction and urinary retention. However, the role of prostatic stents in bladder outlet obstruction is still not clear when compared with other minimally invasive options. By using a prostatic stent to simulate transurethral resection of the prostate, the risk of post-resection incontinence in patients with combined severe bladder outlet obstruction and severe overactive bladder has been possible to assess before the operation. However, larger controlled clinical studies are needed to corroborate the value of the test. SUMMARY: Prostatic obstruction can induce severe overactive bladder in some cases. A prostatic stent to relieve outflow obstruction and to simulate transurethral resection of the prostate decreases the risk of post-resection incontinence in patients with combined severe bladder outlet obstruction and severe overactive bladder because very high risk patients can be excluded from surgery. The stent test indicates that patients who do not leak and experience reduced symptoms when they are relieved of their outlet obstruction can be advised to have a transurethral resection of the prostate.     

How to Make the Diagnosis of Benign Prostatic Disease

We have a number of clinical points which we can use to assess whether or not a man with symptoms suffers from benign prostatic enlargement and/or bladder outlet obstruction due to benign prostatic hyperplasia. These clinical points are lower urinary tract symptoms, digital rectal examination, ultrasound of the prostate and bladder (measuring prostate volume and bladder wall thickness), flow rates, residual urine, and pressure–flow studies. The diagnosis of symptomatic BPE and the decision of whether or not specific treatment is advisable will be based on the combination of several of these examinations, of which some are more important than others.     

Nd:YAG laser ablation of the prostate as a treatment for benign prostatic hypertrophy.

Many techniques have been used to relieve obstructive symptoms associated with benign prostatic hypertrophy. Transurethral resection of the prostate (TURP) with an electrocautery loop is the most commonly performed operation to relieve bladder neck and urethral obstruction caused by prostatic adenoma. There is increased interest in alternative therapies to reduce prostatic size for symptom relief in this condition. We describe a technique using the neodymium:YAG (Nd:YAG) laser and a 600-microns laser quartz fibre with an attached terminal gold-plated metal alloy reflector to provide reliable deep penetration into prostatic tissue for prostatic adenoma ablation. We report the first use of this technique in three patients with benign prostatic obstruction and one with localised adenocarcinoma of the prostate.     

Inflammatory Pseudotumor of the Spleen: Report of a Case

We report the case of an inflammatory pseudotumor of the spleen in an asymptomatic 55-year-old woman, whose lesion was accidentally found and clinically misdiagnosed to be lymphoma. An inflammatory pseudotumor of the spleen was histopathologically diagnosed following a splenectomy. This lesion is a benign, reactive, and inflammatory process and its etiopathogenesis still remains elusive. The preoperative diagnosis is difficult and the optimal management of the asymptomastic patient with the disease is unclear. This entity should be kept in mind in the differential diagnosis of splenic space-occupying lesions.     

Inflammatory pseudotumor of the urinary bladder--possible relationship to nodular fasciitis. Two case reports, cytologic observations, and ultrastructural observations

An inflammatory pseudotumor of the urinary bladder might cause a large, pedunculated intraluminal mass that clinically and radiologically simulates a malignant tumor. This benign lesion can easily be mistaken for a sarcoma because by light microscopy it consists of clon-gated strap cells that resemble rhabdomyoblasts. The loose texture, the myxoid background, the relative paucity of mitoses, and the absence of nuclear hyperchromasia are important histologic determinants of benignity. Smears and imprints yield voluminous tapering cells in an inflammatory background. There are no cytoplasmic cross-striations or Z-bands and the tumor cells have the ultrastructural characteristics of myofibroblasts. It is important to recognize this lesion as benign to avoid the potentially serious consequences of misdiagnosis.     

