Ir J Med Sci (2015) 184:719–721 DOI 10.1007/s11845-015-1322-5
LETTER TO THE EDITOR
An extremely rare mass of bladder: lipoma in the bladder M. Ates1 • M. Karalar1 • Y. Akin2 • N. Okur3 • I. Ozardali4 • I. Keles1
Received: 2 July 2014 / Accepted: 30 May 2015 / Published online: 6 June 2015 Ó Royal Academy of Medicine in Ireland 2015
Dear Editor, There have been described many benign tumours of bladder, but non-epithelial ones are rare [1]. Specifically, bladder lipoma was reported only in a handful of cases in medical literature. This is one of the benign formation of soft tissue. It may also cause voiding disorders such as dysuria, frequency, and haematuria [2]. Herein, we presented an extremely rare case who was admitted to urology outpatient clinic with voiding disorders and was diagnosed as bladder lipoma. A 67-year-old female patient was admitted to our outpatient clinic with chief symptom of dysuria. Urinary frequency and nocturia were other complaints. She had no comorbidity and was a non-smoker in her medical history. Her physical examination, laboratory tests, and urine analysis were normal. Her body mass index (BMI) was 24.9 kg/m2 (normal). Transabdominal ultrasonography (US) revealed that the patient had an echogenic, round, and solid mass measuring approximately 8 mm at the dome of the bladder while there was no significant US finding related with kidneys. The lesion was seen as in the bladder, not out of bladder’s surface. Therefore, we performed
& Y. Akin [email protected] 1
Department of Urology, Afyon Kocatepe University School of Medicine, 03050 Afyonkarahisar, Turkey
2
Department of Urology, Harran University School of Medicine, 63100 Sanliurfa, Turkey
3
Department of Radiology, Afyon Kocatepe University School of Medicine, 03050 Afyonkarahisar, Turkey
4
Department of Pathology, Afyon Kocatepe University School of Medicine, 03050 Afyonkarahisar, Turkey
cystoscopy in our outpatient clinic under local anaesthesia by flexible cystoscopy. There was a smooth, yellow and benign-looking tumour, at the dome of bladder, in endoscopic view. As the tumour did not seem like epithelial tumour, magnetic resonance imaging (MRI) was performed. The tumour was hyperintense in both T1- and T2weighted images, while there was loss of signal in SPIR T1- and T2-weighted images. These findings were specific for lipoma in MRI (Fig. 1). There was no enhancement of the lesion itself in post-contrast series which showed only enhancement of the bladder mucosa overlying the mass. Furthermore, there was no finding suggestive of pelvic lipomatosis in MRI. The informed consent was obtained from patient. In the operation room, first spinal anaesthesia was performed and the genital area was sterilized in lithotomy position. The cystoscopy was indwelled. In endoscopic view, there was a tumour at the dome of bladder, and there was no additional tumour (Fig. 2). The tumour was suitable for resection in endoscopic route. Therefore, it was treated by transurethral resection. There was no residual tumour after endoscopic resection (Fig. 3). The mucosal bleeding was cauterized after resection. A urethral catheter was indwelled. On the first day of surgery the urethral catheter was removed, and the patient was discharged. The pathology specimens were assessed by a single experienced pathologist and ‘‘lipoma’’ was diagnosed as an encapsulated tissue formed by mature lipocytes adjacent to the smooth muscle fibres (Fig. 4a). Liposarcoma was ruled out due to absence of immature, atypical lipoblasts (Fig. 4b). After treatment by transurethral resection, symptoms of patient disappeared. She has been without voiding symptoms during last 6 months and she was in follow-up period, in our outpatient clinic.
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Fig. 1 Pelvic magnetic resonance images. a Axial T1-weighted image without fat-saturation, arrow shows the lesion; b axial T2weighted image without fat-saturation, arrow shows the lesion,
Ir J Med Sci
c coronal post-contrast fat-suppressed T1-weighted image, arrow shows the lesion; d sagittal fat-suppressed T2-weighted image, arrow shows the lesion. B bladder
Fig. 2 The view of tumour in the bladder during cystoscopy Fig. 3 Macroscopic view of the lipoma after resection from bladder
Most of the bladder tumours (95 %) originated from epithelium. However, leiomyoma is the most common nonepithelial tumour and extremely rare in bladder wall [1]. However, there have been some cases of bladder lipoma reported in literature, our case was different from them [2]. Arikan et al. first reported lipomatosis of the bladder, in the literature [3]. The complaints of our case were similar with theirs. It is noteworthy that our and their female patients have similar complaints when compared with male patients in the literature. Notably, our female case was without pelvic lipomatosis and this was the difference of our case
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from the published ones in literature [4]. Excessive deposition of fat in pelvis usually presents at 20–50 years of age [2]. However, chief complaints include features of compression to genitourinary system. Computed tomography and MRI are useful for diagnosis [4, 5]. Non-epithelial bladder tumours may cause haematuria [5]. Although, urine analysis of our case was normal, Lang reported recurrent macroscopic and microscopic haematuria with bladder lipoma [5]. Moreover, Brown et al.
