CASE REPORT
A case of vesical leukoplakia ASTRID DITTEH0JGAARD AND ANNE LENEJESSEN
From the Department of Abdominal Surgery, Regional Hospital, Viborg, and the Department of Obstetrics and Gynecology, Regional Hospital, Smderborg, Denmark
A m Ohstet Gyiiecol Sccmd I99 1 ; 70: 623-624
A Wycar-old woman who had earlier been treated for cervical dysplasia complained of
recurrent cystitis. urgency and frequency, but without signs of genital prolapse. At cystoscopy with biopsies, leukoplakia of the bladder was diagnosed. We describe how the condition is distinguished from squamous metaplasia of the trigone as seen in normal premenopausal women. An association between leukoplakia and cancer is widely accepted. Against this background, a follow-up program is outlined. The possibility of leukoplakia as a multicentric disorder of the genito-urinary tract is briefly discussed. Key words: leukoplakia of the bladder; carcinoma of the bladder Submitted March 22, 1991 Accepted August 26, 1991
Leukoplakia is an uncommon condition and may denote a possibly premalignant histological change from transitional or endodermal mucosa to cornified epithelium. We report a case of vesical leukoplakia in a woman complaining of recurrent cystitis, urge and frequency but without genital prolapse. Cystoscopy with biopsy is recommended and a follow-up program is outlined.
A diagnosis of vesical leukoplakia was confirmed by biopsies. She was placed on long-term antibiotic and acidifying treatment and is being followed halfyearly with cystoscopic examination. Recurrent lesions are biopsied and the affected areas fulgurated. N o malignant progression has been noted for 5 years.
Discussion Case report A 54-year-old woman was admitted to hospital with chronic cystitis accompained by dysuria, urgency and suprapubic pain. The urine was turbid and flocky. Three years perviously she had undergone a left nephrectomy due to recurrent renal calculi and cystopyelitis persisting for 19 years. Microscopic examination of the kidney showed chronic pyelonephritis. She had been treated by cauterization for cervical dysplasia 13 years earlier and had squamous metaplastic changes of the cervix a t later controls. At gynecological examination there were no signs of vesico-genital prolapse. An intravenous pyelogram showed a normal right system and bladder. Cystoscopy revealed cellular debris and plaques in the area of the trigone and left wall.
Frequency, urge, recurrent cystitis and suprapubic pain are common complaints of gynecological patients. Leukoplakia of the bladder is a rare condition associated with chronic cystitis, but the incidence is not known. A t cystoscopy, a characteristic finding is parchment-like plaques anywhere in the bladder and debris (snowstorm appearance). The trigone is usually involved but the ureteral orifices are usually spared. Pathologic criteria are squamous metaplasia and keratosis, downgrowth of the rete pegs and dysplastic squamous metaplasia as seen in the trigone of normal premenopausal women (1,2). There is a strong association between leukoplakia and cancer. Some 22-28% undergo malignant transformation (1, 3, 4). Treatment is controversial. Concomitant diseases should be treated. Most authors agree that Aclu Obster Gynecol Scund 70 (1991)
624
A . D. H@jgaard and A. L. Jessen
the patient should be followed closely with repeated cystoscopy and biopsies. but a s malignant change may occur undetected beneath the leukoplakia, some authors advocate cystectomy when the diagnosis is established ( 1 , 5 , 6). Whether o r not leukoplakia of thc genito-urinary tract in females is multicentric in origin, as could be suggested in our patient, is still not known (7).
3. Morgan RJ, Cameron KM. Vesical leukoplakia. Brit J Urol 1980; 52: 96-100. 4. O'Flynn J D , Mullaney J . Vesical leukoplakia progressing to carcinoma. Brit J Urol 1974; 46: 31-7. 5 . DeKock MLS, Anderson CK, Clark PB. Vesical leukoplakia progressing to carcinoma in women. Brit J Urol 1980; 53: 316-7. 6. Hejgaard A D , Jessen AL. Blaereleukoplaki. Ugeskr Laeger 1991; 153: 2408-9. 7. Javadpour N, Hakim A A , Bush IM. Lcukoplakia o f the bladder in fcmalcs. Obstet Gynecol 1970; 35: 519-23.
References Bcnson RC. Swanson SK, Farrow GM. Relationship of leukoplakia to urothelial malignancy. J Urol 1984; 131: 507-1 1. Mueller SC, Thueroff JW. Kumpelt HJ. Urothelial leukoplakia: New aspects of etiology and therapy. J Urol 1987; 137: 979-83.