A case showing sclerosing adenosis and an unusual form of basal cell hyperplasia of the prostate

We describe an unusual case of benign prostatic hyperplasia that demonstrated florid sclerosing adenosis--an uncommon lesion that may be confused with prostate carcinoma. Immunohistochemistry utilizing Keratin 903, a basal cell-specific antikeratin antibody, was useful in identifying basal cells in sclerosing adenosis, thus verifying its benign nature. In addition, this case had an unusual form of basal cell hyperplasia that resembled basaloid carcinomas (adenoid cystic carcinoma) involving the prostate.     

Ectopic prostatic polyp preoperatively diagnosed as bladder tumor: a case report

We report a case of ectopic prostatic polyp preoperatively diagnosed as bladder tumor. Several examinations highly suggested the possibility of a bladder tumor invading prostatic tissue, but the exophytic lesion was located proximal to the verumontanum. Transurethral resection of the lesion was performed, and the histological examination revealed typical findings of benign prostatic hyperplasia. We reviewed 42 cases of ectopic prostatic tissue reported in the Japanese literature. Ectopic prostatic tissue should be considered in the differential diagnosis of hematuria in the male.     

Inverted papillomas of the prostatic urethra

Inverted papillomas of the genitourinary tract are uncommon benign neoplasms usually occurring in the urinary bladder and less frequently in the upper urinary tract. To date, there are scant data and no comprehensive studies of inverted papilloma originating in the prostatic urethra. We identified 21 cases and evaluated their demographic, clinical, and histopathologic features. Patients had a mean age of 65.1 years (range: 30 to 89 y), with 10/21 (47.6%) presenting with gross hematuria (n = 8) or irritative symptoms (n = 2) related to the inverted papilloma and 11/21 (52.4%) detected incidentally during work-up/treatment of prostate cancer (n = 6) or benign prostatic hypertrophy (BPH) (n = 5). Fourteen cystoscopically evaluated lesions measured 0.1 to 2.0 cm, and were described as polypoid (n = 9), papillary (n = 4), or an enlarged median lobe (n = 1). Lesions were diagnosed on transurethral resection (n = 8), biopsy/polypectomy targeted to the lesion (n = 6), radical prostatectomy for prostate cancer (n = 4), or biopsy unrelated to the lesion (n = 3). Histologically, 14/21 cases (67%) displayed classic inverted papilloma architecture. The remaining cases showed foci of squamous metaplasia with moderate atypia (n = 4), rare true papillary fronds in a classic inverted papilloma background (n = 2), or both (n = 1). Eleven cases with prostatic tissue revealed adenocarcinoma of the prostate [n = 6; Gleason score 6 (n = 3) or 7 (n = 3)], high-grade prostatic intraepithelial neoplasia (n = 1), benign prostatic hypertrophy (n = 3), or adenosis (n = 1). No patients had a prior history of either inverted papilloma or urothelial carcinoma, whereas 2 patients were diagnosed with high-grade urothelial carcinoma of the bladder synchronous with their inverted papilloma diagnosis. Only 1 of the 18 patients with available follow-up had a recurrence of inverted papilloma in the prostatic urethra. None of the other patients had local recurrences or recurrences at other locations in the urinary tract (mean follow-up 39.9 mo; range: 3 to 120 mo). Inverted papillomas of the prostatic urethra are benign lesions that are commonly detected incidentally and are not associated with a history of urothelial malignancy. Although urothelial carcinoma elsewhere in the genitourinary tract may occur simultaneously, malignant transformation or recurrence as a malignant lesion has not been identified in inverted papilloma of the prostatic urethra.     

Ectopic prostate tissue at the bladder dome

A 71-year-old white man with asymptomatic microscopic hematuria had a sessile tumor at the dome of the bladder containing benign prostatic glandular tissue. Benign prostatic polyps occur commonly in the prostatic urethra and bladder neck as vestigial remains of embryonic prostatic elements. Ectopic prostatic tissue elsewhere is rare and has not been described previously arising at the bladder dome. The origin of prostate glands in this unlikely location is unclear. The clinical course of ectopic prostatic polyps at any location is benign, although local recurrence has been reported.