血尿以膀胱澱粉樣蛋白沉積表現-案例報告
李蕎青1,2、李蕎竹2、高鴻偉3、查岱龍1、孫光煥1、于大雄1、吳勝堂1、唐守宏1
1三軍總醫院外科部泌尿外科；2國軍高雄總醫院外科部；3三軍總醫院病理部
Amyloid deposition in urinary bladder with presentation of gross hematuria
Chiao-Ching, Li1,2、Chiao-Zhu Li 2、Hong-Wei, Gao4、Tai-Lung, Cha1、Guang-Huan, Sun1、Dah-Shyong, Yu1、Sheng-Tang, Wu1、Shou-Hung, Tang1
1Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan；
2Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan；3Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
Case presentation:
There are many reasons for hematuria, such as inflammation, infection, stone, neoplasm, trauma, ect…. Work-up for hematuria include urinary analysis, X-ray, ultrasonography, intravenous urography(IVU), cystoscopy, ureteroscopy, computed tomography(CT), or magnetic resonance imaging(MRI). There are more prevalence at malignant than at benign lesion in the urinary bladder. 90% patients who are diagnosed as bladder cancer have hematuria. We share the 65-year-old male who presents painless gross hematuria is diagnosed as amyloid deposition. This is benign lesion and is very rare case.
A 65-year-old man had past history of hyperuricemia without medication. Intermittent painless gross hematuria was stated for 2 months. No other lower urinary tract symptoms nor bladder painful sensation were narrated. He went to our outpatient department for examination. The finding is normal in intravenous urography, but it is vessel congestion and flat type bladder tumor at dome via cystoscopy. Subsequently, transurethral resection of bladder tumor was performed.
The hyaline eosinophilic deposition is found in the subepithelial region. In addition, the apple green color is revealed under the stain of Congo red and positive finding in stain of Thioflavin S. Therefore, amyloid deposition in urinary bladder is diagnosed. The patient recovered well 1 day after operation and discharged. No further hematuria was told.
Amyloid deposition in urinary bladder is less common in literature. This is a benign disease which mostly presents painless gross hematuria. The gross finding is bullous edema of the bladder mucosa. Recurrence may be developed.