Ir J Med Sci
721
Fig. 4 Pathology revealed lipoma in haematoxylin–eosin dying. a Lipoma in light microscopy with haematoxylin– eosin (9100); b normal tissue and high magnification of tumour, in light microscopy with haematoxylin–eosin (9400)
reported urinary infection with bladder lipoma [4]. Neither haematuria nor urinary infection was detected in our case. This was similar that reported by Arıkan et al. [3]. Malign and benign bladder tumours can cause to voiding symptoms. There is no proof of malignant transformation of bladder lipoma, in the literature [1]. Nevertheless, clinicians should be aware of these tumours according to its symptoms, laboratory and radiological findings. Although, there was no pathology in physical examination, laboratory, and urine analysis, tumour was diagnosed in bladder by MRI. Transurethral resection helped us to diagnose and also to treat the bladder lipoma. Scherl et al. reported recurrent lipoma in head and neck, but the recurrence rate of bladder lipoma is still lacking [6]. Nevertheless, longterm follow-up may be necessary for recurrent bladder lipoma.
Conflict of interest
None.
References 1. Meraj S, Narasimhan G, Gerber E, Nagler HM (2002) Bladder wall lipoma. Urology 60:164 2. Tsui JF, Weinberger JM, Kashan M, Weiss JP, Robinson BD, Blaivas JG (2013) Bladder lipoma. J Urol 190:1387–1388 3. Arikan N, Tulunay O, Orhan D, Aydos K, Gogus O (1995) Lipomatosis of the bladder. J Urol 154(2 Pt 1):521–522 4. Brown C, Jones A (2008) Bladder lipoma associated with urinary tract infection. Sci World J 8:573–574 5. Lang EK (2005) Recurrent macroscopic and microscopic hematuria with lipoma at the trigone of the bladder. J Urol 174:724 6. Scherl MP, Som PM, Biller HF, Shah K (1986) Recurrent infiltrating lipoma of the head and neck. Case report and literature review. Arch Otolaryngol Head Neck Surg 112:1210–1212
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LETTER TO THE EDITOR
An extremely rare mass of bladder: lipoma in the bladder M. Ates1 • M. Karalar1 • Y. Akin2 • N. Okur3 • I. Ozardali4 • I. Keles1
Received: 2 July 2014 / Accepted: 30 May 2015 / Published online: 6 June 2015 Ó Royal Academy of Medicine in Ireland 2015
Dear Editor, There have been described many benign tumours of bladder, but non-epithelial ones are rare [1]. Specifically, bladder lipoma was reported only in a handful of cases in medical literature. This is one of the benign formation of soft tissue. It may also cause voiding disorders such as dysuria, frequency, and haematuria [2]. Herein, we presented an extremely rare case who was admitted to urology outpatient clinic with voiding disorders and was diagnosed as bladder lipoma. A 67-year-old female patient was admitted to our outpatient clinic with chief symptom of dysuria. Urinary frequency and nocturia were other complaints. She had no comorbidity and was a non-smoker in her medical history. Her physical examination, laboratory tests, and urine analysis were normal. Her body mass index (BMI) was 24.9 kg/m2 (normal). Transabdominal ultrasonography (US) revealed that the patient had an echogenic, round, and solid mass measuring approximately 8 mm at the dome of the bladder while there was no significant US finding related with kidneys. The lesion was seen as in the bladder, not out of bladder’s surface. Therefore, we performed
& Y. Akin [email protected] 1
Department of Urology, Afyon Kocatepe University School of Medicine, 03050 Afyonkarahisar, Turkey
2
Department of Urology, Harran University School of Medicine, 63100 Sanliurfa, Turkey
3
Department of Radiology, Afyon Kocatepe University School of Medicine, 03050 Afyonkarahisar, Turkey
4
Department of Pathology, Afyon Kocatepe University School of Medicine, 03050 Afyonkarahisar, Turkey
cystoscopy in our outpatient clinic under local anaesthesia by flexible cystoscopy. There was a smooth, yellow and benign-looking tumour, at the dome of bladder, in endoscopic view. As the tumour did not seem like epithelial tumour, magnetic resonance imaging (MRI) was performed. The tumour was hyperintense in both T1- and T2weighted images, while there was loss of signal in SPIR T1- and T2-weighted images. These findings were specific for lipoma in MRI (Fig. 1). There was no enhancement of the lesion itself in post-contrast series which showed only enhancement of the bladder mucosa overlying the mass. Furthermore, there was no finding suggestive of pelvic lipomatosis in MRI. The informed consent was obtained from patient. In the operation room, first spinal anaesthesia was performed and the genital area was sterilized in lithotomy position. The cystoscopy was indwelled. In endoscopic view, there was a tumour at the dome of bladder, and there was no additional tumour (Fig. 2). The tumour was suitable for resection in endoscopic route. Therefore, it was treated by transurethral resection. There was no residual tumour after endoscopic resection (Fig. 3). The mucosal bleeding was cauterized after resection. A urethral catheter was indwelled. On the first day of surgery the urethral catheter was removed, and the patient was discharged. The pathology specimens were assessed by a single experienced pathologist and ‘‘lipoma’’ was diagnosed as an encapsulated tissue formed by mature lipocytes adjacent to the smooth muscle fibres (Fig. 4a). Liposarcoma was ruled out due to absence of immature, atypical lipoblasts (Fig. 4b). After treatment by transurethral resection, symptoms of patient disappeared. She has been without voiding symptoms during last 6 months and she was in follow-up period, in our outpatient clinic.
