病例報告：黏膜下膀胱平滑肌瘤

郭炫廷、蔡昇翰、黃家倫、謝啟誠、王曉暹、陳光國、張心湜、楊景偉

振興醫療財團法人振興醫院泌尿部

Submucosal Bladder Leiomyoma - A case report

Hsuan-Ting Kuo, Sheng-Han Tsai, Chia-Lun Huang, Chieh-Chen, Hsieh, Hsiao-Hsian Wang, Kuang-Kuo Chen, Luke S. Chang and Chin-Wei Yang

Department of Urology, Cheng Hsin General Hospital, Taipei, Taiwan

Introduction:

Leiomyoma of the urinary bladder is rare, which accounts for 0.43 percents of all bladder tumors. Submucosal(intramural) lesion is one of the least types. We herein presented a case of submucosal bladder leiomyoma.

Presentation of case:

A 62-year-old woman was incidentally found to have a bladder tumor suspected to be urothelial carcinoma by abdominal computed tomography scan during admission at gastroenterology ward for acute pancreatitis. Urine cytology specimens were negative for malignant cells. Cystoscopy revealed an eruptive, intact submucosa nodule near the bladder neck. Magnetic resonance imaging was done and reported a suspected urothelial carcinoma lesion with clinical tumor staging T1. Computed tomography of the abdomen was ordered three months later for a follow-up, and there were no interval changes compared with the previous image study. The patient received transurethral enucleation and resection of the bladder tumor, and the pathology reported leiomyoma of the bladder. The patient recovered well after the operation and was scheduled at the outpatient department for a regular follow up.

Discussion:

Leiomyoma is a benign tumor of the urinary bladder which usually occurs in the middle-aged female. It can be classified into endovesical (63%), extravesical (30%) and submucosal (7%) subtypes according to the location of the tumor. Patients with bladder leiomyoma can be asymptomatic, or presented with obstructive symptoms, irritative symptoms, flank pain or hematuria. Surgical options included transurethral resection or enucleation for a small tumor. However, as for a large and symptomatic tumor, partial cystectomy by open, laparoscopic or robotic-assisted approach should be considered. In our case, we reported a middle-aged woman, being asymptomatic at all, presented with no interval changes on image study for three months, and received surgical intervention due to suspicious of urothelial carcinoma of the bladder.