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.     

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.     

Inflammatory pseudotumor of urinary bladder – a diagnostic and management dilemma

Inflammatory pseudotumors (IPT) are uncommon, benign, non-epithelial tumors of the urinary bladder. Only less than 30 cases have been reported so far in world’s literature. The transititional cell carcinoma constitutes 90% of malignant epithelial tumors of urinary bladder. Large, endoscopically unresectable tumors require radical surgery. IPT resemble such tumors, morphologically, radiologically and clinically. The benign nature of this tumor warrants conservative surgical management, either transurethral resection or partial cystectomy. Awareness of this entity and its inclusion in the differential diagnosis may prevent unnecessary radical surgery. We report an unusual case of inflammatory pseudotumor of urinary bladder because of its diagnostic and management dilemma.     

Inflammatory pseudotumor (pseudosarcoma) of the bladder

Inflammatory pseudotumor (pseudosarcoma) of the bladder is a benign proliferative lesion of the submucosal stroma easily mistaken for a malignant neoplasm clinically and histologically. The lesion was first described as a separate entity in a report of 2 patients. Three additional cases have been reported since then. We describe pseudosarcomatous bladder tumors arising in 2 adolescents. Both patients presented with sudden onset of gross painless hematuria related to large polypoid and ulcerated bladder masses found on endoscopy. Initial pathological analysis was interpreted as poorly differentiated sarcoma in both patients but subsequent reviews were consistent with a benign process resembling nodular fasciitis. Simple excision in both patients has been successful in eradicating the lesion. The findings in these 2 patients are described with a discussion of the pathophysiology and review of the literature.     

Inflammatory pseudotumors in children

Inflammatory pseudotumors are so named because they mimic malignant tumors clinically and radiologically. Most often seen in the lungs of young adults, they consist of localized proliferations of mononuclear inflammatory cells and myofibroblasts. There are scattered reports of these tumors occurring in various sites in children. We report five cases of these rare lesions in children; four arising intraabdominally and one in the lung. In contrast to the usual presentation in adulthood, these children were all previously healthy. One child, with the tumor arising from the urinary bladder, was originally diagnosed as having a malignant sarcoma and underwent pelvic exenteration and chemotherapy for this subsequently-proven benign lesion. Local recurrence occurred in one case. Total excision is indicated and is usually possible without unacceptable morbidity. Our cases and a review of the literature point out the importance of pathologic differentiation of these lesions from malignancy with early appropriate surgery.     

Inflammatory (pseudosarcomatous) myofibroblastic tumor of the urinary bladder causing acute abdominal pain.

Inflammatory myofibroblastic tumor is a reactive proliferation of myofibroblasts that rarely involves the urinary bladder. The cause of inflammatory myofibroblastic tumor is unknown but may represent an initial reactive process to an infectious agent or trauma that transforms into neoplastic growth. Cases reported in children, however, often lack any preexisting bladder pathology. The authors present a case in a young child that presented as acute abdominal pain. In general, these tumors follow a benign clinical course after resection, although close monitoring is essential given the rarity of this bladder lesion.     

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.     

Hematologic neoplasms with initial manifestations in lower urinary tract

Hematologic tumors with initial clinical manifestations in the lower urinary tract are exceedingly rare. Six such cases are reported. Four of these were lymphomas, 2 involving the urinary bladder, 1 the urethra, and 1 the right ureter. The remaining 2 were an extramedullary plasmacytoma and a granulocytic sarcoma, both located in the urinary bladder. To our knowledge, this is the first case report of granulocytic sarcoma of the urinary bladder presenting with urologic symptoms.     

Malignant non-urothelial neoplasms of the urinary bladder: a review

OBJECTIVES: Non-urothelial bladder tumors frequently present a diagnostic and therapeutic challenge. We review the peer-reviewed literature to summarize the available evidence on the etiology, diagnosis and optimal management of malignant non-urothelial bladder tumors. METHODS: A comprehensive MEDLINE database search was performed. In addition, the proceedings of recent national and international urological and cancer society meetings were reviewed. RESULTS: Primary non-urothelial bladder tumors are rare in Europe and North America representing less than 5% of all bladder lesions combined. A large number of risk factors have been implicated in the etiology of non-schistosomiasis-related squamous cell carcinoma, yet their exact pathomechanism remains poorly defined. Squamous cell carcinoma, adenocarcinoma, small cell carcinoma, sarcoma and carcinosarcoma/sarcomatoid tumors share an unfavorable prognosis despite aggressive surgical management that relates both to an aggressive biological behaviour as well as to an often times advanced stage at the time of diagnosis. Inflammatory pseudotumors are benign tumors of uncertain histogenesis that may mimic sarcomas. Paraganglioma, primary melanoma and lymphoma represent additional, exceedingly rare bladder tumors. CONCLUSIONS: The systematic investigation of most non-urothelial bladder tumors is limited by the rarity of these lesions. A concerted effort of multiple institutions linked together in a national or international tumor registry will be necessary to advance our understanding of these tumors, evaluate treatment strategies and optimize patient outcome in the future.     

