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URINARY BLADDER LEIOMYOMA

Posted Tue, 01/26/2010 - 01:49 by Nursel Yurttutan

Images

Figure 1

Figure 2

Figure 3

Figure 4

Clinical History:

35 years-old woman with history of pelvic mass

Findings:

Figure 1: Ultrasonography demonstrates a Hypoechoic heterogeneous giant mass arising from the wall of the urinary bladder resulting in its contour abnormality.
Figure2: Axial CT demonstrates marked contrast enhancement of the mass originating from the left bladder wall .
Figure 3 and 4: The relationship of the mass and pelvic structures is seen better on sagittal and coronal reformat images

Diagnosis:

Urinary bladder leiomyoma

Discussion:

Leiomyoma is the most common benign non-epithelial tumor. Urinary bladder leiomyomas account for less than 0.43% of all bladder tumors, and these comprise about 35% of mesenchymal tumors. A patient may or may not have symptoms, according to the location and size of the leiomyoma. Initial symptoms include urinary frequency, urgency, hematuria, and pelvic pain(1)

Evaluation with ultrasound,computed tomography, cystoscopy, urodynamics, and cytology contributed to the diagnosis of urinary bladder leiomyoma.(2)

The symptoms caused by this tumor type is varied, unspecific and in most of the cases depends on its location (intravesical, intramural or extramural).

Most leiomyomas of the bladder show some typical imaging features on CT, MRI and ultrasound, which are helpful in making correct diagnosis and treatment plan preoperatively(3)

At MRI, the normal bladder wall is of intermediate signal intensity on the T1-weighted image, while there is an intermediate signal outer band and a low signal
inner band on the T2-weighted image. On both T1- and T2-weighted images, non-degenerative leiomyomas are usually visualised as low intensity nodules with smooth surfaces. The submucosal location with intact mucosa is a characteristic feature of urinary bladder leiomyoma, and resembles uterine leiomyoma. By contrast,
the more common transitionalcell carcinoma affects the mucosa.

Treatment is by surgery, which achieves excellent results.

References / Suggested Reading:

1.Laparoscopic enucleation of a bladder leiomyoma.Hong SY, Lee TS, Kim JH.J Minim Invasive Gynecol. 2009 Nov-Dec;16(6):772-4.
2.Leiomyoma of the urinary bladder presenting as urinary retention in the female.Saunders SE, Conjeski JM, Zaslau S, Williams J, Kandzari SJ.Can J Urol. 2009 Aug;16(4):4762-4.
3.[Imaging features of nonepithelial tumors of the bladder]Zhang LY, Dai JR.Zhonghua Zhong Liu Za Zhi. 2009 May;31(5):384-7. Chinese

Author

Nursel Yurttutan

URINARY BLADDER LEIOMYOMA

University or Hacettepe