.4ddress for correspondence:
Astrid Dittc Hejgaard. M.D. Neder Hollufvej 30 K DK-5220 Odense S 0 Denmark
A case of vesical leukoplakia ASTRID DITTEH0JGAARD AND ANNE LENEJESSEN
From the Department of Abdominal Surgery, Regional Hospital, Viborg, and the Department of Obstetrics and Gynecology, Regional Hospital, Smderborg, Denmark
A m Ohstet Gyiiecol Sccmd I99 1 ; 70: 623-624
A Wycar-old woman who had earlier been treated for cervical dysplasia complained of
recurrent cystitis. urgency and frequency, but without signs of genital prolapse. At cystoscopy with biopsies, leukoplakia of the bladder was diagnosed. We describe how the condition is distinguished from squamous metaplasia of the trigone as seen in normal premenopausal women. An association between leukoplakia and cancer is widely accepted. Against this background, a follow-up program is outlined. The possibility of leukoplakia as a multicentric disorder of the genito-urinary tract is briefly discussed. Key words: leukoplakia of the bladder; carcinoma of the bladder Submitted March 22, 1991 Accepted August 26, 1991
Leukoplakia is an uncommon condition and may denote a possibly premalignant histological change from transitional or endodermal mucosa to cornified epithelium. We report a case of vesical leukoplakia in a woman complaining of recurrent cystitis, urge and frequency but without genital prolapse. Cystoscopy with biopsy is recommended and a follow-up program is outlined.
A diagnosis of vesical leukoplakia was confirmed by biopsies. She was placed on long-term antibiotic and acidifying treatment and is being followed halfyearly with cystoscopic examination. Recurrent lesions are biopsied and the affected areas fulgurated. N o malignant progression has been noted for 5 years.
Discussion Case report A 54-year-old woman was admitted to hospital with chronic cystitis accompained by dysuria, urgency and suprapubic pain. The urine was turbid and flocky. Three years perviously she had undergone a left nephrectomy due to recurrent renal calculi and cystopyelitis persisting for 19 years. Microscopic examination of the kidney showed chronic pyelonephritis. She had been treated by cauterization for cervical dysplasia 13 years earlier and had squamous metaplastic changes of the cervix a t later controls. At gynecological examination there were no signs of vesico-genital prolapse. An intravenous pyelogram showed a normal right system and bladder. Cystoscopy revealed cellular debris and plaques in the area of the trigone and left wall.
Frequency, urge, recurrent cystitis and suprapubic pain are common complaints of gynecological patients. Leukoplakia of the bladder is a rare condition associated with chronic cystitis, but the incidence is not known. A t cystoscopy, a characteristic finding is parchment-like plaques anywhere in the bladder and debris (snowstorm appearance). The trigone is usually involved but the ureteral orifices are usually spared. Pathologic criteria are squamous metaplasia and keratosis, downgrowth of the rete pegs and dysplastic squamous metaplasia as seen in the trigone of normal premenopausal women (1,2). There is a strong association between leukoplakia and cancer. Some 22-28% undergo malignant transformation (1, 3, 4). Treatment is controversial. Concomitant diseases should be treated. Most authors agree that Aclu Obster Gynecol Scund 70 (1991)
624
A . D. H@jgaard and A. L. Jessen
the patient should be followed closely with repeated cystoscopy and biopsies. but a s malignant change may occur undetected beneath the leukoplakia, some authors advocate cystectomy when the diagnosis is established ( 1 , 5 , 6). Whether o r not leukoplakia of thc genito-urinary tract in females is multicentric in origin, as could be suggested in our patient, is still not known (7).
3. Morgan RJ, Cameron KM. Vesical leukoplakia. Brit J Urol 1980; 52: 96-100. 4. O'Flynn J D , Mullaney J . Vesical leukoplakia progressing to carcinoma. Brit J Urol 1974; 46: 31-7. 5 . DeKock MLS, Anderson CK, Clark PB. Vesical leukoplakia progressing to carcinoma in women. Brit J Urol 1980; 53: 316-7. 6. Hejgaard A D , Jessen AL. Blaereleukoplaki. Ugeskr Laeger 1991; 153: 2408-9. 7. Javadpour N, Hakim A A , Bush IM. Lcukoplakia o f the bladder in fcmalcs. Obstet Gynecol 1970; 35: 519-23.
References Bcnson RC. Swanson SK, Farrow GM. Relationship of leukoplakia to urothelial malignancy. J Urol 1984; 131: 507-1 1. Mueller SC, Thueroff JW. Kumpelt HJ. Urothelial leukoplakia: New aspects of etiology and therapy. J Urol 1987; 137: 979-83.
.4ddress for correspondence:
Astrid Dittc Hejgaard. M.D. Neder Hollufvej 30 K DK-5220 Odense S 0 Denmark
