在影像上難以辨別良惡性的膀胱腫瘤，一個膀胱的發炎性假性腫瘤個案報告

李一宏、林益聖、歐宴泉、許兆畬、童敏哲

童綜合醫院外科部泌尿科

Indistinguishable radiological features of bladder tumor. A case report of inflammatory pseudotumor in urinary bladder

Yi-Hong Li, Yi-Sheng Lin, Yen-Chuan Ou, Chao-Yu Shu, Min-Che Tung

Division of Urology, Department of Surgery,

Tungs' Taichung MetroHarborHospital, Taichung, Taiwan

Introduction:

Urothelial carcinoma is the most common type of bladder cancer but there are some benign tumors/lesions that may have similar characteristics in radiology. Anatomic defects, blood clots, stones, infection or inflammation can be differential diagnosis. Cystoscopy with/without tumor resection is usually necessary to elucidate the final diagnosis. We present a case with first impression as bladder cancer but an inflammatory pseudotumor finally.

Case presentation: The 67-year-old female has a past medical history of hypertension and thyroid nodules status post thyroidectomy. There was no known coagulopathy or anticoagulant medication used. She suffered from intermittent gross hematuria and suprapubic pain for around 6 months. Lab examination showed no anemia and no thrombocytopenia. Her prothrombin time(PT) and activated partial thromboplastin time (aPTT) were within normal limits. Urine analysis showed RBC counts: 10-20 and WBC counts: 0-5 under high power fields. There was no bacteria growth in urine culture. Bedside sonography revealed a bladder tumor near the dome and right lateral wall. The contrast-enhanced computed tomography(CT) confirmed the findings of one 2.1 cm tumor with contrast enhancement but no invasion to surrounding organs. There was no notable lymph node enlargement in the pelvis. Urine cytology showed no evidence of malignancy. We performed cystoscopy and noted one exophytic tumor without papillary-like appearance but intact mucosa at the dome. Submucosal urinary bladder tumor was found. Tissue proof with transurethral resection of bladder tumor(TURBT) was indicated and the pathology reported only a chronic inflammation. The patient received bladder irrigation for 2 days and discharged on postoperative day 3.

Conclusions:

Inflammatory pseudotumor of the urinary bladder is rare in bladder tumors. It shares the same pictures on symptoms and can not be easily differentiated under images even with CT scans or MRI. It tends to spare the trigone and may be exophytic or polypoid. Contrast enhancement is usually noted and these features make diagnostic difficulties. Even though histopathology is essential for diagnosis, urothelial carcinoma may be excluded at one glance during cystoscopy based on the tumor's appearance. In most conditions, adequate tumor resection with TURBT or partial cystectomy is adequate and no notable recurrence in some case series. However, a detailed history taking and image studies are critical for urologists that wouldn't miss the diagnosis.