罕見案例報告：嗜伊紅性膀胱膀胱腫瘤

唐慈翊^1,2、詹鎮豪¹、李永進¹、阮雍順²、沈榮宗¹、王巽玄¹、耿俊閎¹、曹曜軒¹、吳怡萱¹、吳文正²

高雄市立小港醫院¹泌尿科

高雄醫學大學附設醫院²泌尿科

A Rare Case Of Eosinophilic Cystitis Mimic Urothelial Tumor

Tsz-Yi Tang^1,2, Jhen-Hao Jhan¹, Yung-Chin Lee¹, Yung-Shun Juan², Jung-Tsung Shen¹, Hsun-Shuan Wang¹, Jiun-Hung Geng¹, Yao-Hsuan Tsao¹, Yi-Hsuan Wu¹, Wen-Jeng Wu²

Department of Urology¹, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan

Department of Urology², Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

Case report: A 42-year-old man presented to the emergency department with epigastria. As part of the evaluation, computed tomography (CT) was performed. The scan incidentally showed focal thickening of the bladder wall (Panel A, arrow). He had a history of asthma, eosinophilic gastroenteritis, and hepatitis B. On physical examination, soft abdomen without tenderness. Laboratory studies showed a white-cell count of 15040 per cubic millimeter (reference range, 4140 to 10,520), with 12% eosinophil (reference range, 0.5 to 7.5). Thus, he was referred to the urology clinic. The patient denied urinary frequency, hematuria, dysuria, or suprapubic pain. Urinalysis and urine cytology showed negative. Cystoscopy showed an intact mucous layer but external compression in the dome (Panel B). CT and MRI indicated suspicious urothelial tumor with perivesical invasion. Partial cystectomy and pelvic lymph node dissection were done, and histopathological analysis confirmed the diagnosis of eosinophilic cystitis without granulomatous inflammation or lymph node involvement. The patient recovered well and discharged 8 days after surgery. He started steroid treatment and no recurrence 6 months later at follow-up. Eosinophilic cystitis is a rare bladder disorder characterized by transmural inflammation of the bladder predominantly with eosinophils, and may be misdiagnosed as malignancy. Given the benign nature of the lesions, the patient was offered regular antihistamine and steroid therapy to avoid further recurrence.

Conclusions: Eosinophilic cystitis (EC) is a rare clinical inflammatory disorder of the bladder and may mimic malignancy. A combination of surgical approach and medical therapy were needed for these patients and long-term follow up is mandatory.