黃色肉芽腫性膀胱炎偽裝之膀胱腫瘤：一個病例報告

楊鎧伍¹、周詠欽²、陳丕哲¹

嘉義基督教醫院 外科部 泌尿科¹天主教聖馬爾定醫院 泌尿科²

Xanthogranulomatous cystitis mimicking bladder tumor: A case report

Kai-Wu Yang¹, Yeong-Chin Jou²，Pi-Che Chen¹

Divisions of Urology, Department of Surgery, Chia-Yi Christian Hospital¹

Department of Urology, St. Martin De Porres Hospital, Chiayi, Taiwan²

Introduction: 

   Xanthogranulomatous inflammation is a type of benign, chronic granulomatous inflammation, which typically occurs in the gall bladder and kidneys and may occur in other sites including colon. However, isolated urinary bladder involvement is extremely rare. In this report, we present a case of Xanthogranulomatous cystitis mimicking bladder malignancy.

Case presentation: 

    This is a 75 female with underlying of type 2 diabetes mellitus, hypertension and Parkinson's disease under regullarly medical controlled. Tracing back to her medical history, she sufferred from blood stained on toilet paper for weeks. She first went to division of Obstetrics＆Gynecology OPD for help. Due to urine analysis showed hematuria and pyuria and bladder sonography showed a bladder mass, she was refferred to urological OPD. Preoperative abdominal Computed tomography showed multiple bladder tumors at right lateral and inferior wall, measurable greatest dimension abour 4.1cm, Compatible with urothelial cell carcinoma at urinary bladder (cT2N0M0) according to radiology report. TURBT (transurethral resection of bladder tumor) was done on 2021/10/20. Also, postoperative intravesical chemotherapy of Mitomycin instillation was given within within 24 hours of surgery. However, the pathological report showed Xanthogranulomatous cystitis. Antibiotic with Augmentin and Cravit were perscribed for one month. Follow up cystoscopy revealed no recurrence.

Discussion:

   Xanthogranulomatous cystitis (XC) has been recorded as extremely rare (29 case report in English literature). The most common site of the lesion is at or near the dome of the bladder and may of these reports used partial cystectomy as treatment. The diagnosis of XC is based on pathological examinations, with histological pattern normally consists of multinucleated giant cells, lipid-laden macrophages (xanthoma cells), cholesterol crystals, polymorphonuclear leukocytes, plasma cells and lymphocytes of polyclonal origin and fibrosis. The treatment of choice not fully determined. However, curative treatment often requires surgical resection and clinicians combination of broad-spectrum antibiotics for 3 months was usually been used.

Conclusion: 

        Xanthogranulomatous cystitis (XC) has been recorded as extremely rare. It must be considered in the differential diagnosis of bladder masses. The diagnosis can be confirmed by histopathological examination. Antibiotics and surgical management are the available treatment options. Considering it is a benign disorder, transurethral resection should be first choice and short-term antibiotic treatment maybe enough.