膀胱穆勒氏管上皮異位: 罕見病例報告

張珝^{1, 2}、陳俐臻^{1, 2} 、林文榮^{1, 2}、邱文祥^{1, 2, 3}

¹馬偕紀念醫院 泌尿科；²馬偕醫學院； ³陽明醫學院

Syu Jhang^{1, 2}, Li-Chen Chen^{1, 2}, Wun-Rong Lin^{1, 2}, Allen W. Chiu^{1, 2, 3, 4}

¹Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan; ²School of Medicine, Mackay Medical College, Sanzhi, Taiwan; ³School of Medicine, National Yang-Ming University, Taipei, Taiwan

 

Purpose: Müllerianosis of the urinary bladder is a rare bladder neoplasm composed of two or three Müllerian derived tissues (endosalpinx, endometrium and endocervix). Less than 20 cases of müllerianosis of the urinary bladder have been documented in the English literatures. We report a case of incidental müllerianosis of the urinary bladder presenting with umbilical bleeding.

Case report: This 43-year-old healthy female complained of intermittent umbilical bleeding for several weeks. She had no other symptoms including abdominal pain, gross hematuria, urinary frequency or micturition pain. She visited the Obstetrics and Gynecology clinic and was found to have an incidental bladder lesion identified on transabdominal ultrasound. A firm, irregular and unmovable nodule developed in the umbilicus with a diameter of 2 cm. Urinalysis showed 6 red blood cells per high-power field. Abdominal computed tomography illustrated a protruding mass 2.4 cm in diameter located on the posterior wall of the urinary bladder. She first underwent transurethral resection of the tumor. The microscopic histological examination described multiple foci of glands with dilated lumen and surrounding short spindle cells. The glands were composed of bland-looking cells in tall columnar shape. Immunohistochemically, ER and CD10 expressed in the surrounding short spindle cells. Cilia and ER expression presented in dilated glands without spindle cell cuffing. These histological findings were consistent with endometrium and endosalpinx. A diagnosis of müllerianosis was rendered. Occult malignancy was not seen. She had no discomfort after the surgery except intermittent umbilical bleeding. Excision of the umbilical tumor and cystoscopy for follow-up will be arranged.

Conclusion: Müllerianosis of the urinary bladder is extremely rare, which generally affects the women at the reproductive age. The majority of patients with müllerianosis of the urinary bladder have a favorable prognosis. There is no the treatment of choice. We suggest transurethral resection of the tumor for the diagnosis because it is essential to exclude malignant neoplasms of the urinary bladder.