Bladder Leiomyoma in an Adult Female: A Case Report.

Abstract

Introduction: Benign mesenchymal tumors are rare and comprises 1-5% of all bladder neoplasm. Leiomyoma remains the commonestbenign neoplasm accounting for 0.43% of bladder tumors. Clinical manifestations includes lower urinary symptoms, hematuria, suprapubic pain and dysuria. We report a case of bladder leiomyoma in a female with predominantly storage lower urinary tract symptoms. Case report: She is a 42 year old female presenting with predominantly storage lower urinary tract symptoms and recurrent suprapubic pain of a year duration. There is no hematuria, back pain or weight loss. Physical examination revealed mild suprapubic tenderness with no palpable mass. Urologic scan revealed a well circumscribe intermediate echogenic mass involving the anterior- lateral segment of the urinary bladder with a volume of 22.35ml. The kidneys and ureter were normal. Computed tomography urogram revealed a fairly circumscribed mixed density mass arising from the anterior wall of the urinary bladder and extending into the bladder lumen. It measures 4.4x4.3cm in dimension. Urethrocystoscopy revealed a right anterolateral bladder wall sessile tumor. There was no involvement of ureteric orifice. Histological analysis of biopsy specimen showed a bundle of spindle cells with slender, wavy nucei and eosiniphilliccystoplasm. There was no atypia or mitotic changes suggestive of benign stromal tumor. She subsequently had partial cystectomy. Histological analysis of the excised tumor revealed bundles of smooth muscle cell infiltrated by mixed inflammatory cells predominantly eosinophil (>20 per 40x field). There was focal fibrosis with necrotic underlying mucosa but no atypia suggestive of leiomyoma. She has being on yearly follow-up for 5 years with no recurrence of symptoms. Conclusion: Complete surgical resection of bladder leiomyoma is very effective with a favourable outcome and almost no recurrence confirming the benign nature.