膀胱黄斑瘤與輸尿管囊腫共存偽尿路上皮腫瘤之罕見病例報告目

楊欣庭、董世祥

國泰綜合醫院 外科部 泌尿科

Coexistence of Bladder Xanthoma and Ureterocele Mimicking Urothelial Tumor: A rare Case Report

Hsin-Ting Yang, Shih-Shiang Tung

Division of Urology, Department of Surgery, Cathay General Hospital, Taipei, Taiwan

Abstract

An 83-year-old female presented with one week of fever and chills, initially diagnosed as urosepsis with septic shock. CT revealed right hydronephroureter above the UVJ without radiopaque obstruction, but a distal ureteral tumor or chronic VUR could not be excluded. With suspected obstructive uropathy and possible malignancy, surgical intervention was indicated.

Cystoscopy showed a cystic mass at the right ureteral orifice (RUO), suggestive of ureterocele, along with flat bladder lesions near the left ureteral orifice and dome. TURBT was performed. Pathology confirmed a ureterocele with xanthoma at the RUO and bladder xanthomas at the additional sites.

Bladder xanthoma is a rare benign lesion, defined by focal accumulation of lipid-laden histiocytes within the bladder mucosa. Fewer than 30 cases have been reported. It is considered a reactive rather than neoplastic condition, sometimes linked to metabolic disorders but also observed in normolipidemic patients. Typically seen as yellowish nodules or plaques during cystoscopy, these lesions are often incidental but may mimic malignancy. They do not regress with antibiotics, and surgical excision is the treatment of choice. Although benign and not predisposed to malignant transformation, surveillance cystoscopy may be appropriate due to occasional coexistence with bladder tumors.