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.     

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.     

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.     

Primary granulocytic sarcoma of the urinary bladder: case report and review of the literature

We report a case of granulocytic sarcoma of the urinary bladder, with no evidence of hematologic involvement. The patient was initially misdiagnosed and was treated with chemotherapy for transitional carcinoma grade 3. Despite this treatment, the clinical features of the patient progressed, and a repeated biopsy yielded the correct diagnosis. Three cases of granulocytic sarcoma of the urinary bladder have been reported in published studies, with only one of these primary. To our knowledge, ours is the second case of granulocytic sarcoma of the urinary bladder presenting with urologic symptoms but without hematologic findings.     

Case series: Inflammatory myofibroblastic bladder tumor in regional Australia

Introduction and importanceInflammatory myofibroblastic tumor (IMT) is a rare tumor subtype that affects multiple organ systems. This case series adds a regional perspective to the literature, demonstrating rare urological cancers can be managed excellently in regional settings.Case presentationWe report a case series of two patients in regional Australia who were diagnosed with IMT of the urinary bladder. Both patients received computed tomography (CT) and ultrasound (US) imaging to investigate lower urinary tract symptoms (LUTS). Following initial diagnosis of a bladder tumor, both patients underwent surgery, one having a transurethral resection of bladder tumor (TURBT) with the other receiving a partial cystectomy. Histology from both surgeries revealed IMT of the urinary bladder, with the first case going on to receive a partial cystectomy to ensure clear surgical margins. Both patients recovered well post-operatively, with CT cystograms revealing water-tight bladders. Initial follow up reveals no recurrence of disease.Clinical discussionIMT of the urinary bladder is an exceedingly rare clinical entity which is fortunately benign and can be well managed with appropriate surgical intervention.ConclusionIMT can be well managed in regional hospitals equipped with appropriate surgical, pathological and oncological services.     

D-二聚体在膀胱肿瘤诊断中的应用及手术影响

目的探讨D-二聚体含量在膀胱肿瘤诊断中的应用及手术创伤对其含量的影响。方法通过定量酶联免疫吸附试验对43例膀胱移行细胞癌患者行D-二聚体测定。结果肿瘤患者血浆D-二聚体含量较非肿瘤患者及正常组明显增高（P＜0.01）,水后膀胱肿瘤患者及非肿瘤患者血浆D-二聚体含量较术前明显增高（P＜0.01）,肿瘤患者高于非肿瘤患者（P＜0.01）。结论膀胱肿瘤患者体内处于继发性纤溶活性增高状态。手术创伤可增强肿瘤患者和非肿瘤患者血浆纤溶活性增高状态。     

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.     

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.     

Clinical evaluation of urinary basic fetoprotein and the BTA test for detection of bladder cancer

We compared the results of urinary basic fetoprotein (BFP) and the BTA test with those of urinary cytology in patients with bladder cancer. We also analyzed the urinary BFP and the BTA test results in patients with benign diseases and postoperative bladder cancer with no evidence of recurrence. The cutoff value for urinary BFP was set at 10 ng/ml. Classes 4 and 5 according to urinary cytology were defined as positive. The sensitivity of urinary BFP for Ta, 1 bladder cancer was significantly higher than that of urinary cytology (p < 0.05). The urinary cytology positive rate for Ta, 1 bladder cancer improved when combined with urinary BFP and the BTA test. The urinary BFP positive rate for benign diseases was significantly higher in patients with pyuria than in patients without pyuria (p < 0.05). The BTA test positive rate for benign diseases was higher in patients with pyuria than in patients without pyuria. The urinary BFP and the BTA test positive rates for postoperative bladder cancer with no evidence of recurrence was significantly higher in patients with urinary diversion than in patients without urinary diversion (BFP: p < 0.01, BTA: p < 0.05).     

Inverted papilloma of bladder Two cases with questionable malignancy and squamous metaplasia

Two new cases of inverted papilloma of the urinary bladder are presented: one is a benign tumor with marked squamous metaplasia, and the other shows questionable malignancy in a single polypoid mass. This malignant transformation cautions against overconfidence in the benign nature of inverted papilloma of the urinary bladder. The authors believe that careful pathologic examination is necessary for inverted papilloma of the bladder.