123
720
Fig. 1 Pelvic magnetic resonance images. a Axial T1-weighted image without fat-saturation, arrow shows the lesion; b axial T2weighted image without fat-saturation, arrow shows the lesion,
Ir J Med Sci
c coronal post-contrast fat-suppressed T1-weighted image, arrow shows the lesion; d sagittal fat-suppressed T2-weighted image, arrow shows the lesion. B bladder
Fig. 2 The view of tumour in the bladder during cystoscopy Fig. 3 Macroscopic view of the lipoma after resection from bladder
Most of the bladder tumours (95 %) originated from epithelium. However, leiomyoma is the most common nonepithelial tumour and extremely rare in bladder wall [1]. However, there have been some cases of bladder lipoma reported in literature, our case was different from them [2]. Arikan et al. first reported lipomatosis of the bladder, in the literature [3]. The complaints of our case were similar with theirs. It is noteworthy that our and their female patients have similar complaints when compared with male patients in the literature. Notably, our female case was without pelvic lipomatosis and this was the difference of our case
123
from the published ones in literature [4]. Excessive deposition of fat in pelvis usually presents at 20–50 years of age [2]. However, chief complaints include features of compression to genitourinary system. Computed tomography and MRI are useful for diagnosis [4, 5]. Non-epithelial bladder tumours may cause haematuria [5]. Although, urine analysis of our case was normal, Lang reported recurrent macroscopic and microscopic haematuria with bladder lipoma [5]. Moreover, Brown et al.
Ir J Med Sci
721
Fig. 4 Pathology revealed lipoma in haematoxylin–eosin dying. a Lipoma in light microscopy with haematoxylin– eosin (9100); b normal tissue and high magnification of tumour, in light microscopy with haematoxylin–eosin (9400)
reported urinary infection with bladder lipoma [4]. Neither haematuria nor urinary infection was detected in our case. This was similar that reported by Arıkan et al. [3]. Malign and benign bladder tumours can cause to voiding symptoms. There is no proof of malignant transformation of bladder lipoma, in the literature [1]. Nevertheless, clinicians should be aware of these tumours according to its symptoms, laboratory and radiological findings. Although, there was no pathology in physical examination, laboratory, and urine analysis, tumour was diagnosed in bladder by MRI. Transurethral resection helped us to diagnose and also to treat the bladder lipoma. Scherl et al. reported recurrent lipoma in head and neck, but the recurrence rate of bladder lipoma is still lacking [6]. Nevertheless, longterm follow-up may be necessary for recurrent bladder lipoma.
Conflict of interest
None.
References 1. Meraj S, Narasimhan G, Gerber E, Nagler HM (2002) Bladder wall lipoma. Urology 60:164 2. Tsui JF, Weinberger JM, Kashan M, Weiss JP, Robinson BD, Blaivas JG (2013) Bladder lipoma. J Urol 190:1387–1388 3. Arikan N, Tulunay O, Orhan D, Aydos K, Gogus O (1995) Lipomatosis of the bladder. J Urol 154(2 Pt 1):521–522 4. Brown C, Jones A (2008) Bladder lipoma associated with urinary tract infection. Sci World J 8:573–574 5. Lang EK (2005) Recurrent macroscopic and microscopic hematuria with lipoma at the trigone of the bladder. J Urol 174:724 6. Scherl MP, Som PM, Biller HF, Shah K (1986) Recurrent infiltrating lipoma of the head and neck. Case report and literature review. Arch Otolaryngol Head Neck Surg 112:1210–1212
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