模仿惡性腫瘤之感染性骨盆腫瘤：

一例與脆弱擬桿菌相關的膀胱肉芽腫性炎症病例

吳有容

基隆長庚紀念醫院 外科部 泌尿科

Chronic Inflammatory Pelvic Mass Mimicking Malignancy: A Case of Granulomatous Bladder Inflammation Associated with Bacteroides vulgatus

Yu-Jung Wu

Divisions of Urology, Department of Surgery, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan

Abstract
A 62-year-old female presented with a painful, ruptured left inguinal mass with discharge for three months. Imaging suggested a large pelvic tumor, likely of bladder or gynecologic origin, with regional lymphadenopathy and left hydronephrosis. Diagnostic procedures, including transurethral resection of the bladder tumor (TURBT) and biopsy, revealed active and chronic inflammation. Culture of the left inguinal wound pus identified Bacteroides vulgatus. She was treated and discharged with plans for follow-up.

Case Report
The patient reported a painful, discharging left inguinal mass with rupture. Abdominal CT identified an 11 cm left pelvic tumor, suspected to originate from the bladder or cervix, as well as a 14 cm left inguinal tumor with lymphadenopathy, raising concerns for metastasis. Left obstructive uropathy was noted, although the patient had no fever, weight loss, or hematuria. She did report incomplete bladder emptying in recent days. Initial admission included port-A catheter placement, biopsy, and urine cytology, which was negative for malignancy.

The patient was re-admitted for TURBT and left percutaneous nephrostomy. Operative findings revealed a large, irregular tumor on the left posterior-lateral bladder wall with significant vascularity and oozing. Pathology confirmed active and chronic inflammation, while culture of the left inguinal wound pus yielded Bacteroides vulgatus, indicating infection.

Discussion
This case demonstrates a complex presentation involving a large bladder mass with concurrent infection. Granulomatous inflammation secondary to Bacteroides is rare in bladder masses but can closely mimic malignancy in clinical and radiologic findings. The chronic infection likely contributed to the inflammation and obstructive uropathy, requiring careful diagnostic and therapeutic management.

Conclusion
The findings in this case emphasize the importance of thorough diagnostic workup in pelvic masses, particularly when infection may mimic malignancy. The patient requires ongoing monitoring to evaluate for recurrence and to manage complications such as hydronephrosis, ensuring accurate differentiation between infectious and malignant processes.